A monosexual configuration of sexuality assumes that sexual desire is directed at either men or women. Bisexuality resists a choice between oppositional categories and is often theorised as having a transgressive potential to destabilise binary logic, not only in relation to sexuality but also to gender. There is, however, a lack of empirical work exploring how this potential might be realised in the accounts of bisexual individuals. Drawing on interviews with South African bisexual women, we use a narrative-discursive lens to (...) examine the discursive resources employed by participants to trouble or resist hetero-gendered norms. Our findings demonstrate how resistance to the gender binary hinges on citational politics that are fundamentally gendered and linked to sexuality. Instead of entirely destabilising hetero-gendered norms, participants draw on gendered scripts that simultaneously expand norms to accommodate their sexual difference and, through processes of othering, function to reiterate hetero-gendered norms. While complete subversion of gender binaries is not possible in participants’ discursive contexts, what does occur is a ‘slow bending’ of norms. Theorising bisexuality as transgressing oppositional categories closes off opportunities to interrogate the pervasive influence of gender binaries in contexts that remain marked by pervasive heteronormativity and heterosexism. Significantly, it also obscures more modest improvisations of gender scripts that hold potential for destabilising gender binaries. (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)

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)

The aim of this study is to understand how governance mechanisms in cross-sector collaborations (CSCs) for sustainability affect value creation and capture and subsequently the survival of this organizational form. Drawing on a longitudinal, participatory, single-case study of collaborative action in the textile industry, we identify three governance mechanisms—safeguarding, bundling and connecting—that coevolve with the rising and waning of collaborative tensions and the shifting levels of action in the CSC we studied. These mechanisms aided value creation and helped facilitate private (...) value capture. We integrate these insights into a process model that visualizes the interplay between governance mechanisms of tensions and systems of value creation and capture in CSCs for sustainability. Our study contributes to the cross-sector collaboration literature by providing a dynamic and nuanced understanding of how governance mechanisms influence outcomes in CSCs for sustainability. We also add to the business model for sustainability literature by theorizing the value creation and capture system of collaborative rather than individual organizations. Our findings have important implications for policymakers who fund collaborative organizations and practitioners who manage or participate in them. (shrink)

En quoi le corps participe-t-il de l'entente que l'homme a du monde? Que signifie dès lors écouter? Comment établir un rapport juste à l'animal? Quel sens prêter aux couleurs? Pourquoi la tonalité décisive de notre rapport au monde peut-elle advenir à la faveur d'expériences olfactives et gustatives? En quoi la tactilité incite-t-elle à considérer le corps vif comme une donnée originaire et à reconnaître qu'il est bien une vulnérabilité dotée d'aptitudes qui nous dispose au monde? Comment l'angoisse, révélée et cachée (...) tout à la fois par la maladie, est-elle chevillée au corps de l'être-au-monde, le Dasein? Qu'en est-il du corps dans la nostalgie, dans la mélancolie, dans l'ennui et dans la joie? Pourquoi la coexistence, supposant relations et rencontres, implique-t-elle l'articulation des corporéités vives comme dans le tact sensitif ou dans la jalousie amoureuse et dans l'amour pensé en terme de tonalité érotique? Comment comprendre la mobilité et parvenir ainsi jusqu'à l'éminente dignité ontologique du mouvement? De quoi la pensée est-elle redevable au corps? Telles sont les questions qui jalonnent cet ouvrage. Par son orientation résolument phénoménologique, l'Intelligence du corps entend renouveler l'entente du phénomène le plus proprement humain et, cependant, le plus malmené par la métaphysique. Prenant librement appui sur les vues inouïes de Martin Heidegger, consciente de l'actuelle soumission du corps de l'homme à l'arraisonnement technique, Ingrid Auriol ouvre une voie d'accès à l'intelligence du corps libérée de cette violence. (shrink)

