In this paper I look at causality in the context of intervention research, and discuss some problems faced in the evaluation of causal hypotheses via interventions. I draw attention to a simple problem for evaluations that employ randomized controlled trials. The common alternative to randomized trials, the observational study, is shown to face problems of a similar nature. I then argue that these problems become especially acute in cases where the intervention is complex (i.e. that involves intervening (...) in a complex system). Finally, I consider and reject a possible resolution of the problem involving the simulation of complex interventions. The conclusion I draw from this is that we need to radically reframe the way we think about causal inference in complex intervention research. (shrink)

Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a (...) first step, we introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

Cartwright and Munro argued that extrapolation of findings from randomized controlled trials to other settings can be difficult because information about the underlying causal structure and subgroups is often not available. They advocated the use of ‘capacities’ – that is fixed causal contributions – in predicting effects of interventions. In psychiatry, it is often not possible to determine what the fixed causal contributions are and one can only establish ‘approximate capacities’. However, using ‘approximate capacities’ does imply a different way of (...) evaluating health services, especially combined interventions. In health service research, if different studies, randomized controlled trials or other designs, have given different outcomes, the best way to investigate the effectiveness of a particular way of service organization is not to conduct more randomized controlled trials. It is preferable to study the effects of certain elements of the complex intervention, which have been tested before in other settings, that is investigating ‘approximate capacities’. One should check whether the separate elements do form a part of the complex intervention in practice and whether they have the same effect as in other studies and if not, why not. This enhances knowledge about the underlying causal structure and increases the possibility of extrapolation of the findings. (shrink)

BackgroundHow should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and theimplementationof the CEC should be considered as ‘complex interventions’.Main textWe present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such (...) sets of consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors.ConclusionThe conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological (...) treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

This paper proposes a conceptual framework for understanding the implementation process of a complex intervention concerned with professional role change. The proposed framework holds that the intervention must address three interacting systems (socio-cultural, educational and disciplinary) through which a health professional role is evolved. Each system is operationalized by four dimensions (values, methods, actors and targets). As for the implementation, the framework posits that it can be analyzed, by depicting the barriers and facilitators located within the dimensions (...) of the three interacting systems and within the intervention involved in the process through using the “menu of constructs” approach suggested by the Consolidated Framework for Implementation Research (CFIR). The implications of this framework, on theoretical research and practical levels, are reviewed. (shrink)

An amendment to this paper has been published and can be accessed via the original article.

Markets, companies and various forms of business organizations may all (we have argued) be usefully viewed through the lens of CAS -- the theory of complex adaptive systems. In this chapter, I address one fundamental issue that confronts both the theoretician and the business manager: the nature and opportunities for control and intervention in complex adaptive regimes. The problem is obvious enough. A complex adaptive system, as we have defined it, is soft assembled and largely self-organizing. (...) This means that it is the emergent product of multiple, and often very heterogeneous, interacting factors and forces, and that the crucial interactions are not controlled and orchestrated by an overseeing executive, detailed program, or any other source of strict hierarchical control. There is thus a pressing problem -- are such systems strictly out of control and beyond the reach of useful governance? I shall argue that they are not. Such systems, though initially unfamiliar, can nonetheless be led, influenced and enabled in a variety of ways. (shrink)

This review essay expands on two excellent collections dealing with Nietzsche and Wagner and is drawn from the proceedings of conferences in the bicentennial year of Wagner’s birth. It points to four areas underplayed in the contributions. The first involves Nietzsche’s adoption of Wagnerian ideology, especially anti-Judaism, in the late 1860s and early 1870s. The second deals with Nietzsche’s actual activities and sentiments regarding the inaugural Bayreuth festival in 1876 and his later reports of these activities and sentiments. A third (...) topic concerns the break from Wagner, its likely causes, and its stylization in Nietzsche’s recollections from the 1880s. And lastly the essay examines the ambivalence toward Wagner in Nietzsche’s writings from 1888 as part of an autobiographical imperative. In general, the collections reviewed place too much trust in Nietzsche’s own accounts of the relationship with Wagner and fail to recognize that, especially in the 1880s, the philosopher is engaged in a process of self-fashioning to bring his current views into harmony with a history embellished and manipulated to give the appearance of linear development and consistent beliefs. (shrink)

