Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical (...) impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health professionals about a child’s (...) medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child’s life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child’s life but rather some other aspect of the child’s well-being. (shrink)

It is commonly supposed that metaphysical modal claims are to be evaluated with respect to a single domain of possible worlds: a claim is metaphysically necessary just in case it is true in every possible world, and metaphysically possible just in case it is true in some possible world. We argue that the standard understanding is incorrect; rather, whether a given claim is metaphysically necessary or possible is relative to which world is indicatively actual. We motivate our view by attention (...) to discussions in Salmon 1989 and Fine 2005, in which various data are taken to support rejecting the transitivity of accessibility and modal monism ; we argue that relativized metaphysical modality can accommodate these data compatible with both standard modal logic and modal monism. Noting an analogy with two-dimensional semantics, we argue that metaphysical modality has a complex structure, reflecting what is counterfactually possible, relative to each indicatively actual world. In arguing for the need for relativization, we are broadly on the same side as Crossley and Humberstone and Davies and Humberstone ; our contribution here is, first, to offer distinctively metaphysical reasons for relativization, and second, to show that relativization can be incorporated in ways minimally departing from standard modal logic. (shrink)

_Psychoanalysis and Women_, Volume 32 of _The Annual of Psychoanalysis_, is a stunning reprise on theoretical, developmental, and clinical issues that have engaged analysts from Freud on. It begins with clinical contributions by Joyce McDougall and Lynne Layton, two theorists at the forefront of clinical work with women; Jessica Benjamin, Julia Kristeva, and Ethel Spector Person, from their respective vantage points, all engage the issue of passivity, which Freud tended to equate with femininity. Employing a self-psychological framework, Christine (...) Kieffer returns to the Oedipus complex and sheds new light on the typically Pyrrhic oedipal victory of little girls. Section III broadens the historical context of contemporary theorizing about women by offering the personal reminiscences of Nancy Chodorow, Carol Gilligan, Brenda Solomon, and Malkah Notman. A final section, dedicated to "women who shared psychoanalysis," features historical essays on Ida Bauer, Anna Freud, Dorothy Burlingham, Edith Jacobson, and Therese Benedek, along with Linda Hopkins's revealing interview of Marion Milner. Of special note is Marian Tolpin's examination of three women - Bauer, Helene Deutch, and Anna Freud - who helped shape Freud's notion of the "femail castration complex," and Elisabeth Young-Bruehl's exploration of how two women - Anna Freud and Dorothy Burlingham - developed parent-infant observation. _Psychoanalysis and Women_ is an extraordinary chronicle of the distance traveled since Freud characterized women's sexual life as "the dark continent." The contributors vitalize a half century of theory with the lessons of biography, and they broaden clinical sensibilities by drawing on recent developmental, gender-related, and socio-psychological research. In doing so, they attest to the ongoing reconfiguration of Freud's dark continent and show the psychoanalytic psychology of women to be very much a revolution in progress. (shrink)

Agamben's vocabulary is both expansive and idiosyncratic, with words such as 'infancy', 'gesture' and 'profanation' given specific and complex meanings that can bewilder the new reader. Bringing together leading scholars in the field, including Steven DeCaroli, Justin Clemens, Claire Colebrook and Steven DeCaroli the 150 entries explain the key concepts in Agamben's work and his relationship with other thinkers, from Aristotle to Aby Warburg.

