Background Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term care. Design A descriptive (...) qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. (shrink)

Advanced Cell Technology's Ethics Advisory Board has been called window dressing for a corporate marketing plan. But the scientists and managers have paid attention, and the lawyers have gone along.

This article argues that we could improve the design of research protocols by developing an awareness of and a responsiveness to the social contexts of all the actors in the research enterprise, including subjects, investigators, sponsors, and members of the community in which the research will be conducted. “Social context” refers to the settings in which the actors are situated, including, but not limited to, their social, economic, political, cultural, and technological features. The utility of thinking about social contexts is (...) introduced and exemplified by the presentation of a hypothetical case in which one central issue is limitation of the probability of injury to subjects by selection of individuals who are not expected to live long enough for the known risks of the study to become manifest as harms. Benefits of such considerations may include enhanced subject satisfaction and cooperation, community acceptance, and improved data quality, among other desirable consequences. (shrink)

Contributors: Steven M. Cahn, James W. Nickel, J. L. Cowan, Paul W. Taylor, Michael D. Bayles, William A. Nunn III, Alan H. Goldman, Paul Woodruff, Robert A. Shiver, Judith Jarvis Thomson, Robert Simon, George Sher, Robert Amdur, Robert K. Fullinwider, Bernard R. Boxhill, Lisa H. Newton, Anita L. Allen, Celia Wolf-Devine, Sidney Hook, Richaed Waaserstrom, Thomas E. Hill, Jr., John Kekes.

This article argues that we could improve the design of research protocols by developing an awareness of and a responsiveness to the social contexts of all the actors in the research enterprise, including subjects, investigators, sponsors, and members of the community in which the research will be conducted. ?Social context? refers to the settings in which the actors are situated, including, but not limited to, their social, economic, political, cultural, and technological features. The utility of thinking about social contexts is (...) introduced and exemplified by the presentation of a hypothetical case in which one central issue is limitation of the probability of injury to subjects by selection of individuals who are not expected to live long enough for the known risks of the study to become manifest as harms. Benefits of such considerations may include enhanced subject satisfaction and cooperation, community acceptance, and improved data quality, among other desirable consequences. (shrink)

On September 18, 1995, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in Blue Cross & Blue Shield United of Wisconsin v. Marshfield Clinic ) that sets two important precedents regarding the status of health maintenance organizations under antitrust law. Chief Judge Posner, writing for the court, concluded that HMOs do not constitute a market separate from the general market for medical services and that agreements, between HMOs in a region, to operate in separate areas (...) constitute a prohibited form of market splitting.This case primarily involves two HMOs in north central Wisconsin: one a subsidiary of Blue Cross, the other a subsidiary of the Marshfield Clinic. The Blue Cross HMO claimed that the Marshfield HMO had an illegal monopoly in the region's HMO market and therefore violated the Sherman Act ). (shrink)

Peut-on entrevoir des liens fructueux entre la psychologie positive et la spiritualité en contexte psychothérapeutique? La thématique de cet ouvrage intéressera des chercheuses et des chercheurs, des cliniciens et des cliniciennes, des étudiantes et des étudiants des domaines de la psychothérapie et de la relation d’aide, ainsi que toute personne soucieuse de mieux comprendre la complexité de l’être humain. Tout au long de ce collectif, la lectrice ou le lecteur trouvera une pensée tissée serrée, sous forme parfois d’essais théoriques, de (...) réflexions issues d’observations cliniques, de recherches empiriques (réalisées ou en cours), de réflexions basées sur l’expérience professionnelle ou de recension critique de la documentation scientifique. Dix auteurs et auteures oeuvrant en tant que psychologues cliniciens ou cliniciennes, psychothérapeutes, intervenants ou intervenantes dans le domaine de la relation d’aide, et dont plusieurs sont également professeurs et chercheurs, ou professeures et chercheuses dans des universités ontariennes ou québécoises, présentent leurs réflexions originales, en solo ou en collaboration. Ce sont Christian R. Bellehumeur, André Belzile, Cynthia Bilodeau, Alexandre Brien, Laure-Marie Carignan, Stéphanie Larrue, Buuma M. Maisha, Judith Malette, Lucie Mandeville et Lise Séguin. (shrink)

