In this study I intend to prove that there is a close connection between ethical purposes of Environmental Philosophy as World Philosophy and the idea of sacred nature as part of the “world” in a phenomenological sense, which includes sacred space as defined in the philosophy of religion. The main points that intersect here are: the idea of sacred space; the perception of virtue in a sacred world; the beauty of creation: nature, life, human sensibility. The theoretical background of this (...) study contains points of view that express phenomenological, hermeneutic, theological, and aesthetic conceptions belonging to authors and exegetes such as Mircea Eliade, William E. Paden, David Cave, Ion Ianoși, Douglas Allen, Arnold Berleant, and Vincent Blok. I believe that the neglect of the environment-as-a-condition-of-life (the consequences of which can already be seen in ecological imbalances) is caused by, among other factors, the desacralization of human attitudes towards nature and the world of life. Few people still have a feeling of sacred nature or the aesthetic emotion of perceiving beauty in natural forms. The relationship with the environment and nature is reduced to its exploitation as a source of economic profit or as a way for spending free time, a source of personal comfort devoid of any spiritual significance. Surely we cannot go back to archaic religions or medieval Christianity, but we can reintegrate into our moral values something of those cultures’ admiration and respect for the beauty/sublimity of nature and the world as expressions of divine creation, as something sacred. Philosophical debates related to this retrieval and their dissemination could be part of solving the ecological problems of the contemporary world. (shrink)

In this article, I pursue the question whether it is possible to understand Derridean ethics in terms of space rather than time. More precisely, I ask whether what Derrida proposes as an ethics (and exactly what that is will have to be explained) falls under the general heading of future-oriented, ‘eschatological’ or ‘messianic’, ethics that sacrifices the present for a better future, or whether it can be understood in terms of presence, more specifically of the demand to cohabit here and (...) now in the world. After proposing a reading of the to-come in terms of the intrusion of exteriority in the present, I turn to the figure of hospitality to show that Derrida's ethics is better understood in spatial rather than temporal terms: it requires a certain way of relating to the space in which we dwell. (shrink)

This short paper responds to the essays by Shilpi Sinha, Shaireen Rasheed, and Lyudmila Bryzzheva. It considers how racial inequality between teachers and students affects the possibilities of educational hospitality, both in cases of white teachers teaching racialized students and in cases of racialized teachers teaching white students. The response takes a phenomenological turn, considering the relative vulnerability of bodies that encounter each other in educational spaces which, themselves, are not neutral.

The recent revival of the theme of hospitality in the humanities and social sciences reflects a shared concern with issues of belonging, identity and placement that arises out of the experience of globalized social life. In this context, migration — or spatial dislocation and relocation — is often equated with demands for hospitality. There is a need to engage more carefully with the ‘proximities’ that prompt acts of hospitality and inhospitality; to attend more closely to their spatial and temporal dimensions. (...) Is the stranger or the Other primarily one who is recognisably ‘out of place’? Or is there more to being estranged than moving from one territory to another? This brings us to the question of human finitude, and to the possibility of encounters with others that do not simply only occur in time or space, but are themselves generative of new times and spaces. (shrink)

This is an analysis of Lady Mary Wortley Montagu's Turkish Embassy Letters, first written in the early eighteenth century when she travelled to the Ottoman Empire, and finally ‘published’ in 1763. As well as producing ‘the very first example of a secular work by a woman about the Muslim Orient’, Montagu is a pioneer in introducing the Turkish women's practice of inoculation against smallpox into England. This article sets out the long-standing critical debate over the rights and wrongs of the (...) Letters, particularly focusing on the period since the 1970s when feminist and post-colonial readings have presented or questioned Montagu's credentials with respect to the politics of sex, sexuality, race, religion and class. It concludes that Montagu describes how she is received with considerable, if conditional, hospitality by Turkish women in their bagnio and ‘harems’, and that her writing is, in turn, conditionally hospitable towards them. She is explicitly concerned not to fall into the Orientalizing clichés of Early Modern men's travel writing, which typically represents Muslim women as imprisoned in harems, enslaved, starved of sex and sexually voracious. By careful consideration of the historical, political and social context of the societies which Montagu knew, and could make comparison between, a modern reader too can act hospitably in taking Montagu's narrative into her own. (shrink)

