While facing cuts, downsizing and revenue losses, media organizations experience paradoxical demands in being organized for print or linear production with daily deadlines and simultaneously striving to be ‘digital first’ and produce and publish stories online on a continuous basis throughout the day. In this paper, we describe efforts applied when introducing the metaphor flowline in a medium-sized newspaper organization in Norway with the aim of aligning their production and publishing processes to readers’ consumption of online news. Both the production (...) volume of journalistic content, reader consumption and the newsroom workers’ experience of mastering their everyday work life increased dramatically in a very short time. The involvement of a temporary autonomous team in the planning and designing of a test pilot aiming to make flowline “as practice”, was integral to the digital transformation success, allowing for participative action across newsroom boundaries. Based on the empirical findings from the local newspaper organization and drawing on theories on liminality and metaphorical work, this article presents a set of six interrelated steps incorporating a structure for autonomous teams and their role in enabling lasting change in organizations facing digital transformation. (shrink)

This article seeks to address the contemporary politics and ethics at work in the teaching of ethics in higher education. It will do so by addressing the stakes inherent in the translation of certain ?urgent reformulations? of teaching ethics in a contemporary Asian university, in light of a ?demise of politics? due to corporatisation. Using Derrida's reading of Levinas? ideas on ethics, the article claims that the debate on teaching ethics engenders an acceleration of the ?aporia of hospitality?. The article (...) concludes that, since the corporate-managerial reformulation of the university as well as the call for reviving ?real? critical thought both labour under the mark of a growing sense of moral urgency, they are both also violent. This points to the instability of the academic institution, making the Asian university's complicity in colonialism and neo-liberalisation precisely the moment where the promise of philosophy gets intensified, thus allowing students in that Asian university to ex-propriate the European idea of justice. (shrink)

This book provides a synthesis of four versions of program semantic—srelational semantics, predicate transformer semantics, information systems, and domain theory—showing, through an exhaustive case study analysis, that it is possible to do back-and-forth translation from any of these versions of program semantics into any of the others, and demonstrating that while there are many variations of each, in principle they may be thought of as intertranslatable.

The impact of COVID-19 on chronic pain in non-infected vulnerable South American subjects is unknown. Healthcare workers are at increased risk for CP. During the pandemic, many HCWs with CP kept working. Knowing how cognition is affected by CP in these subjects is an important subject for work safety. The attention domain has a pivotal role in cognition. Previously, the Continuous Visual Attention Test was applied to detect specific attention deficits in fibromyalgia patients. The present investigation described CP prevalence in (...) non-infected Brazilian HCWs during the pandemic and assessed HCWs’ attentional performance with the aid of the CVAT. This study was carried out at a reference University Hospital in Rio de Janeiro, Brazil. HCWs of both sexes, aged 20 or older, were interviewed from August to December 2020. A 90-second version of the CVAT was performed. The average reaction time to correct responses and the respective intraindividual reaction time variability for correct responses to target was determined. Omission and commission errors were also calculated. Then, for each participant we calculated the Z-scores of the CVAT variables based on the distribution of CVAT performance of 211 healthy subjects. HCWs with Z-scores > 1.64 were classified as significantly impaired. From the 154 selected HCWs, 72 reported CP during the pandemic. Post hoc ANCOVAs showed that the average correct VRT was significantly higher in the CP group than in the non-CP group. The percentage of participants with impaired VRT performance was 30% in the CP group and 16% in the non-CP group. The difference between these two propositions reached significance. As VRT is associated with the sustained-attention subdomain, our data suggest that this subdomain is disrupted in the CP group. (shrink)

Giordano Bruno (1548-1600), who died at the stake, is one of the best-known symbols of anti-establishment thought. The theme of this volume, which is offered as a collection of essays to honor the distinguished Bruno scholar Hilary Gatti, reflects her constant concern for the principles of cultural freedom and independent thinking. Several essays deal with Bruno himself, including an analysis of the Eroici furori, a study of his reception in relation to the group known as the Novatores, and discussions of (...) several important aspects of his stay in England. The authors and texts discussed here are linked by a relentless interest in the question of authority and originality, and they range from literary figures such as Alberti (1404-72), Vasari (1511-74) and the proponents of quantitative verse in sixteenth-century England to controversial philosophers who, like Bruno, were condemned by the Church, such as Tommaso Campanella (1568-1639) and Giulio Cesare Vanini (1585-1619). Taken together, these chapters show how much that was new and revolutionary in early modern culture came from its confrontation with the past. Martin McLaughlin is Agnelli-Serena Professor of Italian at Oxford. Elisabetta Tarantino is a Teaching Fellow in the Department of Italian at the University of Warwick. (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual in-depth interviews (...) with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