My dissertation, “Love, Self-Constitution, and Practical Necessity,” offers an interpretation of love between people. Love is puzzling because it appears to involve essentially both rational and non-rational phenomena. We are accountable to those we love, so love seems to participate in forms of necessity, commitment, and expectation, which are associated with morality. But non-rational attitudes—forms of desire, attraction, and feeling—are also central to love. Consequently, love is not obviously based in rationality or inclination. In contrast to views that attempt to (...) fit love into existing models of practical reasoning, I argue that love participates in a unique form of practical necessity, different from both moral and psychological necessity, yet bearing resemblances to each. Distinctive to this type of practical necessity is a direct appeal to another particular person that cannot be delivered in third-personal terms—that is, a non-moral yet normative type of expectation on another person. This type of expectation is predominant in loving relationships, but can also make better sense of the experiences of humor and beauty, as well as attitudes like forgiveness, gratitude, and agent-regret. I treat Immanuel Kant’s discussion of the experience of beauty in the Critique of Judgment and Christine Korsgaard’s work on self-constitution as fruitful starting points for this account of love. I conclude that our loving relationships enable us to have distinctive personal selves, and provide support for this account of love by offering a complementary theory of grief. In Part One of the dissertation, I focus on two prominent approaches to love characteristic of the sentimentalist and rationalist traditions. I begin with the work of David Hume, which treats desire (understood as something like a simple impulse or craving) as the paradigmatic mental state, and emphasizes our personal and affective dimensions. Hume has the valuable insight that loving someone affects our sense of ourselves. But Hume’s view becomes unsatisfying when he claims that love is essentially enfeebling, implying that to love is to be passive toward and readily overcome by another person. While this indicates Hume’s awareness that love involves being open and receptive to another person, the problem is that love is also a demanding attitude. Hume lacks the conceptual resources to offer a nuanced view of the self, in which we can—with one attitude—be both demanding of and vulnerable to another person. Hume’s model of a desire-based deliberative process has recently been revived in Harry Frankfurt’s discussions on love and rationality. Frankfurt, however, goes beyond Hume’s picture of the self by introducing a notion of “identification,” which he offers to make sense of our apparent ability to commit ourselves decisively to certain projects or people. I argue that active powers like identification and commitment cannot be accommodated within any basically Humean moral psychology. Such abilities, and with them the possibility of love, depend on something closer to a Kantian conception of rational agency. I next focus on the work of Kant, who provides the substantial counterpart to Humean-inspired moral theories, but is not known for his insight into our emotional lives. In the Metaphysics of Morals, Kant divides love into “practical love”—what we experience when we are morally motivated to help someone—and “pathological love”—what we experience when we feel fond of something. But in reality, we experience love neither as a mere preference for another person, nor as something that generates the kind of demands that would be binding on any rational creature. David Velleman attempts to remedy the deficiency of Kant’s dichotomy. Velleman offers a Kantian theory in which he describes love and respect as two ends of a continuum of attitudes that it is morally appropriate to have toward people. Velleman’s view has the peculiar implication that everyone deserves the love of everyone else, and I argue that this is a fatal flaw. Like Kant and Velleman, Korsgaard characterizes personal love as involving the treatment of other people as Kantian ends-in-themselves to a heightened degree. Korsgaard, though, also contends that our individual identities depend upon our personal relationships, and I take this position seriously for the remainder of the dissertation. Ultimately, however, characterizations of loving relations as subsets of moral relations can account for the authority of the demands of love, but not its particularity. The