This article examines the limits and potential of hospitality through struggles over auditory space in care at the end of life. Drawing upon empirical research and a nurse’s account of noisy mourning in a multicultural hospice ward, I argue that the insurgent force of noise as corporeal generosity can produce impossible dilemmas for care, while also provoking surprising ethical relations and potentialities. Derrida’s ideas about the aporias of the gift and absolute responsibility are used to make sense of the pushy (...) generosity of alterity as it is made to matter through sound. (shrink)

In a restorative classroom inspired by a vision of racial equity, race consciousness is a necessity and a restorative outcome is conceptualized in terms of a sustainable interdependent right-relation, a species of racial justice. Yet, regardless of intent, the constructed space is white. Race-based inequity is reproduced as White students get more of everything from class than do students of Color. What made the space white? How might hospitality affect the restorative possibilities of and in the space? I explore these (...) questions and reconceptualize right-relation as that which necessitates hospitality. (shrink)

This paper examines the meaning of space and its relationship to value. In this paper, I draw on Henri Lefebvre to suggest that our ethics produce and are produced by spaces. Space is not simply a passive material container or neutral geographic location. Space includes the ideas on which buildings are modeled, the ordering of objects and movement patterns within the space, and the symbolic meaning of the space and its objects. Although often unrecognized, space itself is value-laden, and (...) its values are suggested as people interact within that space. By reflecting on the spaces of health care, we will see that we not only must attend to the quandaries caused by the delivery of health care in non-acute places, but also to the values that produce and are produced by spaces. These values influence our moral imagination and shape us as people. (shrink)

The attempt in this article is to reflect on the notion of hospitality, building on Derrida's engagement with the notion. In doing so, I visit some of the debates on cosmopolitanism, a term which, I believe, is sometimes used overenthusiastically, neglecting the negative implications it might carry. Besides, I observe the same uncritical stance towards the reception of Kant's notion of `universal hospitality', developed in his famous piece on `Perpetual Peace', a text that has been at the core of the (...) recent debates on cosmopolitanism. I revisit Kant's text to discuss the implications of his project. I distinguish between `the other' and `the stranger', and try to develop a politics and ethics of hospitality due to the stranger. I conclude with some implications of `not being home'. (shrink)

In the last two decades, we have seen an increasing display of gestures and language of forgiveness in the public realm. Forgiveness has become a secular phenomenon. What do we mean by forgiveness? What is the role of forgiveness in the public place? Does it have the capacity to enhance the political life and well-being of a community? In The Human Condition, first published in 1958, Hannah Arendt offers an unapparelled reading of political forgiveness, described as a quintessential human faculty (...) for the revitalization of the public and political realm. This paper seeks to investigate the implications of Arendt’s understanding of action and forgiveness for the life of the polis, in particular the promotion of a more hospitable public space. Situated within human capacity to act and to love the other in their uniqueness and despite their trespasses and failures, forgiveness contributes, as this paper seeks to demonstrate, to the enhancement of the political sphere by opening this space to “new beginnings.”. (shrink)

There is a growing body of scholarship that is addressing the ethics, in particular, the bioethics of space travel and colonisation. Naturally, a variety of perspectives concerning the ethical issues and moral permissibility of different technological strategies for confronting the rigours of space travel and colonisation have emerged in the debate. Approaches ranging from genetically enhancing human astronauts to modifying the environments of planets to make them hospitable have been proposed as methods. This paper takes a look at a (...) critique of human bioenhancement proposed by Mirko Garasic who argues that the bioenhancement of human astronauts is not only functional but necessary and thus morally permissible. However, he further claims that the bioethical arguments proposed for the context of space do not apply to the context of Earth. This paper forwards three arguments for how Garasic’s views are philosophically dubious: (1) when he examines our responsibility towards future generations he refers to a moral principle (which we will call the principle of mere survival) which, besides being vague, is not morally acceptable; (2) the idea that human bioenhancement is not natural is not only debatable but morally irrelevant; and (3) it is not true that the situations that may arise in space travel cannot occur on Earth. We conclude that not only is the (bio)enhancement of humans on Earth permissible but perhaps even necessary in certain circumstances. (shrink)

