Conflicts between labor unions and nongovernmental organizations often impede private labor regulatory attempts to protect worker rights at supplier factories. Based on a study of a failed private regulatory attempt for Swedish garment retailers, we contribute to existing research into union–NGO relations by demonstrating how conflict arises because unions and NGOs act upon different institutional logics. We also contribute to the institutional logics perspective by challenging the current emphasis on either coexistence or conflict among multiple logics, and showing the heterogeneity (...) in how multiple logics manifest on a local level, how this could shift over time, and suggesting an empirically derived typology of manifestations of multiple logics. (shrink)

Background Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. Methods An explorative qualitative (...) study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. Results The respondents’ ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. Conclusion This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research. (shrink)

I. L'absence du monde humain -- II. Techno-nature élémentaire -- III. Résider dans la techno-imagination.

In lieu of an abstract, here is a brief excerpt of the content:The Crisis of Authority From Holy Obedience to Bold Moral Imagination in European ChristianityKajsa AhlstrandIf we speak of a crisis of authority in Christianity we need to have some kind of common understanding of Christianity. The religion called Christianity is found in all inhabited continents and in a great variety of cultural forms. Two recent lists of countries with the greatest number of Christians show that the United States (...) is the country with the greatest number of Christians, followed by Brazil and Mexico.1 The Americas are on the top of the lists, but among the top ten we also find three Asian countries (China, India, and the Philippines), two African countries (Nigeria and the Democratic Republic of Congo), and four European countries (France, Russia, Germany, and Italy). (Australia is not on any of the lists since the total number of Australian citizens is smaller than the number of Christians in the top ten countries.) Although Christians live on all continents, it is a well-known fact that the majority of Christians now live in the Southern Hemisphere.When we talk about Christianity as an entity we have to be aware that there are enormous variations within Christianity with regard to cultural traditions, standard of living, level of education, and so on. A French Roman Catholic professor of theoretical physics may have very few convictions in common with a Pentecostal Nigerian peasant, although they both regard themselves as Christians.One way of looking at this diversity of values within Christianity is to go to the Inglehart-Welzel cultural map of the world.2 This map shows eight different “fields” of values located within a grid determined by two axes. The vertical axis goes from traditional to rational-secular values, the horizontal axis from survival values to self-expression values.The traditional values to secular-rational values dimension is described as “...the contrast between societies in which religion is very important and those in which it is not. [...] Societies near the traditional pole emphasize the importance of parent-child ties and deference to authority, along with absolute standards and traditional family values [...]. Societies with secular-rational values have the opposite preferences on all of these topics.” [End Page 49]The other dimension, survival values to self-expression values, is described thus: “Self-expression values give high priority to environmental protection, tolerance of diversity and rising demands for participation in decision making in economic and political life. These values also reflect mass polarization over tolerance of outgroups, including foreigners, gays and lesbians and gender equality. The shift from survival values to self-expression values also includes a shift in child-rearing values, from emphasis on hard work toward emphasis on imagination and tolerance as important values to teach a child.”When we apply this to the geographical dimensions of Christianity, we find that societies dominated by Christianity or in which there are significant numbers of Christians are found in every field of the map. This makes it difficult to speak of “Christian values” as if there were any values held by all or even a majority of Christians. Instead we find Christians in Africa who tend to embrace survival and traditional values—that is, religion is very important in their lives and they emphasize the importance of obedience to authority, especially within the family—whereas in the opposite diagonal corner (secular-rational values coupled with self-expression values) we find the Nordic countries, where, although the majority of the population belong to a church, religion plays a very limited role in day-to-day life and children are encouraged to rely on their empathy and imagination rather than to obey their parents and teachers.When we, in the following, move to the topic of a possible crisis of authority in Christianity, we have to remember that the suggested crisis is by no means a universal one. If we use Inglehart’s value map, the crisis of authority is located in the societies that score high on self-expression values, and if they also score high on secular-rational values the “crisis” is further aggravated. What the map does not show, however, is that there are individuals and groups within every... (shrink)