major conclusion of Part One is that any attempt to understand love primarily on a model of practical reasoning with which we are already familiar is doomed to fail. Our experience of love calls for a theory of a unique type of practical necessity. In Part Two I take seriously the possibility that love is simultaneously inescapable (in something like the way morality is supposed to be), and yet ineluctably personal. In love, we experience an engagement with a person as essentially particular, rather than as an instance of a rational agent in general. To make sense of this direct attachment to an individual, I argue that love involves distinctive forms of expectation and disappointment. When those we love let us down, they hurt our feelings, which is not a response to a failed prediction, but nor is it a reaction to a moral insult or offense. According to Peter Strawson and Stephen Darwall, second-personal moral reactive attitudes (such as resentment) always have third-personal analogues (such as indignation). In contrast, I argue that the type of hurt feelings associated with love is a second-personal reactive attitude that does not have a third-personal corollary. I take this as evidence that the expectations involved in love are not objective in the way that the moral is objective. Nor, however, is love a matter of mere preference. On my interpretation, Kant introduces this different type of expectation in the Critique of Judgment. Whereas he characterizes moral judgments as universally communicable, judgments of beauty implicitly involve only second-personal address: I appeal to your direct experience with a particular object. This provides the conceptual space for an account of love according to which it involves a uniquely second-personal form of practical necessity. I contend that the second-personal addresses we make in love are appeals to strengthen the intimacy implicit in the loving relationship, and I identify three interrelated dimensions of that intimacy. First, those we love have the standing to interpret us in a constitutive manner. We fine-tune and make determinate the character of our concerns and interests in part by accepting the interpretations provided by those we love. In that way, the people we love have the normative power to constitute who we are. Second, we share a perspective with those we love in a way that is not reducible to or derivative of our independent perspectives. Loving someone centrally involves the activity of forming concerns together, and we do this in a mode best understood on the model of playing a spontaneous game or improvising music. Finally, being loved enables us to see ourselves as distinctive and special, because the concern those who love us have for us does not track the objective merit of our characteristics. These dimensions of the intimacy that characterizes a loving relationship reveal what it is that we appeal for in love, and how we are hurt when our appeals are rebuffed. In broad terms, this dissertation advocates the recognition of a non-moral yet normative type of expectation, which is predominant in loving relationships. Humor and beauty, too, make more sense when understood in terms of this non-moral yet normative type of expectation, as they involve appeals to others that are more than mere predictions of, but less than rational demands for, a certain kind of response. Introducing this alternative notion of expectation into the discourse of moral philosophy can shed light on other common attitudes that are clearly normative, but defy translation into objective, third-personal terms. Such attitudes include certain experiences of pride and shame, apology and forgiveness, the bestowing of mercy, gratitude, agent-regret, and perhaps a basic sense of trust we have in others. Ultimately, I situate love in respect to grief, which demonstrates my theory’s ability to make sense of related dimensions of our emotional lives. The people we love and grieve over give us a sense of who we are as distinctive, particular individuals, as the three interrelated dimensions of intimacy in loving relationships reveal. Consequently, grief is best understood as a type of practical disorientation—namely, a disorientation that involves the loss of the personal self. I present my account of grief against the type of account that would draw philosophical conclusions about the nature of love and grief from empirical psychological data alone. In particular, these data indicate that we recover quickly from the deaths of loved ones, and Dan Moller draws