The question "Where do we come from?" has fascinated philosophers, scientists, and artists for generations. This book reorients the question of the matrix as a place where everything comes from (_chora_, womb, incubator) by recasting it in terms of acts of "matrixial/maternal hospitality" producing space and matter of and for the other. Irina Aristarkhova theorizes such hospitality with the potential to go beyond tolerance in understanding self/other relations. Building on and critically evaluating a wide range of historical and contemporary scholarship, (...) she applies this theoretical framework to the science, technology, and art of ectogenesis (artificial womb, neonatal incubators, and other types of generation outside of the maternal body) and proves the question "Can the machine nurse?" is critical when approaching and understanding the functional capacities and failures of incubating technologies, such as artificial placenta. Aristarkhova concludes with the science and art of male pregnancy, positioning the condition as a question of the hospitable man and newly defined fatherhood and its challenge to the conception of masculinity as unable to welcome the other. (shrink)

El texto plantea una lectura de la obra de Michel Foucault según la cual en la época clásica –siglos XVII y XVIII– se construye una concepción del espacio que es correlativa a las prácticas discursivas que caracterizan la “episteme de la representación”. Esta concepción vincula los campos estético, social y epistémico a través de la idea del espacio como un ‘campo de visibilidad’ cuyas reglas de constitución comunican un tipo de representación pictórica, un modelo de distribución de las poblaciones y (...) una forma de discurso sobre la enfermedad. Dado que esas reglas, a su vez, se realizan a través de dispositivos concretos de producción de saber y de relaciones de poder, en su descripción espero dar cuenta de los límites históricos y epistémicos de la época clásica. (shrink)

This paper presents part of a larger study of contemporary nursing practice and the rationalisation of hospital length of stay. Informed by Michel Foucault's work on governmentality, length of hospital stay and the re-engineering of surgical services are examined, not in terms of numerical representations of hospital use, but as part of social and political processes through which certain concepts are made susceptible to measurement and practices are organised. Using data generated through fieldwork in a hospital surgical division this analysis (...) offers understandings of how social practices around length of hospital stay are translated and how they pattern contemporary hospital nursing practice. Nursing practice is explored through the reconstitution of hospital beds and the demands of local administration of hospital length of stay. (shrink)

This essay explores thematic overlaps in Jacques Derrida's writings on hospitality and stories of hospitality told by Balga Bedouin in Jordan. Why do these overlaps exist? What produces them? What can these likenesses tell us about the relationship between hospitality, politics and moral reasoning? Juxtaposing an exemplary Jordanian tale of hospitality with motifs and claims central to Derrida's work, I argue that a shared and second language pervades this material. The language in question grows out of real historical relations, but (...) it is also rooted in a desire, keenly felt among metropolitan political theorists and Bedouin social philosophers alike, to locate human interaction in idealized spaces that transcend the political and moral systems in which we live. Playing on contradictory themes of welcome and trespass, hospitality is a rich medium in which to imagine worlds that are more open, and more vulnerable, to Others. (shrink)

The point of departure of this article is that hospitality in education has not been theorized in terms of emotion and affect, partly because its law have been discussed in ways that have not paid much attention to the role of emotion and affect. The analysis broadens our understanding of the ethics and politics of hospitality by considering it as a spatial and affective relational practice. In particular, concepts from affect theory such as the notion of affective atmospheres and atmospheric (...) walls are discussed to highlight the notion of affective hospitality. It is argued that a greater awareness of the micro-politics of hospitality in its everyday enactment in various educational settings can show educators how specific practices of hospitality work to produce affective spaces in which the socio-historical context of privilege may be interrupted. The paper concludes with a discussion of the ethical, political and pedagogical implications of affective hospitality. (shrink)

The general pattern of Christian children’s ministry has been for adults to deliver structured programs to children. Drawing on the biblical imperative of hospitable space, a more profound understanding is to provide bounded opportunities for children themselves to engage in missional ministry. Implications are suggested for local church ministry and Christian parenting.