Research ethics committees (RECs) have a crucial role in protecting children in research. However, studies on REC members’ perspectives on paediatric research are scarce. We conducted a qualitative study to explore Swedish scientific REC members’ perspectives on ethical aspects in applications involving children with severe health conditions. The REC members considered promoting participation, protecting children and regulatory adherence to be central aspects. The results underscored the importance of not neglecting ill children’s rights to adapted information and participation. REC members supported (...) a contextual and holistic approach to vulnerability and risk, which considers the child’s and parents’ psychological wellbeing and the child’s integrity, both short and long term. The ethical complexity of paediatric research requires continuous ethical competence development within RECs. (shrink)

Michael T. Stuart (2021 and 2022) has proposed imagination as an intellectual dual‐process virtue, consisting of imagination1 (underwritten by cognitive Type 1 processing) and imagination2 (supported by Type 2 processing). This paper investigates the consequences of taking such an account seriously. It proposes that the dual‐process view of imagination allows us to incorporate recent insights from virtue epistemology, providing a fresh perspective on how imagination can be epistemically reliable. The argument centers on the distinction between General Reliability (GR) and Functional (...) System Reliability (FSR), for example in relation to Kengo Miyazono and Uko Tooming's (2023) argument for epistemic generativity. Furthermore, the paper claims that the dual‐process virtue account enables us to integrate a wide range of findings from the literature on epistemology and imagination. Moreover, it suggests a novel way to distinguish the virtues of creativity and imagination and presents a case for viewing imagination as a virtue rather than a skill. (shrink)

We give a new account of Björling’s contribution to uniform convergence in connection with Cauchy’s theorem on the continuity of an infinite series. Moreover, we give a complete translation from Swedish into English of Björling’s 1846 proof of the theorem. Our intention is also to discuss Björling’s convergence conditions in view of Grattan-Guinness’ distinction between history and heritage. In connection to Björling’s convergence theory we discuss the interpretation of Cauchy’s infinitesimals.

Gene editing techniques, such as CRISPR, are being heralded as powerful new tools for delivering agricultural products and foods with a variety of beneficial traits quickly, easily, and cheaply. Proponents are concerned, however, about whether the public will accept the new technology and that excessive regulatory oversight could limit the technology’s potential. In this paper, we draw on the sociotechnical imaginaries literature to examine how proponents are imagining the potential benefits and risks of gene editing technologies within agriculture. We derive (...) our data from a content analysis of public comments submitted to the Food and Drug Administration’s 2017 docket titled “Genome Editing in New Plant Varieties Used for Food.” Our sample frame consists of 26 comments representing 30 agriculture and biotech companies, organizations, and trade associations. Our findings reveal three key sociotechnical imaginaries, including that gene editing technologies in agriculture: are not GMO but instead equivalent to traditional plant breeding; have the potential to usher in a new Green Revolution; and could facilitate the democratization of agricultural biotechnologies. We argue that forming and projecting these collective interpretations of the potential of gene editing technologies for crops and foods plays an important role in efforts by proponents to influence regulatory oversight, modes of governance, and build public acceptance. This research contributes to calls by science and technology studies scholars to investigate emergent concerns and imaginaries for novel technoscientific advances to help inform upstream models of public engagement and governance decisions. (shrink)

In this paper we discuss visualizations in mathematics from a historical and didactical perspective. We consider historical debates from the 17th and 19th centuries regarding the role of intuition and visualizations in mathematics. We also consider the problem of what a visualization in mathematical learning can achieve. In an empirical study we investigate what mathematical conclusions university students made on the basis of a visualization. We emphasize that a visualization in mathematics should always be considered in its proper context.

Explores the relationship between technics and humanity, tracing the emergence of a bio-technical conception of existence in contemporary continental philosophy.