the philosophical conclusion that those we love fulfill certain roles in our lives and are replaceable. In contrast, I contend that while we should acknowledge the truth of the objective judgment, made in the third-person, that we will likely recover after the deaths of those we love, it does not follow that we must affirm such a claim from the internal perspective of one person who loves another. As a result, the case of love and grief supports a general claim concerning the proper work of moral philosophy, which is that the understanding of ourselves gained through empirical data is not a substitute for the normative conclusions that are revealed through first-personal reflections on our relationships. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wandering the Magnetosphere*Ingrid Koenig (bio)Navigation notes: These emergent drawings–excerpts from a visual essay–take up the complex network of impacts across physical forces entangled with bio-geo-political time. A key element for this work is a living cosmography to depict movement across time, and to visualize wandering on a planet, in the magnetosphere, and between the internal energy of Earth and the solar energy of the cosmos. Physicists say there (...) are no things, there are only relations between things.Q: Hello ancient stone - may I unfold you like a book? Do you carry a message from deep time? A: Yes, what you’re holding is not a thing, but a process. Click for larger view View full resolutionDrawing from Svalbard, Day 17 expedition, 2019[End Page 97]Drifting on a rocky planet, between the internal energy of Earth and the solar energy of the cosmos–we live within a “cosmo-tectonic circulation” —Jerome Gaillardet, geo-chemist. Click for larger view View full resolutionGeocosmic Logic[End Page 98] Click for larger view View full resolutionHow Entropy is Time (detail) Click for larger view View full resolutionMagnetic Story[End Page 99] Click for larger view View full resolutionMessage From Deep Time 3 Click for larger view View full resolutionMessage From Deep Time 1[End Page 100] Click for larger view View full resolutionLooping Matters 1 (Litli-Hrutur, Iceland) Click for larger view View full resolutionLooping Matters 2[End Page 101] Click for larger view View full resolutionMother Rock Waves (Miradalir Valley, Iceland) Click for larger view View full resolutionMother Rock in Time[End Page 102] Click for larger view View full resolutionVolcanic Logic (Miradalir Valley, Iceland) Click for larger view View full resolutionSonic Lava (Miradalir Valley, Iceland)[End Page 103] Click for larger view View full resolutionWaves Across Time (Miradalir Valley, Iceland) Click for larger view View full resolutionDisorientations[End Page 104] Click for larger view View full resolutionMessage From Deep Time 2 Click for larger view View full resolutionGravitational Thought[End Page 105] Click for larger view View full resolutionMagnetic Thought (Miradalir Valley, Iceland) Click for larger view View full resolutionDistance Ladder Collapse[End Page 106] Click for larger view View full resolutionMattering Logic 3 Click for larger view View full resolutionMattering Logic 4[End Page 107] Click for larger view View full resolutionHow We Make Time into Space Click for larger view View full resolutionHow Entropy is Time (detail 2–Svalbard)[End Page 108]Ingrid Koenig Ingrid Koenig is Associate Professor at Emily Carr University of Art + Design, Vancouver, Canada. She was the inaugural Artist in Residence (2011 to 2021) at TRIUMF, Canada’s particle accelerator center, and co-organizes processes of collaboration between artists and physicists in a project called Leaning Out of Windows. Her studio and research practices traverse the fields of physics, social history, feminist theory, and narratives of science. Her drawings explore the complex phenomena of physics and involve intuitive responses to specific sites through fieldwork in Canada’s Rocky Mountains, Germany, Iceland, Arctic Circle art + science expeditions, and through collaborations with physicists. She has received grants from the Canada Council for the Arts, the Goethe Institute, and the Social Science and Humanities Research Council. She co-edited the recently published book, Leaning Out of Windows: An Art and Physics Collaboration (Figure 1 Publishing, 2023).Footnotes* Excerpts from Wandering the Magnetosphere–drawings by Ingrid Koenig, 2019 to 2023, and ongoingCopyright © 2023 Johns Hopkins University Press and SubStance, Inc... (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