In the field of health technology assessment, there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. (...) However, the potential methodological challenges for ethical analysis are as yet unknown.Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’ experiences of developing, applying and assessing the approaches.The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general. (shrink)

Background:The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.Objectives:To examine ethics interventions conducted on healthcare professionals and healthcare students (...) to achieve ethics-related outcomes.Research design:A systematic review.Methods:Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.Ethical consideration:This systematic review was conducted following good scientific practice in every phase.Findings:It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.Conclusion:Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the needed groundwork (...) for improved models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science. (shrink)

Donald VanDeVeer probes the moral complexities of the question: under what conditions is it permissible to intervene invasively in the lives of competent persons--for example, by deception, force, or coercive threat--for their own good? In a work with broad significance for law, public policy, professional-client relations, and private interactions, he presents a theory of an autonomy-respecting" paternalism. Originally published in 1986. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist (...) of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

When analyzing complex longitudinal data, especially data from different educational settings, researchers generally focus only on the mean part (i.e., the regression coefficients), ignoring the equally important random part (i.e., the random effect variances) of the model. By using Project English Language and Literacy Acquisition (ELLA) data, we demonstrated the importance of taking the complex data structure into account by carefully specifying the random part of the model, showing that not only can it affect the variance estimates, the (...) standard errors, and the tests of significance of the regression coefficients, it also can offer different perspectives of the data, such as information related to the developmental process. We used xxM (Mehta, 2013), which can flexibly estimate different grade-level variances separately and the potential carryover effect from each grade factor to the later time measures. Implications of the findings and limitations of the study are discussed. (shrink)

Although much recent social science and humanities work has been a revolt against simplification, this volume explores the contrast between simplicity and complexity to reveal that this dichotomy, itself, is too simplistic. John Law and Annemarie Mol have gathered a distinguished panel of contributors to offer—particularly within the field of science studies—approaches to a theory of complexity, and at the same time a theoretical introduction to the topic. Indeed, they examine not only ways of relating to complexity but complexity _in (...) practice._ Individual essays study complexity from a variety of perspectives, addressing market behavior, medical interventions, aeronautical design, the governing of supranational states, ecology, roadbuilding, meteorology, the science of complexity itself, and the psychology of childhood trauma. Other topics include complex wholes in the sciences, moral complexity in seemingly amoral endeavors, and issues relating to the protection of African elephants. With a focus on such concepts as multiplicity, partial connections, and ebbs and flows, the collection includes narratives from Kenya, Great Britain, Papua New Guinea, the Netherlands, France, and the meetings of the European Commission, written by anthropologists, economists, philosophers, psychologists, sociologists, and scholars of science, technology, and society. _Contributors._ Andrew Barry, Steven D. Brown, Michel Callon, Chunglin Kwa, John Law, Nick Lee, Annemarie Mol, Marilyn Strathern, Laurent Thévenot, Charis Thompson. (shrink)

I argue that the Causal Markov Condition (CMC) is in principle applicable to the Einstein–Podolsky–Rosen (EPR) correlations. This is in line with my defence in the past of the applicability of the Principle of Common Cause to quantum mechanics. I first review a contrary claim by Dan Hausman and Jim Woodward, who endeavour to preserve the CMC against a possible counterexample by asserting that the conditions for the application of the CMC are not met in the EPR experiment. In their (...) view the CMC is inapplicable to the EPR correlations—i.e. it neither obtains nor fails. The view is grounded upon the non-separability of the quantum state, and the consequent unavailability of interventions. I urge that whether interventions are available in EPR—and why—is a complex and contextual question that does not have a unique or uniform answer. Instead, I argue that different combinations of causal hypotheses under test and interpretations of quantum mechanics yield different answers to the question. (shrink)