Hur verkar glömskan i samhällets och människors minne? Vilka kunskaper och erfarenheter glöms bort och försvinner, medvetet eller omedvetet, också inom forskarsamhället? Varför, hur, med vilka medel och med vilka konsekvenser? Hos den enskilda individen kan glömskan bero på olika sjukdomstillstånd. I vissa politiska sammanhang kan glömska vara ett försåtligt maktmedel. I dagens forskarsamhälle har publiceringsaktiviteten accelererat genom datoriseringen. Inom många kunskapsområden kan forskningen därför te sig som ett isberg, där endast ett fåtal arbeten sticker upp över ytan, refereras och (...) kommuniceras. Vad finns av viktigt vetande under ytan och hur förhåller vi oss till det övergripande - eller underliggande - behovet av "knowing-what-is-known"? (shrink)

L’enjeu de ce recueil est de contribuer à repenser la notion de limite, en l’envisageant sous les différentes figures, philosophiques, écologiques, politiques, que lui confère notre présent. Comme le montrent, sous des modalités diverses, les contributions de ce collectif, la limite peut et doit être conçue en dehors des valeurs négatives – borne, restriction ou frontière –, qui en affaiblissent la portée. Elle peut alors être pensée sur le fond de cet illimité où s’ouvre la question même du dehors. Si (...) la finitude demeure la condition de l’existence, de l’art et de la pensée, assumer notre condition finie ne consiste donc pas à se murer dans le connu, mais bien à en transgresser les bornes, et ce faisant, à s’illimiter. Au plus loin de la fermeture des frontières que prônent certaines politiques, ou de la certitude dogmatique dans laquelle certains cherchent à réassurer leur pensée, la limite ne vit que de son rapport fécond à l’illimité. Interrogeant l’existence, la politique, l’art – autant dire, la pensée même –, les textes de ce recueil mettent au jour un certain don de l’illimité. (shrink)

In this paper we consider the major development of mathematical analysis during the mid-nineteenth century. On the basis of Jahnke’s (Hist Math 20(3):265–284, 1993 ) distinction between considering mathematics as an empirical science based on time and space and considering mathematics as a purely conceptual science we discuss the Swedish nineteenth century mathematician E.G. Björling’s general view of real- and complexvalued functions. We argue that Björling had a tendency to sometimes consider mathematical objects in a naturalistic way. One example is (...) how Björling interprets Cauchy’s definition of the logarithm function with respect to complex variables, which is investigated in the paper. Furthermore, in view of an article written by Björling (Kongl Vetens Akad Förh Stockholm 166–228, 1852 ) we consider Cauchy’s theorem on power series expansions of complex valued functions. We investigate Björling’s, Cauchy’s and the Belgian mathematician Lamarle’s different conditions for expanding a complex function of a complex variable in a power series. We argue that one reason why Cauchy’s theorem was controversial could be the ambiguities of fundamental concepts in analysis that existed during the mid-nineteenth century. This problem is demonstrated with examples from Björling, Cauchy and Lamarle. (shrink)

This collection of articles from both distinguished and emerging authors working at the intersections of philosophy, literary theory, media, and technology does not intend to fix new moral rules. Instead, the volume explores the ethos of digital environments, asking how we can orient ourselves in them and inviting us to renewed moral reflection in the face of dilemmas they entail.

