The call of the wild -- A stranger in strange lands -- Song of myself -- Senses and sensibilities -- I, robot -- Lord of the things -- And then there were none.

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other (...) disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions. (shrink)

Generalisation, universal knowledge claims, and recommendations within disaster studies are problematic because they lead to miscommunication and the misapplication of actionable knowledge. The consequences and impacts thereof are not often considered by experts; forgone as irrelevant to the academic division of labour. There is a disconnect between expert assertions for disaster risk reduction (DRR) and their practical suitability for laypersons. Experts currently assert independently of the context within which protective action measures (PAMs) are to be used, measures unconnected to the (...) people for whom they are developed. This has knock-on effects for DRR: much expert-generated science and policy remains unused, unimplemented, and sometimes misapplied. I use philosophical accounts of assertion and epistemic blame to highlight the epistemic relationship between experts and laypersons. This relationship includes responsibilities and agreements between epistemic agents. Since multilevel DRR knowledge still transfers top-down from experts to laypersons, if experts impair the epistemic relationship, they can be held epistemically blameworthy. To address the pervasiveness of top-down systems, I analyse the epistemic framings and narratives currently shaping DRR, and more specifically PAMs and campaigns. I deconstruct universal perspectives that dominate the epistemic processes of generating, disseminating, and implementing DRR knowledge and specifically for co-seismic landslide PAMs for Nepal. I argue for more inclusive, contextual, and epistemically responsible DRR. Co-production of knowledge should begin from the standpoints of marginalised persons who may have an epistemic advantage due to their socio-politically marginalised positions. Often these epistemic contributions are left out of DRR efforts because marginalised persons are rarely afforded equal, if any, epistemic agency, which results in epistemic gaps and a large pool of relevant knowledge remaining unincorporated and unused in DRR research and policy. (shrink)

Using two contemporary cases of the global #MeToo movement and UK-based collective Sisters Uncut, this paper argues that a more in-depth and critical concern with gendered difference is necessary for understanding radical democratic ethics, one that advances and develops current understandings of business ethics. It draws on practices of social activism and dissent through the context of Irigaray’s later writing on democratic politics and Ziarek’s analysis of dissensus and democracy that proceeds from an emphasis on alterity as the capacity to (...) transform nonappropriative self-other relations. Therefore, the aims of the paper are: to develop a deeper understanding of a culture of difference and to consider sexual difference as central to the development of a practical democratic ethics and politics of organizations; to explore two key cases of contemporary feminist social movements that demonstrate connected yet contrasting examples of how feminist politics develops through an appreciation of embodied, intercorporeal differences; and to extend insights from Irigaray and Ziarek to examine ways in which a practical democratic politics proceeding from an embodied ethics of difference forms an important advancement to theorising the connection between ethics, dissent and democracy. (shrink)

The idea that infant participation in research is achievable by researchers ‘voicing’ infants’ experiences and ‘perspectives’ is a central feature of current moves towards participatory research. In this article we offer an alternative. Specifically, we suggest a different point of reference than infants’ own experiences and ‘perspectives’; namely, the encounter between researcher and infant as it unfolds in practice. Drawing from a large-scale study of infants in family day care, and Merleau-Ponty’s notions of écart and reversibility, we articulate the possibility (...) that infants’ participation in research encounters may be felt by researchers in the ways that infants evoke embodied responses. Drawing on Dillon’s ethics of particularity, which builds upon écart and reversibility, we discuss the idea that researchers’ embodied responses to infants provoke possibilities for ethical reflection, which can afford new ways of ‘going on’. We propose that space may be created for infants to influence ECEC practice when researchers attend to their own embodied responses to infants during the research encounter; and to the factors that may diminish infants’ capacities to affect such responses. (shrink)

How biological form is generated remains one of the most fascinating but elusive challenges for science. Moreover, it is widely documented in contemporary literature that development is tightly coordinated. The idea that such development is governed by a coordinating field of force, the morphogenetic field, and its position in embryology research paradigms, is traced in this article. Empirical evidences for field phenomena are described, ranging from bioelectromagnetic effects, morphology, transplantation, regeneration, and other data. Applications of medical potential including treatment of (...) cancer, birth defects, and wound healing are highlighted. The article hypothesizes that distinct morphological forms may have distinct field parameters. Experimentally tractable field parameters may thus provide an exciting research program for probing morphogenesis and phylogenetic diversity. (shrink)

