Complementary and alternative therapiesThere has long been debate about the degree to which conventional health professionals should work closely with complementary and alternative medicine practitioners, if patients choose treatment from both. Some doctors are trained in conventional and alternative therapies but often, liaison depends on the type of therapy, whether it is regulated by law and whether it supplements conventional methods of diagnosis and treatment or claims to provide an alternative to them. Among the therapies often used by patients to (...) supplement conventional medicine, but which do not claim to have a diagnostic purpose, are aromatherapy, massage, stress therapy, reflexology and hypnotherapy. Chinese medicine and homoeopathy are among those which are not statutorily regulated but claim to provide diagnosis and treatment. Practitioners of conventional medicine are often wary of unregulated treatments that supplant evidence-based therapy—even though not all conventional medicine has been proven by randomised controlled trials.The role of complementary and alternative therapies came under scrutiny in England in February 2010 when the Parliamentary Science and Technology Committee published a critical report on NHS funding for homoeopathy. 1 Focusing on whether government policy on homoeopathy was evidence-based, the Committee found a mismatch between the evidence and policy. Its main conclusion was that the evidence indicates that homoeopathy is not efficacious and does not produce results beyond the placebo effect. The Committee said that explanations for why homoeopathy was thought to work were implausible and that further homoeopathic clinical trials could not be justified. The amount that the NHS actually spends on homoeopathic therapies was left unclear and was subject to varying claims from the Society of Homoeopaths and the Health Minister.2 The Parliamentary report recommended that there should be a clear policy on prescribing placebos, including homoeopathic medicines, but the government has been …. (shrink)

Force-feeding of detainees at Guantánamo BayIn April, the US Department of Defense reportedly sent 40 additional military medical personnel, including doctors and nurses, to the Guantánamo Bay Naval Base to carry out the force-feeding of detainees on hunger strike.1 By the end of June, up to 104 of the remaining 166 individuals held in US military detention at Guantánamo were refusing food. The protest against conditions at the base, and the fate of those being held there—including those already cleared for (...) transfer or release—began in February 2013. In June, it was reported that as many as 44 of the hunger strikers were being force-fed by military medical teams.2The response by the US authorities to the hunger strike prompted expressions of outrage from the international medical community.3,4 In April, the American Medical Association wrote to the US secretary of defense, insisting that ‘forced feeding of [competent] detainees violates core ethical values of the medical profession.’5 Adding the voice of the profession in the UK to these calls, at its annual conference in June, the British Medical Association condemned the participation of doctors and nurses in the force-feeding, calling on governments worldwide to ensure that all prisoners have access to confidential, independent medical treatment, and supporting any clinician who challenged cruel, inhuman or degrading treatment. Also in June, the BMA Chairman wrote to President Obama and US secretary of defense, Hagel, urging them to immediately suspend medical involvement in force-feeding at Guantánamo, and to institute an urgent inquiry into how the current situation was allowed to develop.Force-feeding mentally competent adults who are refusing food is a clear violation of medical ethics and is unjustifiable, as articulated by the World Medical Association's Declaration of Malta.6 Doctors with dual loyalties, including military doctors, are bound by the same …. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

This year marks the 10th anniversary of the Female Genital Mutilation Act 2003.1 i The Act makes it an offence for any person to excise, infibulate or otherwise mutilate the whole or any part of a female's labia majora, labia minora or clitoris, or to aid, abet, counsel or procure the mutilation by another person. The exception is where a surgical or obstetric procedure is clinically indicated. There has long been UK legalisation against female genital mutilation but the 2003 Act (...) extended the criminal offence to UK nationals and permanent residents who are overseas, including in countries where the practice is legal. A person found guilty of an offence under the Act can be imprisoned for up to 14 years.Precise figures for the number of girls and women who have undergone, or who are at risk of FGM, in the UK, are hard to establish because of the secrecy surrounding the practice. It is estimated, however, that over 21 000 girls under the age of 15, in England and Wales, are at high risk of FGM.2 Despite this prevalence, recent clinical and policy guidelines3,4 and the legislative framework to prosecute, there have been no prosecutions for FGM in the UK. Worryingly, there is a suggestion that some girls are being brought to the UK for FGM, as the UK is seen as having ‘fewer controls’ and ‘less awareness about FGM’. A recent quote in the BMJ noted ‘People from many countries in Europe go to the UK for this purpose’.5In response to the lack of prosecutions, in November 2012, the Crown Prosecution Service launched an action plan for improving prosecutions. Action points include: gathering more robust data on allegations of FGM; raising with Ministers what the existing reporting …. (shrink)