Object relative clauses are harder to process than subject relative clauses. Under Grillo’s Generalized Minimality framework, complexity effects of object relatives are construed as intervention effects, which result from an interaction between locality constraints on movement and the sentence processing system. Specifically, intervention of the subject DP in the movement dependency is expected to generate a minimality violation whenever processing limitations render the moved object underspecified, resulting in compromised comprehension. In the present study, assuming Generalized Minimality, we compared (...) the processing of object relatives with the processing of subject control in ditransitives, which, like object relatives, instantiates a syntactic dependency across an intervening DP. This comparison is justified by the current debate on whether Control should be analyzed as movement: if control involves movement of the controller DP, as proposed by Hornstein, a parallel between the processing of object relatives and subject control in ditransitives may be anticipated on the basis of intervention. In addition, we explored whether general cognitive factors contribute to complexity effects ascribed to movement across a DP. Sixty-nine adult speakers of European Portuguese read sentences and answered comprehension probes in a self-paced reading task with moving-window display, comprising four experimental conditions: Subject Relatives; Object Relatives; Subject Control; Object Control. Furthermore, participants performed four supplementary tasks, serving as measures of resistance to interference, lexical knowledge, working memory capacity and lexical access ability. The results from the reading task showed that whereas object relatives were harder to process than subject relatives, subject control was not harder to process than object control, arguing against recent movement accounts of control. Furthermore, we found that whereas object relative complexity effects assessed by response times to comprehension probes interacted with Reading Span, object relative complexity effects assessed by comprehension accuracy and reading times did not interact with any of the supplementary tasks. We discuss these results in light of Generalized Minimality and the hypothesis of modularity in syntactic processing. (shrink)

Systems change requires complex interventions. Cross-sector partnerships face the daunting task of addressing complex societal problems by aligning different backgrounds, values, ideas and resources. A major challenge for CSPs is how to link the type of partnership to the intervention needed to drive change. Intervention strategies are thereby increasingly based on Theories of Change. Applying ToCs is often a donor requirement, but it also reflects the ambition of a partnership to enhance its transformative potential. The current (...) use of ToCs in partnering efforts varies greatly. There is a tendency for a linear and relatively simple use of ToCs that does limited justice to the complexity of the problems partnerships aim to address. Since partnership dynamics are already complex and challenging themselves, confusion and disagreement over the appropriate application of ToCs is likely to hamper rather than enhance the transformative potential of partnerships. We develop a complexity alignment framework and a diagnostic tool that enables partnerships to better appreciate the complexity of the context in which they operate, allowing them to adjust their learning strategy. This paper applies recent insights into how to deal with complexity from both the evaluation and theory of change fields to studies investigating the transformative capacity of partnerships. This can serve as a check to define the challenges of partnering projects and can help delineate the societal sources and layers of complexity that cross-sector partnerships deal with such as failure, insufficient responsibility taking and collective action problems at four phases of partnering. (shrink)

Systems change requires complex interventions. Cross-sector partnerships face the daunting task of addressing complex societal problems by aligning different backgrounds, values, ideas and resources. A major challenge for CSPs is how to link the type of partnership to the intervention needed to drive change. Intervention strategies are thereby increasingly based on Theories of Change. Applying ToCs is often a donor requirement, but it also reflects the ambition of a partnership to enhance its transformative potential. The current (...) use of ToCs in partnering efforts varies greatly. There is a tendency for a linear and relatively simple use of ToCs that does limited justice to the complexity of the problems partnerships aim to address. Since partnership dynamics are already complex and challenging themselves, confusion and disagreement over the appropriate application of ToCs is likely to hamper rather than enhance the transformative potential of partnerships. We develop a complexity alignment framework and a diagnostic tool that enables partnerships to better appreciate the complexity of the context in which they operate, allowing them to adjust their learning strategy. This paper applies recent insights into how to deal with complexity from both the evaluation and theory of change fields to studies investigating the transformative capacity of partnerships. This can serve as a check to define the challenges of partnering projects and can help delineate the societal sources and layers of complexity that cross-sector partnerships deal with such as failure, insufficient responsibility taking and collective action problems at four phases of partnering. (shrink)

