An attempt is made to confront Foucault and Bourdieu. First of all by answering the question: Why did Foucault never discuss Bourdieu, while Bourdieu increasingly discusses Foucault, more and more in the sense of a sharp rejection of some of Foucaults main positions? In a second move, the similarities and differences between their positions in the field and their intellectual life histories are outlined. In a third part, Bourdieu's critique of Foucault is presented extensively, up to some pages of Ein (...) soziologischer Selbstversuch. (shrink)

The abolition of the political institutions of the Belgian provinces, as provided in the government declaration of 7 June 1977, puts a question into the usefulness of the provincial institutions.This contribution intends to throw more light on the policy at the provincial level - now and in the near past - by means of a brief functional and financial analysis. Beforehand, it has to be mentioned that juridical and institutional limitations do exercise a restraining influence on the functioning of the (...) provinces.A task-analysis shows that they are mainly concerned with «traditional» tasks, but they recently take into consideration «modern» tasks in the domain of social welfare.However, the means of the Belgian provinces are very limited ; as a result, the current expenditures of the provinces do not exceed 3 % of all public current expenditures. It shows the relative small importance of the provinces in the total government structure. (shrink)

A survey conducted in 1985 at the party conferences of the Belgian ecology parties Agalev and Ecolo, allows to brush an empirically based picture of the militants and the internal functioning of these parties. The "new middle class" background of the militants, the stratarchic order in the cadre party, the manifest links with the socalled "new social movements" and the specific brand of a new left-libertarian ideology all point to the new and different character of these parties, in comparison tothe (...) established Belgian parties. (shrink)

Since the French Revolution the relationship between the Catholic church and modernity has always been very troublesome. First I will describe how the church saw its own position with regard to modernity and how its stance evolved. In a second stage, I will then focus on how modernity `framed' Catholicism: this I will refer to as the modernity and modernization of Catholicism. The insights obtained will be used in a third part in order to get a better understanding of the (...) present and future situation of the church. I will round off with some conclusions concerning Catholic intellectuals and Catholic intellectual traditions from 1800 onwards. (shrink)

In overviewing the empirical evidence gathered on and the literature written about New Social Movements in Belgium this article tries to buttress three general propositions. First, the NSM' highlight a general tendency among social movements today of a thoroughgoing dissociation of the mobilizational potential on the one hand and organizational power on the other hand. Second, the NSM's in Belgium have helped substantially in raising participation levels, broadening the action repertoire of the citizens and changing the nature ofparticipation. Third, although (...) participation levels in Belgium are still beneath the West-European averages, the NSM's consitute in Belgium - with the New Right as their direct opponent - a new cleavage line in an altogether weakening system of cleavages. (shrink)

Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

Multinational corporations' international staffing policies have been evaluated in terms of cost and efficiency arguments. Research has not addressed, however, the ethical impact of these policies on diverse stakeholder groups. This paper presents a conceptual framework by which ethnocentric, polycentric and geocentric staffing policies are theoretically linked to underlying decision-making modes of instrumentality, bounded rationality and economic rationality, respectively. It goes on to describe the ethical rationales associated with each policy type, namely, distributive justice, moral rights of man, and utilitarianism. (...) An investigation of resulting ethical dilemmas affecting relevant MNC stakeholder groups is incorporated and offered as a tool for analyzing the true and full costs of trade-offs when choosing one policy over another. The paper concludes with a discussion of the implications of the conceptual framework for theory and practice and directions for future research. (shrink)

On January 22, 2002, California Governor Gray Davis released the state's long-anticipated, proposed regulations establishing hospital nurse-to-patient ratio requirements. The Safe Staffing Law mandating minimum ratios was enacted in October 1999 in response to legislators concerns that [q]uality of patient care is jeopardized because of staffing changes implemented in response to managed care. While the law was scheduled to take effect by January 1, 2002, conflict within the medical community regarding appropriate ratios slowed down the rulemaking process. Lawmakers now anticipate (...) that the rule will be implemented by January 2003. Approximately 5,000 new nurses will need to be hired for California's hospitals to come into compliance with the proposed regulation. (shrink)