Pitcher has taken upon himself the task of refining and defending the thesis that sense perception is the acquiring of true beliefs concerning particular facts about one's environment, by means of the senses. The book is divided into four parts, the first part being a critical treatment of the sense-data theories via an examination of several of the major arguments traditionally forwarded in defense of the view. The theory advocated by the author is presented in the second part, where the (...) view is first stated in unpolished form and gradually refined and qualified as problems and objections are dealt with. Any philosophical theory of perception, the author maintains, is related to the empirical sciences in that its task is to render intelligible the facts about perception, as uncovered by the relevant sciences. Thus, in the third part of the book, some recent experiments in the psychology of perception are discussed in relation to the theory of perception held by the author. In the final part of the book, Pitcher discusses color perception, since the perception of colors seems, at first glance, to present a problem for his theory. If a dispositional analysis is given for perceptual belief, what behavior is peculiar to the perception of a color? An interesting discussion of the primary-secondary quality contrast follows Pitcher's solution to this problem. Though the author does not claim originality for the theory of perception he offers, there is still much to be said for his treatment of the materials presented.--R. L. M. (shrink)

A systematic account of explanation and meaning, on an introductory level. The book is designed not only for students who are primarily interested in philosophy, but also for students whose primary interests may lie in the physical or social sciences, literature, or history. There are fifteen relatively brief chapters, the first eight of which are concerned with the concept of explanation while the remaining seven chapters deal with the concept of meaning. The author begins his treatment of explanation by dismissing (...) as fruitless disputes over what a 'real' explanation must be. Instead, he proposes to examine different types of explanation in order to determine their differences and the relative importance of their differences. "Scientific Explanation," "What-explanations," and "Reason-giving Explanation" are then distinguished and discussed in the early chapters, and this is followed with chapters on historical explanation and explanation in literary criticism. In the remaining chapters on meaning, the author maintains the view that meanings are not a sort of thing, mental or physical. He supports this thesis through his criticisms of causal theories of meaning, "Fido"-Fido theories of meaning, and theories which attempt to identify the meaning of a word with a mental event or an essential definition. The author favors identifying the meaning of a work with its use and deals with some of the problems connected with this view. A list of additional references for each chapter is provided at the end of the book. Though the book is primarily a systematic account of explanation and meaning, a variety of issues from different areas of contemporary philosophical concern are touched upon along the way. These issues concern, for example, natural laws, explaining human behavior, the nature of historical explanation, interpretation in literature, definition, synonymy, and metaphor. This is a clearly written introduction to contemporary philosophy.--R. L. M. (shrink)

Von Wright describes his position as "teleological" yet distinguishes it from Aristotle's "notion of the good of man relative to a notion of the nature of man," by likening it to that of the utilitarian tradition. There is painstaking attention to the staggering diversity of functions of "good" and related words, and an examination of instrumental, technical, medical, hedonic and utilitarian goodness. Von Wright regards the moral sense of "good" as derivative and defines it in terms of the beneficial, a (...) sub-class of Utilitarian Goodness. Chapters on Virtue, "Good" and "Must," Duty, Justice are included. There are rather few references to other works, very many distinctions, and an Index which includes, among others, the word "all right."--R. L. M. (shrink)

This volume contains fourteen essays, all of which were written by Ebersole over a period of seven years, on various epistemological problems. A few of the essays have appeared before as journal articles, but the bulk of the essays are here printed for the first time. The essays deal with three principle topics: sense-datum theories of perception, memory and the past, and the possibility of knowledge of existence without experience. In style and approach, the essays can be characterized as belonging (...) to the school of analytic philosophy, dealing with philosophical problems with an emphasis on the use and function of relevant linguistic expressions. Although some of the essays are interesting, readers of Wittgenstein will find the material all too familiar.--R. L. M. (shrink)