Systems change requires complex interventions. Cross-sector partnerships (CSPs) face the daunting task of addressing complex societal problems by aligning different backgrounds, values, ideas and resources. A major challenge for CSPs is how to link the type of partnership to the intervention needed to drive change. Intervention strategies are thereby increasingly based on Theories of Change (ToCs). Applying ToCs is often a donor requirement, but it also reflects the ambition of a partnership to enhance its transformative potential. (...) The current use of ToCs in partnering efforts varies greatly. There is a tendency for a linear and relatively simple use of ToCs that does limited justice to the complexity of the problems partnerships aim to address. Since partnership dynamics are already complex and challenging themselves, confusion and disagreement over the appropriate application of ToCs is likely to hamper rather than enhance the transformative potential of partnerships. We develop a complexity alignment framework and a diagnostic tool that enables partnerships to better appreciate the complexity of the context in which they operate, allowing them to adjust their learning strategy. This paper applies recent insights into how to deal with complexity from both the evaluation and theory of change fields to studies investigating the transformative capacity of partnerships. This can (1) serve as a check to define the challenges of partnering projects and (2) can help delineate the societal sources and layers of complexity that cross-sector partnerships deal with such as failure, insufficient responsibility taking and collective action problems at four phases of partnering. (shrink)

Recent improvements in virtual reality allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders, the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: reality and its (...) representation, autonomy, privacy, self-diagnosis and self-treatment, and expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR. (shrink)

Provided that traditional jus ad bellum principles are fulfilled, military humanitarian intervention to stop large scale violations of human rights (such as genocide, crimes against humanity or war crimes) is widely regarded as morally permissible. In cases of “supreme humanitarian emergency”, not only are the victims morally permitted to rebel, but other states are also permitted to militarily intervene. Things are different if the human rights violations in question fall short of supreme humanitarian emergency. Because of the importance of (...) respecting political self-determination, in cases of “ordinary oppression”, we normally think that rebellion might be permissible, but not military humanitarian intervention. Thus, according to the received view, the conditions for the permissibility of intervention coincide with the conditions for the permissibility of revolution in cases of supreme humanitarian emergency, but not in cases of ordinary oppression. In cases of ordinary oppression there is an asymmetry between the conditions for the permissibility of revolution and intervention (call this the Asymmetry View). Should we accept the Asymmetry View? I answer this question by outlining an account of political self-determination and by illustrating the complex role that this notion should play in discussing the morality of revolution and intervention. (shrink)

Science and technology studies analyses of emerging forms of treatment often result in the detailed display of complexities and at times lead to explicit critiques of particular healthcare practices. Simultaneously, there seems to be an increasing interest in exploring more experimental engagements by STS researchers in the proactive construction of such practices. In this article, I explore the relevance of experimental interventions in health care practices for both these care practices and for issues of the normativity of STS research. By (...) analyzing my involvement in changes in the practice of hemophilia home treatment, I indicate how this care practice was reconfigured, partly by drawing on STS insights on the issue of compliance. I also claim that experimenting with forms of ‘‘artful contamination’’ allow STS researchers to do normativity in the practices they engage with. Such practices of interventionist STS research may be of value for refiguring debates in which constructivism has been accused of being normatively deficient. This may make interventionist STS research a fruitfully risky business. (shrink)