This paper takes as its starting point the fact that Bourdieu’s views on sociology as a science have not been sufficiently and adequately understood and discussed. It traces the links between his conception and that of the French tradition of historical epistemology which is critical of positivism. How Bourdieu extends their views, and those of Bachelard especially, beyond the realm of the natural sciences, to the social sciences and sociology in particular, is discussed. In the process he introduces new concepts (...) and methods, such as that of participant objectivation. His perspective reveals a convergence between the natural sciences and the social sciences as human endeavours striving for universal truths. This is reinforced and widened to include the humanities as well as demonstrated by his analysis of the literary field. The paper concludes with the observation that Bourdieu’s post-positivist science is a salutary alternative to the postmodern critique of science. (shrink)

This paper takes as its starting point the fact that Bourdieu’s views on sociology as a science have not been sufficiently and adequately understood and discussed. It traces the links between his conception and that of the French tradition of historical epistemology which is critical of positivism. How Bourdieu extends their views, and those of Bachelard especially, beyond the realm of the natural sciences, to the social sciences and sociology in particular, is discussed. In the process he introduces new concepts (...) and methods, such as that of participant objectivation. His perspective reveals a convergence between the natural sciences and the social sciences as human endeavours striving for universal truths. This is reinforced and widened to include the humanities as well as demonstrated by his analysis of the literary field. The paper concludes with the observation that Bourdieu’s post-positivist science is a salutary alternative to the postmodern critique of science. (shrink)

Climate change is one of the most pressing issues facing humanity and has become an area of growing focus in Business & Society. Looking back and reviewing climate change discussion within this journal highlights the importance of time and space in addressing the climate crisis. Looking forward, we extend existing research by theorizing and politicizing the co-implication of time and space through the concept of “space-time.” To illustrate this, we employ the logical structure of “the trace” to advance business and (...) society scholarship on climate change by shifting the focus to a place-bound emphasis on climate impacts and directing scholarship toward climate change’s temporal markers and material effects. By operationalizing “the trace,” we contribute to Business & Society debates in three ways: reimagining complex stakeholder relations, advancing a performative understanding of climate risk, and foregrounding planetary systems and the physical environment. (shrink)

This paper problematises the ways women’s leadership has been understood in relation to male leadership rather than on its own terms. Focusing specifically on ethical leadership, we challenge and politicise the symbolic status of women in leadership by considering the practice of New Zealand Prime Minister Jacinda Ardern. In so doing, we demonstrate how leadership ethics based on feminised ideals such as care and empathy are problematic in their typecasting of women as being simply the other to men. We apply (...) different strategies of mimesis for developing feminist leadership ethics that does not derive from the masculine. This offers a radical vision for leadership that liberates the feminine and women’s subjectivities from the masculine order. It also offers a practical project for changing women’s working lives through relationality, intercorporeality, collective agency and ethical openness with the desire for fundamental political transformation in the ways in which women can lead. (shrink)

Modern medicine consumes vast amounts of resources, ranging from human to technological and financial. In a well-functioning and well-equipped health system, resource allocation considerations rarely impact clinical decision-making as all patients that need care will (eventually) receive it. In light of this, health care providers (HCPs) are often taught to focus on the patient in front of them, driven by a type of patient-centred ethics (of care) that prioritizes the individual person’s well-being above the aggregate. Informed by the principle of (...) autonomy and respect for individual self-determination, patients in well-resourced health systems often have the autonomy to make decisions that require high resource utilization with little concern directed to how these choices may impact the care provided to other patients or groups of patients. In fact, it is generally accepted that if resources are sufficient, patients and their providers should be able to make medical decisions unencumbered by considerations related to broader resource allocation (with some caveats related to personal or national health insurance schemes). This means that the average HCP in the best case and in their daily routine spends little time considering how their clinical choices might impact the care available to others—concerns related to how resources are allocated, and who receives care are far removed from clinical interaction and related medical decision-making. (shrink)

Volume 19, Issue 6, June 2019, Page 76-78.

The National Socialist Physicians League, was a professional medical organization founded upon the same ideologies that shaped the broader National Socialist agenda. Despite the vast historical and ethical literature focused on physician involvement in Nazi atrocities during the Holocaust, little attention has been paid to the NSDÄB. However, the establishment of this group is important to understanding the forces shaping physician participation in the Nazi party. Physicians often look to professional medical organizations as a source of moral guidance; thus, ideologies (...) of racism and the active harassment of ethnic or racial minority groups by this professional organization may have contributed to the establishment of this behavior as not only permissive but normal. This article will explore how this organization contributed to normalizing, desensitizing and legitimizing behavior that could not be justified by any normative theory of professional medical ethics. (shrink)

This article draws on a study of infant participation in research, and work in philosophical-empirical inquiry, to illuminate some of the inexhaustible entanglements constituting the collec...

