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

In this article we ask what it means for sociologists to practice intersectionality as a theoretical and methodological approach to inequality. What are the implications for choices of subject matter and style of work? We distinguish three styles of understanding intersectionality in practice: group-centered, process-centered, and system-centered. The first, emphasizes placing multiply-marginalized groups and their perspectives at the center of the research. The second, intersectionality as a process, highlights power as relational, seeing the interactions among variables as multiplying oppressions at (...) various points of intersection, and drawing attention to unmarked groups. Finally, seeing intersectionality as shaping the entire social system pushes analysis away from associating specific inequalities with unique institutions, instead looking for processes that are fully interactive, historically co-determining, and complex. Using several examples of recent, highly regarded qualitative studies, we draw attention to the comparative, contextual, and complex dimensions of sociological analysis that can be missing even when race, class, and gender are explicitly brought together. (shrink)

This study proposes two identification cuing factors (i. e., CSR associations and CSR participation) to understand how corporate social responsibility (CSR) relates to employees' identification with their firm.The results reveal that a firm's CSR initiatives increase employee-company identification (E-C identification).E-C identification, in turn, influences employees' commitment to their company. However, CSR associations do not directly influence employees' identification with a firm, but rather influence their identification through perceived external prestige (PEP). Compared to CSR associations, CSR participation has a direct influence (...) on E-C identification. On the basis of these findings, it is argued that CSR performance can be an effective way for companies to maintain a positive relationship with their employees. (shrink)

This study proposes two identification cuing factors to understand how corporate social responsibility relates to employees’ identification with their firm. The results reveal that a firm’s CSR initiatives increase employee–company identification. E–C identification, in turn, influences employees’ commitment to their company. However, CSR associations do not directly influence employees’ identification with a firm, but rather influence their identification through perceived external prestige. Compared to CSR associations, CSR participation has a direct influence on E–C identification. On the basis of these findings, (...) it is argued that CSR performance can be an effective way for companies to maintain a positive relationship with their employees. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChong Siow Ann, Associate ProfessorDr. G appears to experiencing symptoms of schizophrenia, which is arguably the most severe mental disorder and which afflicts about one in a hundred people. This is a psychotic disorder that causes disturbances and distortions in thinking, including neurocognitive impairments, perception and behaviour. There is no cure for this often devastating disorder. Current antipsychotic medications can alleviate some of the symptoms but it often (...) comes at a price as these antipsychotics have burdensome side effects.A feature of this disorder is anosognosia, which is a lack of awareness or “insight” that an illness is present. This lack of insight presents a particular challenge because these individuals would, as in the case of Dr. G, refuse needed treatment as they do not perceive that they are ill. This is not necessarily an all-or-none phenomenon but is rather more complex and multidimensional; there might be an unawareness or recognition on behalf of the patient that they are suffering from a mental illness, the failure to appreciate the necessity of treatment; and/or the inability to recognise and define the psychotic symptoms like unusual thoughts and hallucinations as signs of illness1 and in many instances, all three are present. It is also by no means uncommon. Studies have found that between 60% and 80% of people with schizophrenia lack awareness of their illness to varying degrees.2This phenomenon remains an enigma. Some regard it as a form of psychological defence against the harsh reality of a psychotic illness — awareness of having a chronic and devastating illness might lead to demoralisation, hopelessness and suicide.3 Recent research, however, [End Page 250] indicates that this psychological denial plays a small part, if any, and instead has found an association with certain neuropsychological and neurocognitive deficits,4 as well as functional and structural brain abnormalities in the frontal lobe of the brain.5The prevailing clinical view thus is that this is an intrinsic and organic aspect of the schizophrenic illness which has nothing to do with wilfulness but rather the incapacity to perceive the presence of the illness. Edwin Fuller Torrey, an eminent psychiatrist and executive director of the Stanley Medical Research Foundation, calls anosognosia the “single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications”, and he has remarked that “to keep talking about civil liberty is illogical. Patients are anything but free when they’re at the beck and call of their own delusions”.6It is also this view that it is a product of a brain disorder that some — particularly patients — find unacceptable. At one level, it does not take into context the person’s own experiences, and at a deeper level it calls into question the conception of the self with its capacity to exercise judgements and the autonomy to make decisions.This is a perennial ethical issue in psychiatry when people with severe mental illnesses refuse treatment. This becomes a Catch-22 situation where part of the illness that needs treatment is also preventing any treatment to be given: implicit in the principle of informed consent for treatment is that the person should be aware of the nature and course of their illness and acknowledge the need for treatment. While there are laws for involuntary commitment, the bar is usually high in that there must be a clear and present risk of harm to the person or others. Alan Stone, a professor of law and psychiatry at Harvard University proposed a possible justification for involuntary treatment based on his “thank-you theory” which assumes that patients will become well and subsequently agree that the intervention was in their best interests but research suggests that only half of these patients would admit so.7One suggested mechanism is the use of advance directives — psychiatry’s version of the living will in which people can specify what sort of medical care they would like should they become mentally unwell and unable to exercise appropriate judgement. An intrinsic part of this might include a “Ulysses contract” — just as Ulysess instructed his crew to lash him to the mast of the his ship so that he could... (shrink)