At the center of much of this chapter's disagreement with Jeremy Waldron is interpreting Immanuel Kant's doctrine of jus cosmopoliticum, which can be rendered into English as “cosmopolitan right” or “cosmopolitan law.” Kant's doctrine of universal hospitality opens up a space of discourse. The discourse of hospitality moves from the language of morals to that of juridical right. No matter how limited in scope the right of hospitality may be, Kant's three articles of “Perpetual Peace,” taken together, articulate principles of (...) legal cosmopolitanism, according to which the individual is not only a moral being who is a member of a universal moral community but is also a person entitled to a certain status in a global civil society. Referring to “hospitality” as signifying all human rights claims that are cross-border in scope, may be more intelligible when viewed against the intentions of Kant's essay as a whole. (shrink)

In Of Other Spaces Foucault coined the term "heterotopias" to signify "all the other real sites that can be found within the culture" which "are simultaneously represented, contested, and inverted." For Foucault, heterotopic spaces were first of all spaces of crisis, or transformative spaces, however these have given way to heterotopias of deviation and spaces of discipline, such as psychiatric hospitals or prisons. Foucault's essay provokes us to think through how spaces of crisis and (...) critique function to open up disruptive, subversive or minoritarian fields within philosophical, political, cultural or aesthetic discourses. This book takes this interdisciplinary and international approach to the spatial, challenging existing borders, boundaries, and horizons; from Claire Colebrook's chapter unpacking the heterotopic spaces of America and Mexico that lie beyond reductive ideological spaces of light and darkness, to a Foucauldian reading of the Zapatista resistance. With essays on politics, philosophy, literature, post-colonial studies, and aesthetics from established and emerging academics, this book answers Foucault's call to give us a better understanding of our present cultural epoch."--Provided by publisher. (shrink)

What is hospitality? Who is it addressed to? Hospitality aims at welcoming those who arrive; it demands giving space and time and sharing our own resources with others. In view of the current global migration crisis and in the midst of the social debates and a critique of the failure of affluent countries and Western democracies to respond in solidarity to those in need, this article attempts to re-consider the space for hospitality drawing from the ethical and the political as (...) the two fundamental pillars of social architecture. In an effort to discuss collective grassroots reactions to this general lack of hospitality, I address the Catalan social platform Volem Acollir in their request to the state to open up the borders for the reception of a larger number of migrants. Far from being an individual choice, or an optional political decision, hospitality confronts us with the moral dilemma of the human response to our cultural others. (shrink)

Now more than ever the role of the other has been put into question and marginalized in a redefinition of an “American national self-protective identity” in the current post election climate. In philosophical terms, an identity of a radical other- implies that any change, any difference, any impurity can be conceived as posing a threat to identity. If a specific group of people is identified as preventing the self from being what it ought to be, the other is identified as (...) a security threat. One option is to willingly conform to the assigned role as a threat. The opposite option I argue in my paper is one that can be achieved through the lens of a cosmopolitan framework of hospitality. By exploring the writings of French philosopher, feminist and psychoanalyst Luce Irigary’s cosmopolitan pedagogy of difference rooted in the concept of hospitality from the point of view of education, I hope put forth an alternative phenomenological pedagogy, one that connects issues of positionality with those of an embodied anti-racist philosophy of difference. By using case studies from my own classroom, I hope to elucidate how educators can implement an anti-racist pedagogy in the current post election climate, by creating spaces for dialogue where students are engaging in an authentic discourse on the nature of their positionality. (shrink)

As space travel and intentions to colonise other planets are becoming the norm in public debate and scholarship, we must also confront the technical and survival challenges that emerge from these hostile environments. This paper aims to evaluate the various arguments proposed to meet the challenges of human space travel and extraterrestrial planetary colonisation. In particular, two primary solutions have been present in the literature as the most straightforward solutions to the rigours of extraterrestrial survival and flourishing: (1) geoengineering, where (...) the environment is modified to become hospitable to its inhabitants, and (2) human (bio)enhancement where the genetic heritage of humans is modified to make them more resilient to the difficulties they may encounter as well as to permit them to thrive in non-terrestrial environments. Both positions have strong arguments supporting them but also severe philosophical and practical drawbacks when exposed to different circumstances. This paper aims to show that a principled stance where one position is accepted wholesale necessarily comes at the opportunity cost of the other where the other might be better suited, practically and morally. This paper concludes that case-by-case evaluations of the solutions to space travel and extraterrestrial colonisation are necessary to ensure moral congruency and the survival and flourishing of astronauts now and into the future. (shrink)