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

BackgroundIn June 2019, the Australian state of Victoria joined the growing number of jurisdictions around the world to have legalised some form of voluntary assisted dying. A discourse of safety was prominent during the implementation of the Victorian legislation.Main textIn this paper, we analyse the ethical relationship between legislative “safeguards” and equal access. Drawing primarily on Ruger’s model of equal access to health care services, we analyse the Victorian approach to voluntary assisted dying in terms of four dimensions: horizontal equity, (...) patient agency, high quality care, and supportive social norms. We argue that some provisions framed as safeguards in the legislation create significant barriers to equal access for eligible patients.ConclusionsWhile safety is undoubtedly ethically important, we caution against an overemphasis on safeguarding in voluntary assisted dying legislation given the implications for equal access. (shrink)

Clinical ethics has been developing in paediatric healthcare for several decades. However, information about how paediatricians use clinical ethics case consultation services is extremely limited. In this project, we analysed a large set of case records from the clinical ethics service of one paediatric hospital in Australia. We applied a paediatric-specific typology to the case referrals, based on the triadic doctor–patient–parent relationship. We reviewed the 184 cases referred to the service in the period 2005–2014, noting features including the type of (...) case, the referring department(s) and the patient9s age at referral. The two most common types of referral involved clinician uncertainty about the appropriate care pathway for the child (26% of total referrals) and situations where the child9s parents disagreed with the doctors’ recommendations for the child9s care (22% of total referrals). Referrals came from 28 different departments. Cancer, cardiology/cardiac surgery and general medicine referred the highest numbers of cases. The most common patient age groups were children under 1, and 14–15 years old. For three controversial areas of paediatric healthcare, clinicians had initiated processes of routine review of cases by the clinical ethics service. These insights into the way in which one very active paediatric clinical ethics service is used further our understanding of the work of paediatric clinical ethics, particularly the kinds of ethically challenging cases that paediatricians view as appropriate to refer for clinical ethics support. (shrink)

In contrast to Di Nucci’s characterisation, my argument is not a technoapocalyptic one. The view I put forward is that systems like IBM’s Watson for Oncology create both risks and opportunities from the perspective of shared decision-making. In this response, I address the issues that Di Nucci raises and highlight the importance of bioethicists engaging critically with these developing technologies.

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an opportunity to enhance patients' (...) clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

Undergraduate medical ethics education currently focuses on ethical concepts and reasoning. This paper uses an intern’s story of an ethically challenging situation to argue that this emphasis is problematic in terms of ensuring students’ ethical practice as junior doctors. The story suggests that it is aligning their actions with the values that they reflectively embrace that can present difficulties for junior doctors working in the pressures of the hospital environment, rather than reasoning to an ethically appropriate action. I argue that (...) junior doctors need skills for implementing their ethical decisions and that these ought to form a central component of undergraduate medical ethics education. (shrink)

This paper looks at a genre of meetings that, while neither purely ‘scientific’ nor ‘diplomatic’, drew on elements from both professional spheres and gained prominence in the interwar decades and during the Second World War. It proposes to make sense of ‘technical conferences’ as a phenomenon that was made by and through scientific experts and politicians championing the organizing power of rationality, science and liberal internationalism. Against the background of swelling ranks of state-employed scientists, this paper documents the emergence of (...) technical conferences as the forums where they got down to work. To make this case the paper traces the influence of a new way of thinking about the function and organization of conferences, originating in the time around the First World War, on one international organization in particular: the United Nations Relief and Rehabilitation Administration (UNRRA), as a new hub of scientists and technicians. (shrink)

Machine generated contents note: Introduction: love after Aristotle; 1. Enjoyment: a medieval history; 2. Narcissus after Aristotle: love and ethics in Le Roman de la Rose; 3. Metamorphoses of pleasure in the fourteenth century Dit Amoureux; 4. Love's knowledge: fabliau, allegory, and fourteenth-century anti-intellectualism; 5. On human happiness: Dante, Chaucer, and the felicity of friendship; Coda: Chaucer's philosophical women.