In August 2012, the drug manufacturer, Fresenius Kabi, barred the sale of the anaesthetic, propofol, for use in lethal injections. The company announced that it would not accept orders for the drug from US departments of correction, and put in place similar requirements on all its wholesalers and distributors.1Propofol is one of the world's most widely used anaesthetics. Earlier in 2012, US states began to use propofol in executions following shortages of other drugs which had previously been used in lethal (...) injections. In May 2012, the state of Missouri decided to move to a one-drug protocol, using propofol alone for lethal injections, in place of the three-drug protocol that had been used by most states carrying out the death penalty. Missouri took this decision when supplies of thiopental sodium and pentobarbital, drugs used in the three-drug protocol, became unavailable.2Fresenius Kabi said that it had imposed the restrictions in order to ‘prevent Propofol from being used for purposes other than its approved medical indications’ and to ensure that ‘the immediate access to Propofol needed by medical professionals’ was not hindered. The company said that it objected to the use of its products in any manner that was not in full accordance with the medical indications for which they have been approved by health authorities.3 All forms of Fresenius Kabi propofol are manufactured in Europe. A European Union Council regulation prevents products that may reasonably be expected to be used in executions from being exported from the EU. The company said that, should propofol begin to be used in executions in the USA, inadequate access to the drug in the country was a likely consequence. At the time of writing, the US Food and Drug Administration was reporting shortages of the drug in the USA for …. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority. Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and information (...) about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18. This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Proponents of fetal rights argue that, from the moment of conception, a fetus has significant human rights. There are degrees of opinion, however, about the scope of those rights, with some arguing that, in certain circumstances, such as where the conception is the result of rape, the mother's rights predominate. Others argue that the fetus' rights are absolute and should override the woman's right to life and health so that pregnancies cannot be terminated, even to save women's lives. Various countries (...) explicitly or implicitly recognise the status of the fetus as a separate person with varying degrees of rights. For example, the Irish Constitution recognises the ‘right to life of the unborn’ and the 2004 US Unborn Victims of Violence Act views violence against a pregnant woman as a crime against two people, one of whom is the child in utero. The 1969 American Convention on Human Rights has been signed by most Latin American countries and recognises full human rights as applying from conception. In the UK, the fetus has no legal rights but it is widely agreed that the closer a fetus is to being capable of independent existence outside the womb, the greater the moral obligations owed to it. This is reflected in the abortion law only permitting termination of a pregnancy at the later stages in restricted circumstances.In Brazil, the issue of fetal rights was highlighted in May 2010 when a Bill was put forward which aimed to give the fetus priority in law and to make illegal any act or omission that could have a negative impact on it. The bill proposes that the family, society and the …. (shrink)

Collection of papers delivered at a symposium held in Lausanne, 10-11 September 2009.".

Court of appeal ruling on assisted dyingIn July 2013, the Court of Appeal ruled on an assisted dying case brought by Paul Lamb, a 58-year-old man who has been quadriplegic and without function in any of his limbs, apart from a little movement in his right hand, since a car accident in 1990.1 Mr Lamb was permitted by the Court to take over the legal case of Tony Nicklinson, who died in August 2012, less than a week after his request (...) for judicial review was rejected by the High Court.2 Like Mr Nicklinson, the severity of Mr Lamb's injuries means that he is unable to take his own life, other than by starvation. He would like his life to be ended, preferably by lethal injection administered at home, and does not want to travel to Switzerland for an assisted suicide.Mr Lamb's case was heard, along with that of Mr Nicklinson's wife and that of another man, ‘Martin’, in the Court of Appeal in May.The Court identified three issues from the parties’ submissions: The common law should provide a defence to murder where that takes the form of euthanasia in circumstances where another party is giving effect to the settled wish of a competent person. The legal prohibitions on those providing assistance constitute a disproportionate interference with Article 8 rights to a private and family life. The Director of Public Prosecution's policy statement on factors which he will take into account when considering whether or not to exercise his discretion in favour of prosecuting does not satisfy the …. (shrink)

There is an inextricable link between cultural and clinical safety. In Australia high‐profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to ‘eliminate racism from the (...) health system’, and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in‐depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non‐Indigenous allyship and collaborative curriculum innovations and initiatives. (shrink)

In Simone de Beauvoir's Philosophy of Lived Experience, Eleanore Holveck presents Simone de Beauvoir's theory of literature and metaphysics, including its relationship to the philosophers Edmund Husserl, Martin Heidegger, Immanuel Kant, Maurice Merleau-Ponty, and Jean-Paul Sartre, with references to the literary tradition of Goethe, Maurice Barr_s, Arthur Rimbaud, AndrZ Breton, and Paul Nizan. The book provides a detailed philosophical analysis of Beauvoir's early short stories and several major novels, including The Mandarins and L'invitZe.