Infants, children and adolescents with life-limiting and life-threatening disease need long-term care that may change according to disease’s natural history. With the primary goal of quality of life, the psychologist of pediatric palliative care network deals with a large variety of issues. Little consideration has been given to the variety of intervention areas of psychology in PPC that concern the whole life span of the patient and family. The PPC network is composed by a multidisciplinary team of palliative care (...) specialists that intervenes at home, in the hospital and in every place where the patient is living. The network coordinates different public health services to respond to clinical, psychosocial and spiritual needs. In these scenarios, the psychological need is not a single event but a moment inserted in the complexity of the child’s needs. This retrospective monocentric project consists of an analysis of characteristics of psychological interventions in our PPC service. The time frame taken into consideration is 2019–2020, analyzing the clinical records of 186 patients of Pediatric Palliative Care and Pain Service of Veneto Region. The areas that emerged in the analysis show how the intervention of the psychologist in PPC does not concern only end-of-life, but a series of topics that are significant for the family to guarantee psycho-social wellbeing oriented toward the best quality of life. In conclusion, these different topics highlight the complexity of the child and family experience. This variety must be taken into consideration, the psychologist must increase holistic support with a dedicated skills curriculum. (shrink)

Recent advances in genetic research pose many complex problems for moral and political philosophers. On the one hand, these advances promise great things. Genetic enhancement techniques might allow us to prevent or cure a variety of debilitating diseases. But on the other hand, talk about intervening in people's genetic make-up conjures up memories of the sinister episodes of past eugenic movements. Such movements violated the most basic principles of justice. How can society capitalize on the benefits of genetic (...) class='Hi'>intervention and yet avoid the injustices of past eugenic movements? What basic moral principles should guide public policy and individual choice concerning the use of genetic interventions? These important questions are tackled by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler in From Chance to Choice: Genetics and Justice. This book brings together the thoughts of leading scholars in the field and is likely to set the agenda for serious debate on this topic. (shrink)

Recent advances in genetic research pose many complex problems for moral and political philosophers. On the one hand, these advances promise great things. Genetic enhancement techniques might allow us to prevent or cure a variety of debilitating diseases. But on the other hand, talk about intervening in people's genetic make-up conjures up memories of the sinister episodes of past eugenic movements. Such movements violated the most basic principles of justice. How can society capitalize on the benefits of genetic (...) class='Hi'>intervention and yet avoid the injustices of past eugenic movements? What basic moral principles should guide public policy and individual choice concerning the use of genetic interventions? These important questions are tackled by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler inFrom Chance to Choice: Genetics and Justice. This book brings together the thoughts of leading scholars in the field and is likely to set the agenda for serious debate on this topic. (shrink)

After the end of the Cold War, many in the West viewed Africa as a testing ground for the solidarist argument that sovereignty was no longer an absolute principle and that the international community could intervene to protect individual from human rights violations. This argument seems particularly challenging in the African context, given the continental leadership’s historic commitment to territorial integrity and non-intervention. However, as the author shows, African leaders from 1945 to 1990 were largely upholding the pluralist international (...) norms of the time. In other words, the case for humanitarian intervention – and the problems posed by the practice – are not region-specific. The early 1990s, during which the United Nations intervened in Somalia, seemed to confirm the solidarist position. However, the failure to intervene in Rwanda in 1994, and the more recent experience of interventions in Sierra Leone, present a more mixed picture. Humanitarian intervention remains a controversial practice because of its coercive means, and its tendency to attribute blame or responsibility in what are often very complex civil conflicts. (shrink)

Improving the evidence in public health is an important goal for the health promotion community. With better evidence, health professionals can make better decisions to achieve effectiveness in their interventions. The relative failure of such evidence in public health is well-known, and it is due to several factors. Briefly, from an epistemological point of view, it is not easy to develop evidence-based public health because public health interventions are highly complex and indeterminate. This paper proposes an analytical explanation of (...) the complexity and indeterminacy of public health interventions in terms of 12 points. Public health interventions are considered as a causal chain constituted by three elements and two levels of evaluation. Public health interventions thus differ from clinical interventions, which comprise two causal elements and one level of evaluation. From the two levels of evaluation, we suggest a classification of evidence into four typologies: evidence of both relations; evidence of the second but not of the first relation; evidence of the first but not of the second relation; and no evidence of either relation. In addition, a grading of indeterminacy of public health interventions is introduced. This theoretical point of view could be useful for public health professionals to better define and classify the public health interventions before acting. (shrink)

Given the contemporary complexity of cities, landscape and society, urgent social tasks call for an integral, multidisciplinary approach. Rietveld Landscape’s strategic interventions focus and use the forces of existing developments and processes. This design method creates new opportunities for landscape, architecture, the public domain, ecology, recreation and economic activity.