This article explores histories of the science of stress and its measurement from the mid 19th century, and brings these into dialogue with critical sociological analysis of emerging responses to work stress in policy and practice. In particular, it shows how the contemporary development of biomedical and consumer devices for stress self-monitoring is based on selectively rediscovering the biological determinants and biomarkers of stress, human functioning in terms of evolutionary ecology, and the physical health impacts of stress. It considers how (...) the placement of the individual body and its environment within particular spatio-temporal configurations renders it subject to experimental investigation through standardized apparatus, electricity, and statistical normalization. Examining key themes and processes such as homeostasis, metricization, datafication, and emotional governance, we conclude that the figure of the ‘body electric’ plays a central limiting role in current technology-supported approaches to managing work stress, and that an historical account can usefully open these to collective scrutiny. (shrink)

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case‐by‐case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, harm mitigation, (...) exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case‐by‐case exemptions for individual patients. We propose a process for ethical decision‐making that provides a shared language and structure to decrease the risks and burdens of decision‐making when clinicians or managers are considering requests for exemptions. (shrink)

If you just can't decide what to wear, this enlightening guide will lead you through the diverse and sometimes contradictory aspects of fashion in a series of lively, entertaining and thoughtful essays from prominent philosophers and writers. A unique and enlightening insight into the underlying philosophy behind the power of fashion Contributions address issues in fashion from a variety of viewpoints, including aesthetics, the nature of fashion and fashionability, ethics, gender and identity politics, and design Includes a foreword by Jennifer (...) Baumgardner, feminist author, activist and cultural critic, editor of Ms magazine and regular contributor to major women's magazines including Glamour and Marie-Claire. (shrink)

The words “idea” and “concept” have been, and still are, the source of so much confusion in psychology that we shall do well to banish them from the vocabulary of that science. I have urged this reform and have endeavoured to promote it by writing a psychology without ideas.It has seemed to me that the word “concept” plays a no less pernicious rôle in logic. But it was not until I began to look into the matter with a view to (...) writing this article that I became aware of the desperate degree and extent of the confusion obtaining in all that pertains to the concepts of logic. (shrink)

O autor Darlei Dall’Agnol é formado em Filosofia pela Universidade de Caxias do sul e cursou mestrado em Filosofia na Universidade Federal do Rio Grande do Sul, com uma dissertação sobre ética e linguagem em Wittgestein; fez Doutorado em Filosofia na Universidade de Bristol, Inglaterra, defendendo tese sobre valor intrínseco na ética de Moore. Publicou vários livros na área de Ética e possui inúmeros artigos e capítulos de livros publicados no Brasil e no exterior. Algumas das obras desse autor são: (...) Ética e Linguagem: uma Introdução ao Tractatus de Wittgenstein, Valor Intrínseco – Metaética, ética normativa e ética prática em G. E. Moore, ambas com publicação em 2005. (shrink)

Selection of Critical Notices of a number of books on Wittgenstein's work - over 20 by 2013 - including books devoted to The TRACTATUS, the PHILOSOPHICAL INVESTIGATIONS and various collections of essays etc. by Wittgenstein scholars and others.

In their essay arguing for ethical review of social research, Sheehan et al write: > Inquiry and human life are intertwined and interdependent. To be human is to be curious, to ask questions about yourself, the world, and your place in the world. This process of inquiry is undertaken individually, but is a social activity.1 As researchers in medical ethics, all the authors in this issue have chosen to ask a particular type of question about the world: questions about ethical (...) complexity and justification. Their inquiries are rich and diverse. We can see each as an individual piece of scholarship, contributing to our knowledge of a specific topic. But we can also see medical ethics as a social activity—one undertaken by a community of authors and readers, debating and reasoning together. What is striking when we think of medical ethics in this second way is the diversity of approaches to research that are useful in our discussions. Understanding ethics in healthcare is furthered by very different types of research, and this issue of the journal clearly illustrates this breadth of approaches to scholarship in medical ethics. The three articles on transplant ethics provide an excellent example of this diversity of scholarship in medical ethics. All explore ethical aspects of transplantation but using different approaches. Ladin and colleagues2 identify an ethical problem through empirical inquiry. Their research examines the requirement that a patient have adequate social support in …. (shrink)