How to achieve sustainable communities with decent work and economic growth without negative environmental impact, is at the heart of the United Nations Sustainable Development Goals and a top priority of many governments around the world. This article critically explores the role of government intervention for achieving sustainable local prosperity in frontier markets of developing countries, where such advancement is especially crucial. More specifically, we explore by an in-depth case study how multiple stakeholders cooperate to enhance local development and export (...) from firms in the leather and leather products industry in Ethiopia. From a multistakeholder engagement perspective, including representatives of local businesses, United Nations, Ministry of Trade and Industry, and other development partners, we analyze how government interventions have resulted in unintended outcomes despite their good intention. We contribute with a new understanding of why development initiatives in frontier markets struggle with stakeholder integration, caused by power asymmetry and lack of institutional trust which prevents the achievements of sustainable development goals. Contextualized implications for firms, government, and non-governmental actors on how to improve collaboration are provided, and policy implications are proposed. (shrink)

Several studies have shown that preference is not necessarily synonymous with choice. In particular, the most preferred object from a set of objects presented in a non—choice context is not necessarily chosen when the same objects are options in a choice situation (Lichtenstein & Slovic, 1971, 1973; Tversky, Sattah, & Slovic, 1988) . Our research on the choice—preference discrepancy replicates these findings and thus bears some resemblance to the study by Tversky, Sattah, and Slovic (1988). Two competing explanations are tested.

Counterfactual thinking—the capacity to reflect on what would, could, or should have been if events had transpired differently—is a pervasive, yet seemingly paradoxical human tendency. On the one hand, counterfactual thoughts can be comforting and inspiring (Carroll & Shepperd, Chapter 28), but on the other they can be anxiety provoking and depressing (Zeelenberg & Pieters, Chapter 27). Likewise, such thoughts can illuminate pathways toward better future outcomes (Wong, Galinsky, & Kray, Chapter 11), yet they can also promote confusion and lead (...) us astray (Sanna, Schwarz, & Kennedy, Chapter 13). The first part of this chapter focuses on work that supports the prevailing Zeitgeist in the counterfactual thinking literature: Counterfactual thinking is beneficial. The second part of the chapter, however, strikes a more cautionary tone by reviewing work that describes some deleterious consequences of counterfactual thinking. We conclude by offering a tentative reconciliation of these conflicting perspectives and suggesting directions for future research. (shrink)

In the present research, the authors hypothesized that additive counterfactual thinking mind-sets, activated by adding new antecedent elements to reconstruct reality, promote an expansive processing style that broadens conceptual attention and facilitates performance on creative generation tasks, whereas subtractive counterfactual thinking mind-sets, activated by removing antecedent elements to reconstruct reality, promote a relational processing style that enhances tendencies to consider relationships and associations and facilitates performance on analytical problem-solving tasks. A reanalysis of a published data set suggested that the counterfactual (...) mind-set primes previously used in the literature tend to evoke subtractive counterfactuals. Studies 1 and 2 then demonstrated that subtractive counterfactual mind-sets enhanced performance on analytical problem-solving tasks relative to additive counterfactual mind-sets, whereas Studies 3 and 4 found that additive counterfactual mind-sets enhanced performance on creative generation tasks relative to subtractive counterfactual mind-sets. (shrink)

Omnipresent in popular culture, especially in film and literature, the theme of the 'end of the world' is often rejected from contemporary philosophy as hysterical apocalyptism. This volume attempts to show that it is vital that we address the motif of the 'end' in contemporary world – but that this cannot be done without thinking it anew.

We summarize some of the classic theoretical underpinnings of the emerging psychology of meaning, with special emphasis on the existentialist perspective that understood meaning in a way that converges with our present understanding and provides a blueprint for subsequent efforts. As we go on to describe, all of these perspectives intersect at a central understanding of meaning making: the ways that we make sense of ourselves and our environment, the feelings that are aroused when these understandings are constructed or violated, (...) and the common ways in which we respond to these violations. In particular, we focus on a general distinction within the notion of meaning that can often obscure what meaning always is—a sense of what is, and a sense of why this should be so. To a remarkable extent, the chapters that constitute this volume on meaning mirror this distinction, focusing on both the what and the why of sense making. In particular, these chapters also describe a strikingly analogous account of the feelings and behaviors that follow from violations of either the whats or the whys of sense making. (shrink)