In this paper we aim to demonstrate the enormous ethical complexity that is prevalent in child obesity cases. This complexity, we argue, favors a cautious approach. Against those perhaps inclined to blame neglectful parents, we argue that laying the blame for child obesity at the feet of parents is simplistic once the broader context is taken into account. We also show that parents not only enjoy important relational prerogatives worth defending, but that children, too, are beneficiaries of that relationship in (...) ways difficult to match elsewhere. Finally, against the backdrop of growing public concern and pressure to intervene earlier in the life cycle, we examine the perhaps unintended stigmatizing effects that labeling and intervention can have and consider a number of risks and potential harms occasioned by state interventions in these cases. (shrink)

Causal models show promise as a foundation for the semantics of counterfactual sentences. However, current approaches face limitations compared to the alternative similarity theory: they only apply to a limited subset of counterfactuals and the connection to counterfactual logic is not straightforward. This article addresses these difficulties using exogenous interventions, where causal interventions change the values of exogenous variables rather than structural equations. This model accommodates judgments about backtracking counterfactuals, extends to logically complex counterfactuals, and validates familiar principles of (...) counterfactual logic. This combines the interventionist intuitions of the causal approach with the logical advantages of the similarity approach. (shrink)

Teaching mathematics and improving mathematics competence are pending subjects within our educational system. The PEIM (Programa Evolutivo Instruccional para Matemáticas), a constructivist intervention program for the improvement of mathematical performance, affects the different agents involved in math learning, guaranteeing a significant improvement in students’ performance. The program is based on the following pillars: (a) students become the main agents of their learning by constructing their own knowledge; (b) the teacher must be the guide to facilitate and guarantee such a (...) construction by being a great connoisseur of the fundamental aspects of the development of the child’s mathematical thinking; (c) the mathematical contents must be sequenced in terms of the complexity and significance for the student as well as contextualized at all times; and (d) the classroom must have a constructivist climate highlighting cooperative work among students. The implementation of PEIM along with the empirical evaluation conducted in several centers in Madrid and Zaragoza (Spain) confirm how students improve their mathematical competence. Both first- and second-grade students in elementary education were far more effective in solving problems, highlighting the use of more advanced strategies in their resolution and a lower incidence of conceptual errors. Moreover, it was possible to verify how the students proving greater difficulty, experienced an evolution in learning similarly to those who did not present it. The program provides customized education to allow the teacher to know at all times how he should be more influential on the students’ learning through mathematical profiles. Both teaching practice and teachers were observed, being that of the experimental group more prone to analyzing processes and allowing the construction of knowledge by students, due to their psycho-developmental training. As a result, we found several improvements through the implementation of the program that may serve, for upcoming years, as a basis for the necessary changes in the teaching of mathematics. (shrink)

Prompted by the debate over Michael Lebowitz's contributions on the relative absence of class struggle in Marx's Capital, this paper seeks to push analysis forward by closer examination of the notion of the value of labour-power. It does so by arguing that labour markets are structured, reproduced and transformed in complex and differentiated ways, whilst the moral and historical elements that make up the use-value interpretation of the value of labour-power also need to be addressed in a differentiated manner (...) rather than as a fixed bundle. (shrink)

In the aftermath of the complex humanitarian crises of the 1990s, the concept of the Responsibility to Protect emerged powerfully on the international stage. The report of the International C...