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, (...) increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields. (shrink)

Assessing mastery of bioethics in a graduate program requires careful attention not simply to the content knowledge and skill development of students but also to the principles of sound assessment processes. In this article, we describe the rationale, development process, and features of the comprehensive exam we created as a culminating experience of a master’s program in bioethics. The exam became the students’ opportunity to demonstrate the way they were able to integrate course, textual, and practical knowledge gained throughout the (...) experience of the program. Additionally, the exam assessed students’ proficiency in the field of bioethics and their ability to critically and constructively analyze bioethical issues. In this article, we offer tips to other exam creators regarding our experiences with question and answer development, scoring of the exam, and relationships between coursework and exam preparation and completion. We also include a sample rubric for others to see how we determined which student answers were satisfactory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eve W. Stoddard REASON ON TRIAL: LEGAL METAPHORS IN THE CRITIQUE OF PURE REASON 6 6 r I 1WO things fill the mind with ever new and increasing admi_I_ ration and awe, the oftener and more steadily we reflect on them: the starry heavens above me and the moral law within me." ' These are perhaps Kant's most well-known and oft-repeated words. They reflect not only the profound (...) feeling that underlies his technical and abstruse treatises, but also his characteristic preoccupation with law. The "starry heavens" are a synecdoche both for the wonder of nature as we perceive it in all its multiplicity, and for the marvel of science's ability to reduce, order, and subdue that infinite multiplicity into a few elegant laws. These two types of law, natural and moral, define the focus of Kant's critical philosophy, and metaphors drawn from jurisprudence pervade all three critiques. In the context of controversial statements on the role of metaphor in philosophical texts by Jacques Derrida, Paul Ricoeur, and Richard Rorty, I will analyze the legal metaphors in the prefaces and Transcendental Deductions of the Critique ofPure Reason. My goal in engaging Kant's texts in this controversy over metaphor is twofold: on the one hand to assess experimentally the value of these positions on metaphor in the history of philosophy, and, on the other hand, to examine the relations between critical conceptualization and insurgent metaphoricity in Kant's carefully elaborated and systematized text. In a textwhose key words are "universal and necessary for all possible experience," contingentand ambiguous metaphors might be expected to cause problematic unravelings. Richard Rorty has argued recently that "the history ofscience, culture and politics" should be viewed "as a history of metaphor rather than of discovery." 2 He compares the creations of new vocabularies to the 245 246Philosophy and Literature invention of "new tools" ("CL," p. 5), alluding to "Nietzsche's definition of truth as a mobile army of metaphors" (p. 6). From Plato's figures of the world as cave and the mind as charioteer with unruly horses, we shift to Locke's view of mind as tahda rasa and Descartes's description of the world as a machine. Rorty's paradigm of cultural history as a history of metaphor enters into an earlier, unresolved debate between Jacques Derrida and Paul Ricoeur over the relationship between metaphor and philosophical discourse. Like Derrida, Rorty follows Nietzsche's claims about metaphor in the history of philosophy, a view Ricoeur wants to disprove so that he can recover the privileged univocity of speculative discourse. However Rorty has nothing in common with die complexity and "invaginated" ambiguities, the dazzling multivocity of Derrida's writing on the economics of metaphor. Although Rorty appears at first to agree with Derrida that there is no truth or reality apart from the linguistic tropes which dominate different epochs and cultures, he retains a metaphysical distinction between literal reference and figurative play. Rorty adopts Donald Davidson's theory that metaphors do not have "meaning" precisely because diey have no place in the language game into which they are inserted. They produce an effect, but it is not meaning: "One can only savour it or spit it out"; it is not a " 'truth-value candidate' " ("CL," p. 6). However, through repeated use, the metaphor will find a role in the language game; dying as a metaphor, it will live as a literal statement. Therefore Rorty agrees with Ricoeur that a moribund metaphor is no longer a metaphor, but a literally functioning segment of discourse. Thus despite his initial move toward a Derridean, or atleast Nietzschean, position, Rorty ultimately takes a stand consonant with Ricoeur's desire to rescue speculative discourse from the unruliness of metaphor. Considering Rorty's celebration of Freud in an article on "The Contingency of Selfhood," 3 his failure to consider the role of unconscious associations and overdetermination in the writing and reading of texts is surprising. Dead or alive, a metaphor brings with it a host ofpersonal and public, conscious and unconscious, new and traditional associations that become juxtaposed against a similar number of associations connected with the signifying chain into which the metaphor has been inserted. In... (shrink)

Angelaki, Volume 18, Issue 4, Page 179-194, December 2013.