BackgroundThe aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients’ role expectations predict treatment outcome or are possible predictors of treatment dropout.MethodThe study comprised 58 adolescents suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation – Outcome Measure were filled in at baseline (...) and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline.ResultsThe results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out.ConclusionOffering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents’ own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment. (shrink)

The goal of the current chapter is to discuss how counterfactual thinking serves a more general sense-making function and to delineate the mechanisms by which this may occur. To demonstrate the meaning as sense-making function of counterfactual thinking, we (Lindberg & Markman, 2012) selected a historical event that was likely to be compelling to most student participants, yet not one with which most students would be familiar. This allowed for the manipulation of event details for the purpose of examining (...) underlying cognitive mechanisms believed to influence the sense-making process. Two sets of studies were conducted. The current work lends further support for the sense-making function of counterfactual thinking. (shrink)

This article addresses resilience in relation to climate change. Currently, our communities are not resilient to climate changes due to a strikingly limited political and scientific framing of climate change as solely a problem of emissions and individual behaviour. Owing to vulgarized interpretations of individual incentives for climate action, contextual barriers to action and the efficiency of individual climate action, this causes an action deficit on both collective and individual levels. We argue that a paradigm shift is needed in order (...) to engage with more adequate academic analysis and efficient policies. This new paradigm should focus on the capacities of societal institutions, which reflect precisely the level of climate resilience in a society. Resilience is not about societal and political immovability when faced with crisis of the dimensions of the climate crisis. It is about changing our society and politics and building institutions that enable us to properly respond to crisis. (shrink)

Gene editing in agriculture and food (GEAF) is a nascent development with few products and is unfamiliar among the wider US public. GEAF has garnered significant praise for its potential to solve for a variety of agronomic problems but has also evoked controversy regarding safety and ethical standards of development and application. Given the wake of other agribiotechnology debates including GMOs (genetically modified organisms), this study made use of 36 in-depth key interviews to build the first U.S. based typology of (...) proponent and critic priorities for shaping public trust in GEAF actors and objects. Key organizational actors provide early and foundational messaging, which is likely to contribute heavily to public salience, comprehension, and decision-making as potential consumers reflect upon their experiences, envision future outcomes, and consider the reputation of those trying to influence them. As is documented in our results, the trust-building priorities of these groups often stand in opposition to one another and are influenced by distinct motivations for how the public will come to trust or distrust GEAF actors and objects as more products are developed and enter the market. (shrink)

Cooperation is a great challenge for natural selection. Some scholars assume that cooperation could not evolve within the framework of natural selection. It is undeniable that natural selection, at least at the individual level, favors selfishness and defectors. Nonetheless, this selfish tendency does not necessarily imply that cooperation could not evolve by means of natural selection. In this paper, we specifically acknowledge certain basic challenges for the evolution of the human ability to cooperate at the level of large groups. In (...) this paper, we discuss topics like the human ability for “supercooperation,” the importance of repetition and reputation, and Multilevel Selection Theory as the basic mechanisms of evolution of cooperation. (shrink)

This book, in language accessible to the general reader, investigates twelve of the most notorious, most interesting, and most instructive episodes involving the interaction between science and Christianity, aiming to tell each story in its historical specificity and local particularity. Among the events treated in When Science and Christianity Meet are the Galileo affair, the seventeenth-century clockwork universe, Noah's ark and flood in the development of natural history, struggles over Darwinian evolution, debates about the origin of the human species, and (...) the Scopes trial. Readers will be introduced to St. Augustine, Roger Bacon, Pope Urban VIII, Isaac Newton, Pierre-Simon de Laplace, Carl Linnaeus, Charles Darwin, T. H. Huxley, Sigmund Freud, and many other participants in the historical drama of science and Christianity. (shrink)