Feigning symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests have been developed to help clinicians differentiate feigned from genuine symptom presentations. While a deviant SVT score is an indicator of a feigned symptom presentation, a non-deviant score provides support for the hypothesis that the symptom presentation is valid. Ideally, non-deviant SVT scores should temper suspicion of feigning even in cases where the patient fits the DSM’s stereotypical yet faulty profile of the “antisocial” feigner. Across three studies, (...) we tested whether non-deviant SVT scores, indeed, have this corrective effect. We gave psychology students and clinical experts a case alluding to the DSM profile of feigning. In successive steps, they received information about the case, among which non-deviant SVT outcomes. After each step, participants rated how strongly they suspected feigning and how confident they were about their judgment. Both students and experts showed suspicion rates around the midpoint of the scale and did not respond to non-deviant SVT outcomes with lowered suspicion rates. In Study 4, we educated participants about the shortcomings of the DSM’s antisocial typology of feigning and the importance of the negative predictive power of SVTs, after which they processed the case information. Judgments remained roughly similar to those in Studies 1–3. Taken together, our findings suggest that students and experts alike have difficulties understanding that non-deviant scores on SVTs reduce the probability of feigning as a correct differential diagnosis. (shrink)

Digital Earth applications provide a common ground for visualizing, simulating, and modeling real-world situations. The potential of Digital Earth applications has increased significantly with the evolution of artificial intelligence systems and the capacity to collect and process complex amounts of geospatial data. Yet, the widespread techno-optimism at the root of Digital Earth must now confront concerns over high-risk artificial intelligence systems and power asymmetries of a datafied society. In this commentary, we claim that not only can current debates about data (...) governance and ethical artificial intelligence inform development in the field of Digital Earth, but that the specificities of geospatial data, together with the expectations surrounding Digital Earth applications, offer a fruitful lens through which to examine current debates on data governance and artificial intelligence ethics. In particular, we argue that for the implementation of ethical artificial intelligence and inclusive approaches to data governance, Digital Earth initiatives need to involve stakeholders and communities at the local level and be sensitive to social, legal, cultural, and institutional contexts, including conflicts that might arise within those contexts. (shrink)

The expansion of livestock production throughout the world has led to increased demand for high protein animal feed. This expansion has created economic benefits for livestock farmers and other actors in the chain, but also resulted in environmental and social side effects. This study aims to identify a set of sustainability issues that cover the environmental, economic and social dimensions of soymeal and beef production chains. The method applied combines the results of multiple studies, including a literature review and stakeholder (...) surveys. Stakeholder surveys were conducted for three different interest groups and two geographical regions . Our results reveal that the selection of issues in most sustainability assessment studies is a relatively arbitrary decision, while the literature also states that identifying issues is an important step in a sustainability assessment. Defining sustainability issues from a whole chain perspective is important, as issues of sustainability emerge at various stages along the production chain, and are found to vary across stakeholders’ interests. Business stakeholders, for example, perceived economic issues to be more important, whereas the majority of consumer stakeholders and other stakeholders perceived social and environmental issues, respectively, to be more important. Different education levels, knowledge, and living patterns in various geographical regions can affect the stakeholders’ perceptions. The combination of a heterogeneous group of stakeholders and the consideration of multiple chain stages constitutes a useful approach to identify sustainability issues along food chains. (shrink)

Volume 25, Issue 2, February - March 2020, Page 225-226.

Two theme–setting quotations introduce this essay—that of Yeats's falcon, deaf to the falconer's call, adrift in space above the blood–dimmed tide, counterpoised to Pierre Teilhard de Chardin's call to abandon old nationalistic prejudices and build the earth. With primary references to the thought of Teilhard, along with, among others, to Ewert Cousins, Andrew M. Greeley, Karl Jaspers, Marshall McLuhan, Ilya Prigogine, Karl Rahner, Leonard Swidler, David Tracy, and Alfred North Whitehead, I argue that the most crucial intellectual paradigm shift of (...) the twenty–first century will challenge humanity to take the turn from uncritical attachment to rigid absolutism or atomistic fragmentation toward a sense of open–ended, off–centered centeredness and fluid connections—from a static to a dynamic model of reality. Central to my argument is the Teilhardian reinterpretation of the Christian metaphors of creation, fall, incarnation, salvation, and the eschaton in the evolutionary terms of the emergence of cosmic consciousness from the chrysalis of the world of the past—from chaos to order, from biosphere via noosphere to theosphere. Facilitated by the exponential growth of populations, collaborative research, science, technology, and global communication (most dramatically manifested by the Internet), this emergent understanding of what it means to be human can, first, foster the awareness that in humanity evolution has become conscious of itself, and then, gradually, precipitate the formation of “the global village” (the mystical body of Christ), as respectful dialogue replaces diatribe and the dualistic pugilism of Samuel Huntington's “Clash of Civilizations” is gradually transformed into a nonadversarial mentality that values shared humanity and a common purpose. Thus, eons hence, empowered by love–energy, the transmutation of the human into the ultra–human can take the ultimate quantum leap into a yet higher dimension where spirit/energy is no longer in need of flesh/mass, and Earth can be safely left behind. (shrink)