This manuscript explores the argument for lower student-to-school counselor ratios in U.S. public education. Drawing upon a comprehensive historical review and existing research, we establish the integral role of school counselors and the notable benefits of reduced student-to-counselor ratios. Our analysis of national data exposes marked disparities across states and districts, with the most underfunded often serving higher percentages of low-income students and students of color. This situation raises significant ethical concerns, prompting a call for conscientious policy reform and targeted (...) investment. Informed by emerging best practices, we propose recommendations for enhancing counselor staffing and ultimately student outcomes. This ethical argument underscores the need for proactive actions and provides a basis for future research to further delineate the impact of school counselor ratios on educational equity and student success. (shrink)

In the article the subject of the theme and purpose of the work is the conceptualization of the formation and development of a new type of society – the smart- society developing in the modern era of the information revolution. The article uses the system methodology for the analysis of complex problems of development of project-oriented business from information to smart-business and analysed category vehicle concept of the development of project-oriented business. Defined the essence of the project-oriented organization and its (...) purpose in terms of the transition from the information entity to smart organizations in terms of digital transformation. Shown is an example of the application of smart technologies-staffìng organizations, indicating difficulties finding staff to work in the smart organìzcaìâh in the conditions of the digital transformation of society in the age of the Internet. (shrink)

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta‐level and to (...) identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research. (shrink)

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified (...) four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Taking a refreshingly hands-on approach to introductory ethics, A 21st Century Ethical Toolbox provides students with a set of tools to help them understand and make a constructive difference in real-life moral controversies. Thoroughly optimistic, it invites students to approach ethical issues with a reconstructive intent, making room for more and better options than the traditional "pro" and "con" positions that have grown up around tough problems like abortion and animal rights. Ideal for introductory and applied ethics courses, this unique (...) text does not treat ethics as a purely academic, historical, or theoretical subject, but as a wide-ranging and ongoing set of challenges that calls for multiple and interwoven kinds of intelligence. It covers the skills that are most vital to making real progress in ethics, including paying careful attention to the values at stake on all sides of an issue; looking for creative opportunities within difficult problems; critical-thinking skills such as defining key terms and making sure to judge similar cases alike; and learning how to engage in constructive dialogue. Instructors can readily use the experiential and applied activities inspired by this "toolbox" of practical skills to design an interactive and collaborative ethics course. Students can carry these essential skills directly from this book into such projects as campaigning for environmental awareness and staffing local homeless shelters. In addition to his own discussion, Weston includes gripping and provocative short selections from essayists, activists, and philosophers, and also cites his own students. Extensive "Exercises and Notes" sections end each chapter, and a detailed appendix offers instructors advice on how to use the Toolbox in the classroom. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These (...) nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the ‘low staffing’ factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout. (shrink)

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: (...) Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses. (shrink)

Objectives: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning.Design: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives.Participants: The lead for teaching and learning at each medical school was invited to complete a questionnaire.Results: Completed responses were received from 22/28 schools . Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics (...) teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development.Conclusions: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally. (shrink)

The broad success of the 2018–2019 #RedforEd movement in achieving more equitable outcomes for not only teachers but also other constituents in the community has generated interest in the role of teacher strikes in defending the common good. My article contributes to this conversation by interpreting the demands made by teachers and paraprofessionals and school-related personnel in the 2019 Chicago Public Schools strike through an ethics of care. Enlisting the notions of caring-for, completion, and competence from care ethics, this analysis (...) elucidates the strike demands–namely, smaller class sizes, more bilingual education teachers and special education teachers, and adequate staffing of PSRPs providing wraparound services for high-needs students–as aiming at securing conditions for CPS faculty to provide better care for their students. This article also brings to light the varied and complex requirements placed on CPS faculty in their caring work in schools and as such, proposes an educator’s ethical commitment to care for students as one plausible reason for some educators to leave the classroom for the picket line. I suggest, further, that educators, by striking, are enacting a political form of caring termed caring-with alongside fellow citizens and advocating collective responsibility in caring for all persons as care receivers and care givers. The 2019 CPS strike can therefore be seen as a response not only to disinvestment in public schools and teachers, but to the broader crisis of care deficit and democratic deficit in society. (shrink)