This paper looks at the relationship between spacetime functionalism and Harvey Brown’s dynamical relativity. One popular way of reading and extending Brown’s programme in the literature rests on viewing his position as a version of relationism. But a kind of spacetime functionalism extends the project in a different way, by focussing on the account Brown gives of the role of spacetime in relativistic theories. It is then possible to see this as giving a functional account of the concept of spacetime (...) which may be applied to theories that go beyond relativity. This paper explores the way in which both the relationist project and the functionalist project relate to Brown’s work, despite being incompatible. Ultimately, these should not be seen as two conflicting readings of Brown, but two different directions in which to take his project. (shrink)

I argue that the best spacetime setting for Newtonian gravitation (NG) is the curved spacetime setting associated with geometrized Newtonian gravitation (GNG). Appreciation of the ‘Newtonian equivalence principle’ leads us to conclude that the gravitational field in NG itself is a gauge quantity, and that the freely falling frames are naturally identified with inertial frames. In this context, the spacetime structure of NG is represented not by the flat neo-Newtonian connection usually made explicit in formulations, but by the sum of (...) the flat connection and the gravitational field. 1 Introduction2 Newtonian Gravity: The Orthodox Approach3 Newtonian Gravity: Additional Symmetries4 Cosmological Considerations5 A Newtonian Equivalence Principle: Inertial Frames in Newtonian Gravitation6 Theory Equivalence?7 Conclusion. (shrink)

Prelinguistic infants must find a way to isolate meaningful chunks from the continuous streams of speech that they hear. BootLex, a new model which uses distributional cues to build a lexicon, demonstrates how much can be accomplished using this single source of information. This conceptually simple probabilistic algorithm achieves significant segmentation results on various kinds of language corpora - English, Japanese, and Spanish; child- and adult-directed speech, and written texts; and several variations in coding structure - and reveals which statistical (...) characteristics of the input have an influence on segmentation performance. BootLex is then compared, quantitatively and qualitatively, with three other groups of computational models of the same infant segmentation process, paying particular attention to functional characteristics of the models and their similarity to human cognition. Commonalities and contrasts among the models are discussed, as well as their implications both for theories of the cognitive problem of segmentation itself, and for the general enterprise of computational cognitive modeling. (shrink)

I argue that the need to understand spacetime structure as emergent in quantum gravity is less radical and surprising it might appear. A clear understanding of the link between general relativity's geometrical structures and empirical geometry reveals that this empirical geometry is exactly the kind of thing that could be an effective and emergent matter. Furthermore, any theory with torsion will involve an effective geometry, even though these theories look, at first glance, like theories with straightforward spacetime geometry. As it's (...) highly likely that there will be a role for torsion in quantum gravity, it's also highly likely that any theory of quantum gravity will require us to get to grips with emergent spacetime structure. (shrink)

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of (...) suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

Miranda Fricker’s influential concept of epistemic injustice has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is (...) therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice. (shrink)

Several modern accounts of explanation acknowledge the importance of abstraction and idealization for our explanatory practice. However, once we allow a role for abstraction, questions remain. I ask whether the relation between explanations at different theoretical levels should be thought of wholly in terms of abstraction, and argue that changes of the quantities in terms of which we describe a system can lead to novel explanations that are not merely abstractions of some more detailed picture. I use the example of (...) phase transitions as described by statistical mechanics and thermodynamics to illustrate this, and to demonstrate some details of the relationship between abstraction, idealization, and novel explanation. (shrink)

As honey bee colonies continue to perish at high rates, beekeepers are divided on how best to keep bees healthy and productive. In this article, I describe the tensions between conventional beekeepers and a new wave of beekeepers hoping to “save the bees” through a more “natural” approach to beekeeping. Drawing on animal studies and multispecies literature, I show how beekeepers in both camps are constrained by the reality of the Anthropocene: novel ecologies, shifting baselines, and the hybridity of honey (...) bees themselves—part wild animal subject to environmental change, part industrial organism, embedded in circuits of migratory pollination. Beekeepers on both sides are investing in genetics as a solution to honey bee health problems. Thinking with bees helps deepen the literature on multispecies encounters and interrogate the idea of sustainability in agriculture, while thinking with the Anthropocene prompts us to ask what “saving the bees” even means in today’s changing world. (shrink)