As with other areas of the social world, academic research in the contemporary healthcare setting has undergone adaptation and change. For example, research methods are increasingly incorporating citizen participation in the research process, and there has been an increase in collaborative research that brings academic and industry partners together. There have been numerous positive outcomes associated with both of these growing methodological and collaborative processes; nonetheless, both bring with them ethical considerations that require careful thought and attention. This paper addresses (...) the ethical considerations that research teams must consider when using participatory methods and/or when working with industry and outlines a novel informed consent matrix designed to maintain the high ethical standard to which academic research in the healthcare arena has traditionally adhered. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 42.1 (2004) 115-116 [Access article in PDF] Robert J. Dostal, editor. The Cambridge Companion to Gadamer. New York: Cambridge University Press, 2002. Pp. xiii + 317. Cloth, $65.00. Paper, $23.00. This twelve-essay collection should introduce Gadamer to new readers while engaging those familiar with his work. Essays treat central elements of Gadamer's hermeneutical philosophy: his concept of understanding; tradition and authority; the ontology (...) of language; and the centrality of dialogue. A varied group of scholars trace Gadamer's major philosophical influences and situate him in debates with rival critics of modernity.The book opens with Robert Dostal's biographical sketch, from Gadamer's Marburg years, fascination with Heidegger's interpretation of Aristotle, and the Leipzig rectorship, through his productive Heidelberg period, reception of Truth and Method, and later engagement with issues like globalization and health. Dostal rejects claims of Nazi collusion, and characterizes as superficial critiques of Gadamer's writings at this time on Plato and Herder. Dostal might have gone further: Gadamer's writings develop a politics of recognition among equal, different and autonomous subjects, and his central notions of conversation and I-Thou dialogue are deeply anti-authoritarian.For a general audience, Charles Taylor best communicates the humane relevance of Gadamer's thought, astutely captured as the challenge of trying to understand others without absorbing them into our interpretive frameworks but by letting them challenge those frameworks. New readers might also benefit from accounts of Gadamer's notion of understanding (Jean Grondin) and its ethical dimensions (Georgia Warnke).For readers more familiar with Gadamer, Brice Wachterhauser illustrates the critical dimensions of Gadamer's views of tradition and authority, drawing on John McDowell's work, illuminating the intentional character of belief justification. Falling into neither skepticism nor objectivism, Wachterhauser shows that Gadamer's claim, "Being that can be understood is language," is inextricably tied to epistemic realism: while our beliefs are formed through interpretations, they remain answerable to the world. "Our world has an 'inherent' intelligibility that is... 'independent' of the languages, traditions and standpoints through which the world is mediated" (73). Otherwise, the world could not challenge us—Wachterhauser's reading thus has the virtue of accounting for the experience of the tug of, e.g., nature or a text against willful or incorrect claims to know it.Quite different is an essay by J. M. Baker, who explores Gadamer's view that the relevance of poetry for philosophy is its speculative content. Contrasting Hegel's claim that poetry no longer reveals truth and is superceded by the prose of philosophy, Baker illustrates Gadamer's view with readings of Mallarmé and Rilke. Mallarmé, says Baker, "elaborated a language that at once brings things otherwise inaccessible into presence yet defeats any attempt to name that presence," his "pure poetry" repudiating reference yet suggesting a kind of revelation. Poetry expresses the "invisible," by which is meant not the opposite of the material, but "... things [that] have in their same material exteriority an invisibility that has first of all to be articulated" (158). This articulation, for Gadamer, is the first task of a post-Hegelian aesthetic.Richard Bernstein outlines the intersections of hermeneutics, critical theory, and deconstruction, using each to reveal the others' aporia. For Habermas, phronesis does not go far enough in understanding modernity's pathologies, showing the need for democratic political theory. For Gadamer, efforts to build a universal political theory lack an appreciation of human finitude. Derrida's skepticism about slippage and misprisions of language challenges Gadamer's account of the "fusion of horizons," which emphasizes [End Page 115] dialogical achievement in understanding. Yet Derrida's deconstruction depends (to have effect through language) on a concern for coherence, as his view of the "undecidability" of ethical decisions shares the risk to identity of Gadamer's commitment to the "openness of experience."In a provocative essay, Robert Pippin analyzes Gadamer's complex relation to Hegel. Gadamer shares a view of Hegel as mired in a philosophy of consciousness, i.e., the "problem of reflection." Tracing the trajectory of this problem from Locke... (shrink)

Volume 25, Issue 2, February - March 2020, Page 225-226.