Rereading a canonic book in medical humanities can generate an immediate sense of how much has changed in the larger conversations still circulating around the issues that book broached in significant ways. The appearance in 2013 of the second edition of Arthur Frank's The Wounded Storyteller, first published in 1995, prompted me to review what has happened in the field of body studies in the intervening decades. Some developments point to the continuing importance of Frank's book, and others raise productive (...) questions about its limitations. (shrink)

This book provides a comprehensive insight into the ways in which psychoanalysts think and work. Mary Brownescombe Heller and Sheena Pollet bring together internationally known contributors trained at the Institute of Psychoanalysis to explore the broad range of clinical work, thinking, and teaching undertaken with children, families, adults and staff by psychoanalysts in the UK public health sector. Divided into four sections, _The Work of Psychoanalysts in the Public Health Sector_ covers: clinical work with parents and young children clinical (...) work with adults and their families analytic thinking in health service practice analytic support for health service staff. Experienced psychoanalysts discuss work with various client groups including parents with babies, children, adolescents who self harm, and adults with serious mental health conditions and psychosis. The book also explores how psychoanalytically-informed work can be used alongside other treatment methods, and how health service staff can best be trained and supported. _The Work of Psychoanalysts in the Public Health Sector_ offers the reader a broad perspective and a clear understanding of the various analytical concepts used in clinical practice. It will be invaluable reading for anyone interested in, or already using psychoanalytic ideas and techniques in the health sector, as well as students in training. (shrink)

Theft, grievances and absenteeism show the need to examine mutual loyalty and establish a‘win‐win’policy.

[Un]disciplined Gestures and [Un]common sense: The Sensual, Acoustic Logic[s] of Paradox and Art Photography and the Representation of Modernist Architectural Space: From the Melancholy Fragment to the Colour of Utopia.

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

In 1968, Jürgen Habermas claimed that, in an advanced technological society, the emancipatory force of knowledge can only be regained by actively recovering the ‘forgotten experience of reflection’. In this article, we argue that, in the contemporary situation, critical reflection requires a deliberative ambiance, a process of mutual learning, a consciously organised process of deliberative and distributed reflection. And this especially applies, we argue, to critical reflection concerning a specific subset of technologies which are actually oriented towards optimising human cognition. (...) In order to create a deliberative ambiance, fostering critical upstream reflection on emerging technologies, we developed the concept of a mutual learning exercise. Building on a number of case studies, we analyse what an MLE involves, both practically and conceptually, focussing on key aspects such as ambiance and expertise, the role of ‘genres of the imagination’ and the profiles of various ‘subcultures of debate’. Ideally, an MLE becomes a contemporary version of the Socratic agora, providing a stage where multiple and sometimes unexpected voices and perspectives mutually challenge each other, in order to strength-en the societal robustness and responsiveness of emerg-ing technologies. (shrink)

Background HIV prevention trials conducted among disadvantaged vulnerable at-risk populations in developing countries present unique ethical dilemmas. A key concern in bioethics is the validity of informed consent for trial participation obtained from research subjects in such settings. The purpose of this study was to investigate the effectiveness of a continuous informed consent process adopted during the MDP301 phase III vaginal microbicide trial in Mwanza, Tanzania. Methods A total of 1146 women at increased risk of HIV acquisition working as alcohol (...) and food vendors or in bars, restaurants, hotels and guesthouses have been recruited into the MDP301 phase III efficacy and safety trial in Mwanza. During preparations for the trial, participatory community research methods were used to develop a locally-appropriate pictorial flipchart in order to convey key messages about the trial to potential participants. Pre-recorded audio tapes were also developed to facilitate understanding and compliance with gel-use instructions. A comprehension checklist is administered by clinical staff to all participants at screening, enrolment, 12, 24, 40 and 50 week follow-up visits during the trial. To investigate women's perceptions and experiences of the trial, including how well participants internalize and retain key messages provided through a continuous informed consent process, a random sub-sample of 102 women were invited to participate in in-depth interviews conducted immediately after their 4, 24 and 52 week follow-up visits. Results 99 women completed interviews at 4-weeks, 83 at 24-weeks, and 74 at 52 weeks. In all interviews there was evidence of good comprehension and retention of key trial messages including that the gel is not currently know to be effective against HIV; that this is the key reason for conducting the trial; and that women should stop using gel in the event of pregnancy. Conclusions Providing information to trial participants in a focussed, locally-appropriate manner, using methods developed in consultation with the community, and within a continuous informed-consent framework resulted in high levels of comprehension and message retention in this setting. This approach may represent a model for researchers conducting HIV prevention trials among other vulnerable populations in resource-poor settings. Trial registration Current Controlled Trials ISRCTN64716212. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/Protective highlights counter normative consequences and opposes the use enhancers. The Individual/Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)