List of contributors; Acknowledgments; Introduction Robert S. Westman and David C. Lindberg; 1. Conceptions of the scientific revolution from Bacon to Butterfield: a preliminary sketch David C. Lindberg; 2. Conceptions of science in the scientific revolution Ernan McMullin; 3. Metaphysics and the new science Gary Hatfield; 4. Proof, portics, and patronage: Copernicus’s preface to De revolutionibus Robert S. Westman; 5. A reappraisal of the role of the universities in the scientific revolution John Gascoigne; 6. Natural magic, hermetism, and (...) occultism in early modern science Brian P. Copenhaver; 7. Natural history and the emblematic world view William B. Ashworth, Jr.; 8. From the secrets of nature to public knowledge William Eamon; 9. Chemistry in the scientific revolution: problems of language and communication Jan V. Golinski; 10. The new philosophy and medicine in seventeenth-century England Harold J. Cook; 11. Science and heterodoxy: an early modern problem reconsidered Michael Hunter; 12. Infinitesimals and transcendent relations: the mathematics of motion in the late seventeenth century Michael S. Mahoney; 13. The case of mechanics: one revolution or many? Alan Gabbey; Index. (shrink)

The doctorate forms the basis for academic careers and the regeneration of academia, and has increasingly become important for other sectors of society. The latter is reflected in efforts on institutional, national as well as supranational levels to change and adapt the doctoral degree to new expectations. As doctoral education is embedded in research, changes in governance and funding of research further affect the doctorate. The evaluation of the doctoral thesis appears, however, to have remained true to the academic tradition: (...) an examination committee exercising their gatekeeping in a ceremonial setting. This study sets out to explore doctoral examination committees’ evaluation practices. Insights were gained through six focus group interviews with experienced examination committee members at three large research-intensive universities in Sweden. Of particular interest is how the object of evaluation is formed, the nature of the boundary-work conducted, and variations in examination practices related to different and changing conditions for research and doctoral education. Our results show how the object of evaluation emerges through a gradual interpretation of the thesis and defence, becoming more complex and nuanced as the process of evaluation progresses from its initial stages to the final closed discussions of the committee. The finalised object of evaluation, only fully present at the conclusion of the closed meeting and hence transient in nature, encompasses the research contribution, educational achievement, and academic competence of the candidate. Furthermore, the boundary-work conducted in this process often transcends the object of evaluation to include also supervision and the local context for doctoral education and research, and hence contributes to upholding, and potential changing, norms in research fields, educational contexts, and academia at large. This extended boundary-work intensified as problems and inconsistencies were discovered during the evaluation process. The ceremonial staging underscored the gravity of the decision and the extended boundary-work. Despite changing conditions for the doctorate, our findings highlight the importance of the practice of evaluation committees, and the disciplinary communities to which they belong, for upholding and negotiating norms in academia. (shrink)

Bernard Stiegler is known as a leading philosopher of technics. He has developed an original interpretation of technics as an externalized epiphylogenetic memory that remembers in the p...

Bacterial resistance mechanisms to the antibiotics known as β‐lactams, which include the penicillins and cephalosporins, can take several forms but frequently involve the production of β‐lactamases from either plasmid‐ or chromosomally‐encoded loci. Gram negative bacteria express a β‐lactamase from evolutionarily related chromosomal ampC genes. Genetic analysis of both inducible and constitutively expressed AmpC β‐lactamases provide insights into the mechanisms regulating production of the enzyme. Evolutionary relationships between the genes of different species are discussed, as well as the regulatory mechanisms that (...) in both laboratory mutants and clinical isolates lead to overproduction of β‐lactamase. (shrink)

PurposeTo explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.IntroductionResponsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the (...) partner’s use of responsive strategies.Materials and methodsA therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when the participants used the gaze-controlled device and the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.ResultsInter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.ConclusionThe communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not. (shrink)

Defined as patients who ‘lack decision-making capacity and a surrogate decision-maker’, the unrepresented present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical (...) error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient. (shrink)

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite (...) conception of a doctor’s energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care. (shrink)