In lieu of an abstract, here is a brief excerpt of the content:Many scholars have contended that Clare of Assisi’s original intention upon leaving her family home to take up religious life sometime around 1211 was to lead a life essentially like that of the mendicant friars.1 She and the women who soon joined her would be not only poor and penitential, but also itinerant and apostolic. Like the friars their life would be marked by both insertion into the world (...) and seclusion from it as they alternated between active service and recollected contemplation. The important proof text for this claim is a passage in a letter composed by Jacques de Vitry in 1216, just five years after Clare’s conversion. Many scholars, including Paul Sabatier, Luigi Pellegrini, Roberto Rusconi, Marco Bartoli, Ingrid Peterson, Chiara Frugoni, Giovanni Boccali, and Chiara Augusta Lainati believe the text to be the earliest witness to the manner of life led by Clare and her followers during their initial years.2 The letter has been used to argue further that the women were explicitly grouped together with the Lesser Brothers, were known by the parallel title of “Lesser Sisters,” and had the freedom to come and go as they wished during their early years in San Damiano.Since claims about the women’s early likeness to the friars’ mendicant way of life are often made as brief assertions resting on Jacques’s letter, I think it important to consider in a more detained fashion the provocative passage thought to support them. Closer scrutiny of Jacques’s text shows that while none of these claims can be entirely ruled out, importantly, none can be supported with any solid evidence. I agree essentially with scholars such as Lilly Zarncke, Ernest McDonnell, Maria Pia Alberzoni, Jacques Dalarun, and Lezlie Knox who consider the letter’s language too general to know if it refers specifically to Clare and her sisters.3 I suggest, furthermore, that there are reasons to conclude that this is certainly unlikely if the passage is interpreted to mean, specifically, that Clare and her sisters carried on an active apostolate outside of San Damiano.Jacques de Vitry is generally recognized as one of the most astute and forward-thinking observers of his time in terms of recognizing the importance of new religious groups. A Parisian master, canon regular, and bishop, Jacques had the opportunity to live in a variety of settings, including his native France, the Low Countries, Italy, and the holy land.4 In 1216, he traveled from Liège in the Low Countries to Perugia to be consecrated bishop by Honorius III, who himself had just been elevated to the papacy.5 Along with observations about other matters, Jacques shared the following comment about religious men and women in a letter that he sent almost certainly to a group of his friends back in Liège. He was writing in the early days of October 1216 as he was leaving Italy on a boat that would carry him to his new episcopal see in Acre. The letter, the first of six that survive, is prized not only for its reference to the Lesser Sisters, but also as the very first written testimony regarding the Franciscan movement in general. The great nineteenth-century historian Paul Sabatier thought it provided a more vivid and precise description of Francis’s ministry than any single passage contained in his early biographies.6 The passage, which represents less than seven percent of the entire letter, is rendered thus in a widely available English translation:I found one consolation in those parts, nevertheless: many men and women [multi enim utriusque sexus], rich and worldly, after renouncing everything for Christ, fled the world. They are called Lesser Brothers and Lesser Sisters [fratres minores et sorores minores]. They are held in great esteem by the Lord Pope and the cardinals. They do not occupy themselves with temporal affairs, but work each day with great desire and.. (shrink)

The main purpose of this dissertation is to examine critically and discuss the role of imagination in science and religion, with particular emphasis on its possible epistemic, creative, and meaning-making functions. In order to answer my research questions, I apply theories and concepts from contemporary philosophy of mind on scientific and religious practices. This framework allows me to explore the mental state of imagination, not as an isolated phenomenon but, rather, as one of many mental states that co-exist and interplay (...) in our cogntive architecture. Based on the philosophical discourse of philosophy of mind, four types of imagination are indentified and conceptualized: sensory, propositional, experiential, and creative imagination. These categories are then employed on five phenomena that can be found in scientific and religious environments: metaphors, models, thought experiments, aspect perception, and - in the religious case - rituals. In relation to the concept of religious "seeing" I consider how imaginings may influence visionary experiences and visualization, and compare these phenomena with cases of scientific visualization and eureka experiences. In regard to scientific and religious models, a distinction is made between, on the one hand, two notions of truth and, on the other hand, truth-independent meaning-making. In light of these categories, I differentiate between, and critically discuss, the use of imagination in doxastic, non-doxastic and fictionalist accounts. In light of this investigation, I formulate and defend the position of interactivism, which acknowledges a constant interplay between different attitudes and mental states. In my examination of rituals and scientific and religious thought experiments, special attention is given to the mental capacity to recreate the experiences that are entailed in an imagined scenario. At the end of the investigation, I consider the possible impact that my study might have on how we view science and religion as well as the dialogue bewteen these two fields. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)