Essays and articles in the November‐December 2022 issue of the Hastings Center Report explore the complexities of medical decision‐making. A case‐study essay, for example, argues that the dismaying decision to perform resuscitation efforts on a patient who had obviously been dead for some time can be understood in the context of the harmful practice of defensive medicine. A narrative essay concerns whether an adolescent with locked‐in syndrome should be asked her wishes about life‐sustaining interventions, and the articles illuminate the ethical (...) value of the parental role in pediatric decision‐making, an array of ways in which patient decision‐making is interdependent, and the limitations of measures designed to evaluate the quality of a patient's decision and decision‐making process. (shrink)

With a critical eye, Gabriel Rockhill guides you through complex debates in history, politics and aesthetics, giving you an overview of key issues and central figures, including Foucault, Derrida, Castoriadis, Badiou and Ranciere.Rockhill also engages in a nuanced exploration of recent work that calls into question the stereotype of 'prominent figures' and 'intellectual movements. Far from hiding behind towering figures of the intellectual world, Rockhill stakes out positions in relationship to them and formulates precise arguments in favour of a (...) new understanding of the historical relationship between art and politics. (shrink)

Provided that traditional jus ad bellum principles are fulfilled, military humanitarian intervention to stop large scale violations of human rights (such as genocide, crimes against humanity or war crimes) is widely regarded as morally permissible. In cases of “supreme humanitarian emergency”, not only are the victims morally permitted to rebel, but other states are also permitted to militarily intervene. Things are different if the human rights violations in question fall short of supreme humanitarian emergency. Because of the importance of (...) respecting political self‐determination, in cases of “ordinary oppression”, we normally think that rebellion might be permissible, but not military humanitarian intervention. Thus, according to the received view, the conditions for the permissibility of intervention coincide with the conditions for the permissibility of revolution in cases of supreme humanitarian emergency, but not in cases of ordinary oppression. In cases of ordinary oppression there is an asymmetry between the conditions for the permissibility of revolution and intervention (call this the Asymmetry View). Should we accept the Asymmetry View? I answer this question by outlining an account of political self‐determination and by illustrating the complex role that this notion should play in discussing the morality of revolution and intervention. (shrink)

Plusieurs de ceux qui présentent des problèmes de santé mentale se retrouvent dans le système judiciaire. Leur profil clinique se caractérise par une problématique complexe où se juxtaposent divers troubles ou déficits. Il n’est pas toujours facile de dépister ces personnes et d’intervenir auprès d’elles dans le cadre du processus judiciaire et pénal, qui n’est pas conçu pour répondre à leurs besoins cliniques. De son côté, le réseau de la santé et des services sociaux semble lui aussi peu adapté pour (...) intervenir auprès de cette clientèle marginale, souvent réfractaire à l’aide et parfois intimidante. Ces deux réseaux fonctionnent en parallèle, très peu familiers l’un de l’autre. Ils ont tendance à se renvoyer cette clientèle problématique. L’État doit s’assurer de soutenir et de coordonner des services qui peuvent rejoindre et aider ces personnes. (shrink)

Background: Providing care for a home-dwelling person with dementia who resists care is an ethical and practical complex and challenging task. Faced with a growing number of persons with dementia, the healthcare professional’s understanding of how to best care for and prevent unnecessary use of coercion with persons with dementia is of key importance. Research aim: The aim of this study was to explore the use of trust-building interventions in home-dwelling persons with dementia resisting care, as described by health (...) professionals in documents of decisions of forced treatment and care. Research design: A qualitative thematic document analysis inspired by critical realism was conducted. Participants and research context: Descriptions of trust-building interventions were extracted from 88 documents of forced treatment and care for home-dwelling persons with dementia, receiving home healthcare, in 2015 and 2016. Ethical considerations: Approved by the Regional Committee for Medical and Health Research Ethics, reference number 2017/788, and controlled by the Norwegian Centre for Research Data, reference number 54897. The study adhered to the guidelines of the Declaration of Helsinki. Findings: We found that “balancing safe care with the person’s integrity” was an overarching theme that permeated the descriptions of trust-building interventions in the study. Three main themes were identified when the data were analyzed: safeguarding care, protecting integrity, and optimizing the environment. Discussion and conclusion: Health professionals balanced on a thin line between care and integrity when met with resistance from person with dementia. However, the trust-building interventions used in the most challenging situations did not differ from the interventions used in general in dementia care. Two knowledge gaps were identified: how to perform appropriate assessments of situations of home-dwelling persons with dementia when met with resistance to care, and whether environmental initiatives may also benefit home-dwelling persons with dementia who are not easily cared for. (shrink)