本书是一本关于陈冲体验人生感悟人生的书法集子。内容包括:悟道篇;明理篇;做人篇;处世篇等。.

This article explores the gendered construction of South Korean citizenship through the lens of North Korean settlers' experiences in South Korea. Drawing on ethnographic research, the author delves into the citizen-making process, critically examining the impact of gendered modernizing projects on North Korean settlers' daily lives. North Korean settlers are expected to get rid of their ethnic markers and transform themselves into modern citizen-subjects of South Korea. The author demonstrates that the overall frame of perception of North Korean settlers is (...) deeply gendered, with modernity as a powerful ethnic marker. The notion of ethnicized citizenship in the context of two Koreas offers a concrete account of how ethnicities are created and employed in stratified structure of citizenship. (shrink)

Theories of citizenship have largely focused on the provision of rights by law and policy measures, as if rights are universally beneficial and cost-free and the invitations of rights will be accepted once offered. I challenge this assumption and highlight the need to empirically address how people negotiate with the benefit and cost of claiming rights. Based on ethnographic research in South Korea, this article delves into the everyday lives of migrant women in two feminized sectors of migration—cross-border marriage and (...) sexual commerce—to situate the act of claiming rights in relation to the gendered pursuit of moral respect. I show that feminist groups in South Korea relied on the discourse of victimization and trafficking in pressuring the South Korean state to account for the human rights of migrant wives and migrant hostesses, while reinforcing the moral hierarchy that renders problematic migrant women’s work and intimate relationships. I argue that the distinctive material and moral costs that accompanied human rights–based provisions compelled migrant wives and hostesses to pursue divergent paths in seeking alternate bases to citizenship that would support their inclusion as moral equals. (shrink)

Four Daoist texts illustrate the dynamic image of the Daoist immortal world on which a Daoist environmental ethics can be built. The first text is the Daodejing with two of the oldest commentaries. The second is Tao Hongjing’s Diagram of Rank and Functions of True Spirits. The third is the collection of poems by Immortal Changchun, titled Panxiji. The fourth is the Morning and Evening Liturgical Prayer Book of the Quanzhen Order, which represents Daoist ecological concerns for the natural world. (...) Daoism not only accords with the impetus and spirit of environmental ethics but can also make a concrete contribution to its implementation. (shrink)

A growing literature looks at how the design of the electoral system shapes the voting behavior of politicians in parliaments. Existing research tends to confirm that in mixed-member systems the politicians elected in the single-member districts are more likely to vote against their parties than the politicians elected on the party lists. However, we find that in South Korea, the members of the Korean National Assembly who were elected on PR lists are more likely to vote against their party leadership (...) than the members elected in single-member districts (SMDs). This counterintuitive behavior stems from the particular structure of candidate selection and politicians' career paths. This suggests that any theory of how electoral systems shape individual parliamentary behavior needs to look beyond the opportunities provided by the electoral rules for voters to reward or punish individual politicians (as opposed to parties), to the structure of candidate selection inside parties and the related career paths of politicians. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex interaction (...) of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)

This paper intends to append the frame of dialectic upon St. John of the Cross’ delineation of mysticism. Its underlying hypothesis is that the dialectical structuring of St. John’s mystical theology promises to unravel the web of relational concepts embedded within his immense writings on this unique phenomenon. It is hoped that as a consequence of this undertaking, relevant pairs of correlative opposites that figure prominently in mysticism can be elucidated and perhaps come to some form of resolution.