Background Central to the involvement of children in health research is the notion of risk. In this paper we present one of the factors, a matter of trust, that shaped Canadian parents' and children's perceptions and assessments of risk in child health research. Participants and methods Part of a larger qualitative research study, 82 parents took part an in-depth qualitative interview, with 51 parents having children who had participated in health research and 31 having children with no research history. 51 (...) children ranging from 6 to 19 years of age were also interviewed, with 28 having a history of participation in child health research and 23 having no history. Children also took part in 3 focus groups interviews. Themes emerged through a grounded theory analysis of coded interview transcripts. Findings The presence or absence of trust was not only perceived by parents and children as a contributing factor to involving children in health research, but also shaped their perceptions and assessments of risk. Three interrelated subthemes identified were: (1) relationships of trust; (2) placing trust in symbols of authority; and (3) the continuum of trust. Conclusions Our study reinforces that trust is an important factor when parents assess risk in child health research and shows that children use the language of trust in relation to risk. More discussion regarding trust in training researchers is warranted given the trust in researchers and institutions evident in this study. We also recommend further study of the continuum of trust in child health research. (shrink)

Client-provider relationships have significant effects on how individuals comprehend their life situation during chronic disease and illness. Yet, little is known about how frontline health care providers (HCPs) influence client’s identity formation through meaning-making with clients such as HIV-positive women living in poverty. This requires ethical consideration of the meanings made between clients and providers about client’s health and well-being, both individually and in the larger society. Health care providers (N = 15) and married women living with HIV (N = (...) 33) in north-central India engaged in separate intensive interviews providing narrative data which were analysed using a conceptual framework crossing Lipsky’s street-level bureaucracy theory (Lipsky 2010) with meaning-making processes. HCPs and women construct meanings of women’s role as caregivers that impact women’s sense of identity, health, and well-being. Findings indicate that despite being well-intentioned, HCPs inadvertently reinforce rigid gender norms and convey that women’s worth is tied to their familial caregiving role. HCPs’ discretionary advocacy may also reinforce societal images of women as incapable and needy, thereby harming them more generally. Attention to the gender-sensitive training of HIV health care providers may assure that discretion is ethically interrogated to promote gender equity and enhance women’s access to social welfare services. (shrink)

BackgroundLarge-scale, centralized data repositories are playing a critical and unprecedented role in fostering innovative health research, leading to new opportunities as well as dilemmas for the medical sciences. Uncovering the reasons as to why citizens do or do not contribute to such repositories, for example, to population-based biobanks, is therefore crucial. We investigated and compared the views of existing participants and non-participants on contributing to large-scale, centralized health research data repositories with those of ex-participants regarding the decision to end their (...) participation. This comparison could yield new insights into motives of participation and non-participation, in particular the behavioural change of withdrawal.MethodsWe conducted 36 in-depth interviews with ex-participants, participants, and non-participants of a three-generation, population-based biobank in the Netherlands. The interviews focused on the respondents’ decision-making processes relating to their participation in a large-scale, centralized repository for health research data.ResultsThe decision of participants and non-participants to contribute to the biobank was motivated by a desire to help others. Whereas participants perceived only benefits relating to their participation and were unconcerned about potential risks, non-participants and ex-participants raised concerns about the threat of large-scale, centralized public data repositories and public institutes, such as social exclusion or commercialization. Our analysis of ex-participants’ perceptions suggests that intrapersonal characteristics, such as levels of trust in society, participation conceived as a social norm, and basic societal values account for differences between participants and non-participants.ConclusionsOur findings indicate the fluidity of motives centring on helping others in decisions to participate in large-scale, centralized health research data repositories. Efforts to improve participation should focus on enhancing the trustworthiness of such data repositories and developing layered strategies for communication with participants and with the public. Accordingly, personalized approaches for recruiting participants and transmitting information along with appropriate regulatory frameworks are required, which have important implications for current data management and informed consent procedures. (shrink)