"Humanitarian intervention" as used below means action by international actors across national boundaries including the use of military force taken with the objective of relieving severe and widespread human suffering and violation of human rights within states where local authorities are unwilling or unable to do so. This essay will attempt better to understand decisions about humanitarian intervention from the narrow perspective of looking at the proximate considerations attendant to the intervention itself, particularly focusing on the priority (...) of ground_level implementation and the recognition of the integral relationship between military action and reconstruction. Since what is confronted on the ground will be determinative, it is important to see if the decisions above can be better connected to the realities below. The inherent complexity of the subject will be confirmed here using selected cases with which the author has experience in the field; concepts and constructs identified which have been developed in attempts to frame the problem; constraints faced by the policy_makers indicated; and moral aspects of the enterprise considered. (shrink)

BackgroundSome people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical (...) interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team.MethodsA three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process?ResultsDecision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: Risks, burdens and benefits; Treatment goals; Normative ethical values; Interested parties.ConclusionsDecision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of ‘who decides’ cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum. (shrink)

The moral complexity surrounding intervention is influenced by a broad spectrum of both ethical and practical assumptions and considerations.

During the last few decades we have witnessed a proliferation of exercises dealing with the public participation of citizens in various different dimensions of their societies, including issues of science and technology. On the one hand, these mechanisms provide more robust forms of public engagement with matters that were traditionally dealt with by experts; on the other hand, they raise concerns relating to their design, efficiency or potential for the empowerment of citizens. As part of the EC-funded project DEEPEN (Deepening (...) Ethical Engagement and Participation in Emerging Nanotechnologies) a research team in Coimbra, Portugal, was put in charge of identifying the ethical and social “impacts” of emerging nanotechnologies, transforming the traditional focus groups through the incorporation of two methodological innovations: the Pedagogy of the Oppressed and the Theatre of the Oppressed. This article reflects on the outcomes and complexities of the introduction of these two methodologies. Since the participants had little or no information on nanotechnologies, we reflect on the politics of these focus groups by exploring how issues of intervention, subjectivity, representation and agency were interconnected during this exercise of public participation in Science and Technology, analyzing the role of social sciences in developing nanoethics. (shrink)

In this paper, we propose an empirically based Monte Carlo bus-network model as a test bed to simulate intervention strategies to overcome the inefficiencies of bus bunching. The EMB model is an agent-based model which utilizes the positional and temporal data of the buses obtained from the Global Positioning System to constitute a set of empirical velocity distributions of the buses and a set of exponential distributions of interarrival time of passengers at the bus stops. Monte Carlo sampling is (...) then performed on these two derived probability distributions to yield the stochastic dynamics of both the buses’ motion and passengers’ arrival. Our EMB model is generic and can be applied to any real-world bus network system. In particular, we have validated the model against the Nanyang Technological University’s Shuttle Bus System by demonstrating its accuracy in capturing the bunching dynamics of the shuttle buses. Furthermore, we have analyzed the efficacy of three intervention strategies: holding, no-boarding, and centralized-pulsing, against bus bunching by incorporating the rule set of these strategies into the model. Under the scenario where the buses have the same velocity, we found that all three strategies improve both the waiting and travelling times of the commuters. However, when the buses have different velocities, only the centralized-pulsing scheme consistently outperforms the control scenario where the buses periodically bunch together. (shrink)