BackgroundResearchers worry that patients in early-phase research experience unrealistic optimism about benefits and risks of participation. The standard measure of unrealistic optimism is the Comparative Risk/Benefit Assessment questionnaire, which asks people to estimate their chances of an outcome relative to others in similar situations. Such a comparative framework may not be a natural way for research participants to think about their chances.ObjectiveTo examine how people interpret questions measuring unrealistic optimism and how their interpretations are associated with their responses.MethodsUsing an early-phase (...) cancer trial vignette, we administered the CRBA to 297 adults from the general public. They estimated their comparative chances of risk and benefit, then provided rationales for their estimates.ResultsFor both CRBA benefit and risk questions, about 50% of respondents chose 0, and 50% chose a non-0 response. Respondents’ rationales for their estimates showed that overall only about 40%–44% gave comparative rationales, indicating that they interpreted the CRBA as intended. 68.7% of respondents who gave the ‘correct’ 0 rating gave comparative rationales, whereas only 11.6% of respondents who gave non-0 ratings did so. A similar trend was seen for chances of risk.ConclusionResearch participants may not understand comparative benefit and risk questions as intended; attributions of unrealistic optimism may require additional evidence that the respondents’ estimates are intended to be comparative. (shrink)

A common assumption in the selection of nonhuman animal subjects for research and the approval of research is that, if the risks of a procedure are too great for humans, and if there is a so-called scientific necessity, then it is permissible to use nonhuman animal subjects. I reject the common assumption as neglecting the central ethical issue of the permissibility of using nonhuman animal subjects and as being inconsistent with the principle of justice used in human subjects research ethics. (...) This principle requires that certain classes of individuals not be subjected to a disproportionate share of the burdens or risks of research. I argue for an extension of this principle to nonhuman animal research and show that a prima facie violation of the principle occurs because nonhuman animals bear an overwhelmingly disproportionate share of the risks of research without sufficient justification or reciprocal benefit. (shrink)

What should we do about “tainted” public commemorations? Recent events have highlighted the urgency of reaching a consensus on this question. However, existing discussions appear to be dominated by two naïve opposing views – to remove or preserve them. My aims in this essay are two-fold. First, I argue that the two views are not naïve, but undergirded by concerns with securing self-respect and with the character of our engagement with the past. Second, I offer a qualified defence of vandalising (...) tainted commemorations. The defence comprises two parts. I consider two prominent suggestions – to install counter-commemorations and to add contextualising plaques – and argue that they are typically beset with difficulties. I then argue that in some circumstances, constrained vandalism is a response to tainted commemorations which effectively adjudicates the demands of the two opposing views. (shrink)

The term, "objectionable commemorations”, refers to a broad category of public artefacts – such as, and especially, memorials, monuments and statues – that are regarded as morally problematic in virtue of what or whom they honour. In this regard, they are a special class of public artefacts that are subject to public contestation. In this paper, we survey the general ethical and political issues on this topic. First, we categorise the arguments on offer in the literature, concerning the objectionable nature (...) of such commemorations. Second, we review common political responses to objectionable commemorations. Finally, we identify fruitful areas for further philosophical inquiry on this topic. (shrink)

While understanding and expressing causal relations are universal aspects of human cognition, language users may differ in their capacity to perceive, interpret, and express events. One source of variation in descriptions of caused motion events is agentivity, which refers to the attribution of a result to the agent's action. Depending on the perspective taken, the same event may be described with agentive or non-agentive interpretations. Does language play a role in how people construe and express caused motion events? The present (...) study investigated the use of agentive vs. non-agentive language by speakers of different languages (i.e., monolingual speakers of English and Korean, and Korean learners of English). All three groups described prototypical causal events similarly, using agentive language (active transitive sentences). However, when it came to non-prototypical causal events (where the agent was not shown in the scene), they diverged in their choice of language: English speakers favored agentive language (passive transitive sentences), whereas Korean speakers preferred non-agentive language (intransitive sentences). Korean learners of English patterned with Korean speakers, demonstrating L1 influence on their use of English. These findings highlight the effects of language on motion event construal. (shrink)