From the co-founder and president of PETA, Ingrid Newkirk, and bestselling author Gene Stone comes Animalkind, a book that offers both a tour of the wonderful world of animals and a guide to simple ways in which we can reduce the harm we cause them in our everyday lives.

From the co-founder and president of PETA, Ingrid Newkirk, and bestselling author Gene Stone comes Animalkind, a book that offers both a tour of the wonderful world of animals and a guide to simple ways in which we can reduce the harm we cause them in our everyday lives.

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

Sind wir auf dem Weg in eine Gesellschaft ohne Diskurs? Der Journalismus stosst im digitalen Zeitalter auf zahlreiche Veranderungen, die die Erfullung seiner verfassungsrechtlichen und gesellschaftlichen Aufgabe erschweren. Der Band thematisiert aus medienethischer Perspektive die journalistischen Herausforderungen und Potenziale des Medienwandels.

In the past decade, scholars such as Samuel Freeman, Martin O’Neill, Alan Thomas and others have argued that no matter how widely Rawls’s theory of justice (TJ) was understood as a defence of the welfare state (WS), the socio-economic system Rawls defends and always defended is property-owing democracy (POD). In this article I present the argument that Rawls did not defend POD in TJ. However, while the claim that it was POD the socio-economic system implied by the principle of difference (...) generated heated reactions by defenders of the WS, the argument I raise differs from most of them. In the article I maintain that, for Rawls, principles of justice underdetermine the choice of social systems, and that although this is true of both principles, it is especially true of the difference principle, whose ability to arbitrate between different social and economic policies is limited. I show how the attempt to uniquely determine the set of social and economic policies authorized by the difference principle clashes with what Rawls explicitly states in TJ and contrasts with central aspects of his sociological and political conception of socio-economic decision-making. Although my aim is to show that the difference principle itself does not discriminate among socio-economic systems, this does not preclude that additional reasons can help in narrowing the range of socio-economic systems allowed. With reference to the ideal of social union that Rawls expounds in the third part of TJ, I argue that TJ does, in fact, offer additional reasons to appraise the WS as preferable to POD. I maintain that the centrality Rawls attributes to the social unity of a just society provides the basis for an understanding of Rawls’s position towards POD after TJ. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

Christian Jakob Kraus (1753–1807), political economist and Professor of Practical Philosophy at the University of Königsberg, has long been neglected by historians, dismissed as a translator, a teacher, and a derivative disciple of Adam Smith. This article posits sociability as a useful category for understanding Kraus’s life, thought, and legacy. It aims to thereby reposition him as a meaningful figure in the late German Enlightenment. First, Kraus is presented as a natural Einsiedler who, surrounded by the commercially vibrant Königsberg, comes (...) to champion a methodology foregrounding praxis, lived experience, and the application of ideas for communal benefit. This ‘sociable’ approach to knowledge is contextualised within broader critiques of scholarly esotericism across Germany. Second, his work is treated as a case study elucidating the interdependence of individualism and sociability in the wider European Enlightenment. I argue that Kraus expressed a ‘sociable individualism,’ drawing upon Smith and Immanuel Kant, which harmonised autonomy and community. (shrink)

The background of the conflict study presented in part II consists of ten transdisciplinary and transcultural anthropological studies based on the paradigm of historical anthropology. On this basis, the “Berlin Ritual and Gesture Study” financed by the German Research Foundation was carried out. This 12 years lasting research project examined the role of rituals and gestures in the major fields of socialization “family”, “school”, “peer-group” and “media” in the context of a Berlin inner city primary school. It provided the conceptual (...) and methodological starting point for the exploration of the possible beginning of a mobbing conflict and the difficulties to handle it. In this study, a methodology of ethnography of education was developed which served as basis for the analysis of the mobbing process in Part II. (shrink)

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must (...) call bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

Graphical AbstractEnvironmental oxygen might have been the key for the evolution of novel developmental mechanisms, such as the interdigital cell death of amniotes. Increased amount of oxygen can also induce cell death in interdigital regions of an amphibian that typically lacks it. To learn more about the role of environmental oxygen in the evolution of new traits, see the article number 2000025 by Ingrid Rosenburg Cordeiro and Mikiko Tanaka. Cover image by Itoko Tanaka and Mikiko Tanaka.

A significant portion of newborns cared for in the neonatal intensive care unit or other ICUs, such as the cardiac ICU, have a medical condition with a genetic component, including congenital malformations, the leading cause of death in the NICU. In many cases, however, it is not clear which condition the child has or what can be done to help him or her. Genomic sequencing of sick newborns has the potential to bypass the prolonged journey to a diagnosis, improving the (...) medical care of individual infants. Sequencing also has the potential to benefit others beyond the child whose genome is sequenced and his or her immediate family. Sequence data from sick newborns will expand medicine's understanding of genetic diseases, leading to improvements in clinicians’ ability to counsel family and to provide even more targeted care. Not only will more frequent use of sequencing lead to discovery of new genes; it will also provide unique insights into the full spectrum of known Mendelian genetic diseases, so‐called phenotypic expansion, when a gene previously recognized as associated with a phenotype is found to be associated with an expanded set of clinical features. Genetic and environmental changes that modify the expression of a genetic disease may also be elucidated. (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)