Loneliness is often described as a deadly epidemic sweeping across the population, a silent killer. Loneliness, we are told, is a social disease that must be cured. But what does it mean to think of loneliness as a feminist issue, and what might a specifically feminist theorisation bring to conceptualisations of loneliness? In this paper, I argue that feminism helps us see that loneliness is not just personal but political. I trace how stories of loneliness surface, circulate, shift and compound (...) within the specificity of the present, centring on recent strategies proposed by the UK government in their ‘national mission to end loneliness’. I outline how this policy discourse upholds certain normative attachments as having the promise to alleviate loneliness: coupled love, the family, community. Such framings serve to depoliticise contemporary conditions of loneliness, positioning loneliness as a personal failure, with the cure for loneliness as the responsibility of individuals and communities. Absent in government depictions of the problem of loneliness are the wider mechanisms that condemn people to lonely lives, when infrastructures fail, when people find themselves violently cut off from the world. Finally, I speculate on what might happen if we were to challenge this framing of loneliness as always and only a problem in need of a cure. I seek to uncover some of the political potentials of loneliness, asking what can be learnt through reflecting upon shared experiences of loneliness? For, as feminist politics has shown us, feelings of disaffection and alienation can help us imagine other worlds. (shrink)

ArgumentI argue through an analysis of spectacle that the relationship between wildlife documentary films’ entertainment and educational mandates is complex and co-constitutive. Accuracy-based criticism of wildlife films reveals assumptions of a deficit model of science communication and positions spectacle as an external commercial pressure influencing the genre. Using thePlanet Earth series as a case study, I describe spectacle's prominence within the recent blue-chip renaissance in wildlife film, resulting from technological innovations and twenty-first-century consumer and broadcast market contexts. I connect spectacle (...) in contemporary wildlife films to its relevant precursors within natural history, situating spectacle as a central feature of natural history display designed to inspire awe and wonder in audiences. I show that contemporary documentary spectacle is best understood as an opportunity for affective knowing rather than a constraint on accuracy; as a result, spectacle contributes to the virtuous inter-reinforcement of entertainment and education at work in blue-chip wildlife films. (shrink)

This investigation places recent research about changes in wives' and husbands' domestic labor in the context of well-known reporting differences between different kinds of housework surveys. An analysis of the “reporting gap” between direct-question reports of housework hours from the National Survey of Families and Households and time-diary reports from Americans' Use of Time, 1985, shows that both husbands and wives overreport their housework contributions. Furthermore, gender attitudes, total housework, class, education, income, family size, and employment status together significantly affect (...) the overreport, although the variables operate in different ways for wives and husbands. It is concluded that changing and uneven social perceptions of the appropriate domestic roles of women and men have resulted in reporting biases that do not necessarily correspond to actual changes in housework behavior. These findings cast doubt on claims that contemporary husbands are doing more housework than their predecessors. (shrink)

For centuries in the UK and elsewhere, charities have been widely regarded as admirable and virtuous organisations. Business corporations, by contrast, have been characterised in the popular imagination as entities that lack a capacity for moral judgement. Drawing on the philosophical literature on the moral agency of organisations, we examine how the law shapes the ability of charities and business corporations headquartered in England to exercise moral agency. Paradoxically, we find that charities are legally constrained in exercising moral agency in (...) ways in which business corporations are not. Implications for charities and business corporations are then explored. (shrink)

This article examines the rise of meta-commentary in US media, and considers the consequences it has for the social construction and the performance of intellectual expertise. Media meta-commentary is defined as critical reflection about media practices and performances, in which the primary basis for criticism is the comparison of different media formats. Meta-commentary began to emerge with the differentiation of the aesthetic sphere and the development of a new kind of expert, the cultural critic. Cultural criticism led to a proliferation (...) of expert performance styles, including a type of counter-performance that rejects the somber and serious nature of traditional intellectual practices. By the 1980s, these new styles of intellectual performance were being reinforced by important institutional and regulatory changes within the media industry, and ultimately by the proliferation of new digital technologies and DIY culture. By the twenty-first century, media meta-commentary had become a distinctive and peculiar form of expert discourse, which legitimates the act of criticism while also relativizing it. The current environment suggests two possible outcomes: a hopeful one that encourages greater reflexivity, and a more ominous one that points toward populism. (shrink)

Acoustic experiences of nature represent a growing area in restorative environments research and are explored in this narrative literature review. First, the work surveyed indicates that nature is broadly characterized by the sounds of birdsong, wind, and water, and these sounds can enhance positive perceptions of natural environments presented through visual means. Second, isolated from other sensory modalities these sounds are often, although not always, positively affectively appraised and perceived as restorative. Third, after stress and/or fatigue nature sounds and soundscapes (...) can lead to subjectively and objectively improved mood and cognitive performance, as well as reductions in arousal, although some inconsistencies in findings are observed. Fourth, theoretical frameworks of restorative environments would benefit from inclusion of acoustic environmental properties such as sound intensity or frequency. Fifth, findings regarding positive, learned semantic associations with nature have arisen as a result of recent work on sounds and restoration. This represents another important area of potential theoretical development for broader restorative environments research. (shrink)

Deleuze, The Dark Precursor is organized around three themes that critically overlap: dialectic, structure, and being.