This is an exploration of women’s tradition of hospitality, the epistemic and moral contribution of their practices of welcoming the other and their historical experience as providers of care. The essay claims that female hospitality has largely consisted of care for others, which challenges a social model based on individualism and self-sufficiency. The argument is rooted in ethnography and Jewish thought and reclaims the home as an ethical space. This text analyses two disturbing and painful stories from the Tanakh that (...) are both examples of the consequences of extreme or absolute hospitality and violence against women. The famous works of Jacques Derrida and Emmanuel Lévinas on hospitality as ethics and hospitality as the feminine are discussed vis-à-vis anthropological and feminist approaches to the connection between the female welcoming of the other and the ethics of care. Finally, the reflections of the members of Beit Midrash Arevot shed light on a traditionist feminism that develops an ethics and practice of hospitality as welcoming otherness. (shrink)

Materializing absence, Jenny Hockey, Carol Komaromy and Kate Woodthorpe -- Never say die: CPR in hospital space, Susie Page -- Making hospice space, Ken Worpole -- Dying spaces in dying places, Carol Komaromy -- The materialities of absence after stillbirth: historical perspectives, Jan Bleyen -- Distributed personhood and the transformation of agency: an anthropological perspective on inquests, Susan Langer -- Behind closed doors? corpses and mourners in English and American funeral premises, Sheila Harper -- Private grief in public (...) class='Hi'>spaces: interpreting memorialisation in the contemporary cemetary, Kate Woodthorpe -- Wandering lines and cul-de-sacs: trajectories of ashes in the United Kingdom, Leonie Kellaher, Jenny Hockey and David Prendergast -- Natural burial: the de-materialising of death?, Andy Clayden, Jenny Hockey and Mark Powell -- What will the neighbours say? reactions to field and garden burial, Tony Walter and Clare Gittings -- Memorialising the suicide victim: "walking the walk," Caroline Simone -- Potent reminders: an examination of responses to roadside memorials in Ireland, Una McConville and Regina McQuillan -- Geographies of the spirit world, Douglas J. Davies -- Recovering presence, Jenny Hockey, Carol Komaromy and Kate Woodthorpe. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God’s existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense of specifically Christian bioethical (...) norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics. (shrink)

Neoliberal rationality eliminates what these thinkers termed the "good life" or the "true realm of freedom", by which they did not mean luxury, leisure, or indulgence, but rather the cultivation and expression of distinctly human capacities for ethical and political freedom, creativity, unbounded reflection, or invention.The legacy of Kant's political writings is uniquely duplicitous. This is because the space of the Kantian text is capable—as great philosophical works often are—of sustaining immense contradictions.1 On the one hand, as has long been (...) well known, Kant's universalist notion of reason provided justification for and implicitly sanctioned the violence of racist colonial civilizing... (shrink)

To what extent do we pay attention to the text and images that cover our hospital walls and do we offer any critique either as professionals or service users? In the past we might have expected to see functional or helpful instructions about where to go (or not to go) and in more well‐endowed buildings, perhaps we would see some works of art, sculpture, stained glass even, with the intention to encourage, distract or even forewarn us. However, it is now (...) common in UK hospitals, for wall space to be used as a portal for a range of institutional political messages, that convey information about everything from its own values, behaviours to advertisements for products and services to requirements for rule following. Michel Foucault's ideas about Heterotopic space can help us to see that hospitals tend to fall (awkwardly) between being a public and personal health care space, and this is a possible explanation for the confused material culture and messages that are shared there. This paper draws on ethnographic methods to reflect on personal experience in order to offer a critique of the contemporary political discourse which has become 'literally' written onto our hospital walls. (shrink)