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to (...) abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and (...) continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations. (shrink)

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and 20 (...) institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Background:Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice – hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of its kind (...) carried out in New Zealand.Aim/objective:The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate.Research design/participants/context:This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research.Ethical considerations:Ethics approval for this study was granted by the New Zealand Ministry of Health’s Central Regional Health and Disability Ethics Committee on 14 June 2012.Findings:The themes identified in the data centred on three dominant elements that – together – shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff.Discussion:While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses’ ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere.Conclusion:Moral distress is inevitable in an ethical climate where the organisation’s main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care. (shrink)

As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues (...) associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are ‘fit for reallocation’ have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated. (shrink)

Non-governmental organizations often regard expanding revenue and reducing costs as standard procedures to achieve corporate sustainability, while at the same time considering human resources as important assets. Government agencies have greater flexibility in staffing, and their human resource strategies for employee education and training often use organizational learning to develop operational performance. Training is regarded as a panacea for corporate sustainability and channels have been established to support employees' learning. Curriculum development of synchronous online learning is an approach that requires (...) further investigation. We distributed 360 questionnaires to supervisors and employees of the Taipei City Government, Taiwan. A total of 268 valid copies were retrieved, giving a response rate of 74%. The study results are expected to help public sector employers enhance employee cohesiveness and generate more operational team spirit. (shrink)

Summary This paper investigates the extent of overseas migration by British chemists over the period 1887–1971. Notwithstanding the ‘brain drain’ alarms of the 1960s, overseas employment was characteristic of some 19% of British chemists’ careers throughout our period, though its nature changed considerably. Our study examines the overseas employment histories of four cohorts of members of the [Royal] Institute of Chemistry in the ‘Chemists’ Database’ at the Open University. Those employed abroad were not only highly qualified but also both geographically (...) mobile and occupationally versatile. Over the period, the pattern of chemists’ migration was broadly similar to that of British migration trends more generally. Except in the interwar years, chemists’ rate of migration was relatively constant. However, the length of time they spent abroad declined markedly over the period: long-term migration became less characteristic than short-term overseas employment for purposes of career development. From the late nineteenth century, British chemists staffed the Empire, but also found employment in the expanding US economy. After 1945, chemists’ destinations shifted more markedly towards North America, including Canada, and later also to Europe. Our work thus provides a new perspective on the dynamics of scientists’ migration and contributes to studies on the brain drain. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

This article explores the strategic management of government affairs in companies active in the EU. The article relies on a unique large-N dataset on the functioning and staffing of EU government affairs. The analysis shows that companies delegate government affairs functions to in-house managers with specific competences, who stay in office for long periods and who have an extensive knowledge of the core competences of the company, thanks to their educational background and work experience in the private sector. These findings (...) suggest that how companies strategically manage and staff government affairs in Brussels rests on the distinct structure of business–government relations in the EU, which are based on the exchange of technical information and the establishment of credibility and long-run trust arrangements. (shrink)

We describe the ethics consultation service (ECS) at the Cleveland Clinic and report on its activities over a 24-month period in which 478 consultations were performed. To our knowledge, this is the largest case series of ethics consultations reported to date. Established more than 25 years ago, the ECS at the Cleveland Clinic is staffed by multiple consultants with advanced training in bioethics. Several of these ethicists work closely with specialized clinical units and research departments, where they participate in multidisciplinary (...) meetings and provide specialized assistance. This combination of historical experience, large numbers of consultation requests, and specialized clinical ethicists suggests that the experience at the Cleveland Clinic may be helpful to ethicists and others who may be considering how to structure and sustain a vibrant ECS. Our results highlight the diversity of activities performed by a high-volume ECS at a tertiary care facility. Our hope in sharing the inner workings of the ECS at the Cleveland Clinic is to promote dialogue on common practices and approaches across medical institutions that support ethics consultation. (shrink)