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

Having Too Much is the first academic volume devoted to limitarianism: the idea that the use of economic or ecosystem resources should not exceed certain limits. This concept has deep roots in economic and political thought. One can find similar statements of such limits in thinkers such as Plato, Aquinas, and Spinoza. But Having Too Much is the first time in contemporary political philosophy that limitarianism is explored at length and in detail. Bringing together in one place the best writing (...) from key theorists of limitarianism, this book is an essential contribution to political philosophy in general, and theories of distributive justice in particular. Including some of the key published articles as well as new chapters, Having Too Much is necessary reading for scholars and students of political theory and philosophy, as well as anyone interested in questions of distributive justice. (shrink)

Research on gender and antimicrobial resistance (AMR) beyond women’s biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people’s diverse identities and experiences, including their gender, socio-economic status, race, disability, age, (...) and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice. (shrink)

L’institution est rencontrée dans divers ouvrages de Merleau-Ponty et dans des domaines aussi différents que le langage, l’art, le savoir, la politique, l’histoire et la vie personnelle. Le cours de 1954 développe cette notion tout en essayant d’articuler cette diversité. Cependant cette mise en avant de l’institution pour aborder des domaines aussi différents ne peut être comprise que rattachée à la perspective d’une nouvelle philosophie de la conscience, laquelle implique une nouvelle approche de la dialectique, que Merleau-Ponty poursuivra jusqu’au Visible (...) et l’invisible. Dans cet article, nous essayons d’éclairer la continuité entre les enjeux de ce cours et ceux du Visible et l’invisible. (shrink)

This commentary focuses upon the ‘fetishism of persons’ in Marx which Balibar claims both mirrors and animates the better-known fetishism of things. Revisiting the chapter on exchange in which Balibar grounds his thesis, the essay attends to the theatrical metaphors by which Marx presents legal personhood as a pantomime of commodity fetishism. The essay demonstrates how the movable immobility of the commodity comes to life in its inverse, the mobile and immovable figure of the legal person; it then claims that (...) this inversion positions legal persons as animate props for property. But if legal persons, the essay asks, merely personify economic relations, by what means are they sufficiently distanced from commodities to be able to become their reflex and puppet? In other words, what vestibule keeps personal liberty’s analogy with economic relations from collapsing into identity? A significant historical answer, the essay asserts, is transatlantic chattel slavery—not only because this institution is both ideological foil to, and material basis for, liberal capital, but also because the slave herself, as animate property, undoes the distinction between persons and commodities. The essay concludes by insisting upon the significance of this neglected figure in philosophies of the transindividual, while also taking first steps toward a transindividual analysis of slavery. (shrink)

This essay examines the early reception of Scheler’s anthropological thought in Spain. The article traces the two main ways of reception of Scheler’s work in the School of Madrid and the School of Barcelona. I argue that, on the one hand, the Spanish translations of the works of the early phenomenologists – Scheler was a central figure among them – contributed to the diffusion of Scheler’s thought; and that, on the other hand, the Spanish authors subjected Scheler’s thought to a (...) critical assimilation and further developments. Scheler influenced the Spanish philosophy of the human affectivity, in which the capacity to feel, the values and love as a kernel of the human being occupy an exceptional position. This reception shows the originality of Spanish authors that incorporate Scheler’s ideas to their anthropological interest and develop these ideas in the direction of their own phenomenological anthropology. (shrink)

In this collection of new essays scientists, psychologists, theoretical physicists and other experts in the mind-body connection explore the nature of consciousness and its future as a new paradigm in science. This volume clarifies the meaning of consciousness and establishes a model for further exploration of a burgeoning realm of scientific study.