In this paper we outline the possibilities of an ethic of care based on our self-affection and subjectivity in the ethical spaces between-two. In this we first refer to three Irigarayan concepts – breath, silence and listening from the third phase of her philosophy, and discuss them within the methodological framework of an ethics of intersubjectivity and interiority. Together with attentiveness, we analyse them as four categories of our ethical becoming. Furthermore, we argue that self-affection is based on our (...) inchoate receptivity for the needs of the other and is thus dialectical in its character. In this we critically confront some epistemological views of our ethical becoming. We wind up this paper with a proposal for an ethics towards two autonomous subjects, based on care and our shared ethical becoming – both as signs of our deepest hospitality towards the other. (shrink)

REIMER‐KIRKHAM S, SHARMA S, PESUT B, SAWATZKY R, MEYERHOFF H and COCHRANE M. Nursing Inquiry 2012; 19: 202–212 Sacred spaces in public places: religious and spiritual plurality in health careSeveral intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as ‘new’, ‘alternative’, ‘emergent’ and ‘progressive’ spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These (...) shifts are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high‐paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients’ beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3‐year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of ‘sacred’ and ‘place’, exploring how the sacred – that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power – takes form in social and material spaces in hospitals. (shrink)

The present paper explores patients’ experience of lived space at the hospital and at home. To expand the understanding of the existential meaning of lived space the study revisited two empirical studies and a study of a meta-synthesis on health and caring. Phenomenological philosophy was chosen as a theoretical framework for an excursive analysis. The paper demonstrates that existential dimensions of lived space at the hospital and at home differ significantly. For the patients, the hospital space means alien territory as (...) opposed to the familiar territory of home. To some extent the experienced differences are due to the physical environment; however, as our analysis shows, other and more significant meanings are also involved. For patients, lived space at the hospital primarily concerns the influence of complex institutional power structures and specific cultural and social conventions, e.g. the role of the good patient and the ambiance of hospitals. Home, on the other hand, offers familiar lived space in which patients feel protected and safe. Further, the paper relates patients’ experience of lived space to a phenomenological view of lived space in order to illustrate the radical influence of illness on patients’ lifeworld and experience of lived space. The combination of illness and general discomfort may influence patients’ experience of home negatively; the former experience of home as a sanctuary changes into feelings of being left on one’s own and burdened by too much responsibility. Consequently, in the light of the increasing focus on patients’ self-monitoring at home, it is important for healthcare professionals to recognize the influence of spatial aspects on patients’ well-being both at the hospital and at home. (shrink)

The ArgumentEmergency medicine, a new medical specialty in the United States, is an ethical practice that has developed through its interaction with the spaces in which it is situated. We discuss this claim in two steps followed by a demonstration. First we examine the historical evolution of the hospital, to provide the background for a lengthier account of the historical transformation of the emergency room. We then introduce Foucault's approach to ethics, to explain the sense in which emergency medicine (...) is an ethical practice constituted, in part, by its space of operation. The preliminaries of the application of our historico-ethical framework to emergency medicine, are presented, focusing on cardiopulmonary resuscitation. Our intention is to provide a framework for the newest clinical specialty as an ethical practice in order to understand how to individuate its emerging ethical problems. The emphasis on space throughout enables us to integrate the historical development of emergency medicine with its present concrete setting, and to establish a basis for analyzing emergency medicine that does not rely uncritically on either a preferred ethical perspective or the perspective of its practitioners. (shrink)

“I'm Jewish, you know, and my mother said, ‘Always trust the rabbis.’” I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility—white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces—the absence of his voice, the too-large bed for his shrinking (...) frame, the always-empty chair by his bedside, and most of all, the myriad gaps in his life story. He was what in hospitals is often called a “patient alone”: someone who lacks decisional capacity and has no surrogate to make medical decisions for him. Mr. Weisman's aloneness prompted his primary team to consult our bioethics service in order to formulate goals of care for him, including the possibility of hospice care. (shrink)

In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians (...) about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are ethics committee meetings, Nursing Ethics Forum, ethics Brown Bag workshops, PICU ethics rounds, Grand Rounds, NICU Comprehensive Care Rounds, Palliative Care Team case conferences, multidisciplinary consults in Fetal Health Center, and ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today. (shrink)

Community-based participatory research is growing in popularity as a research strategy to engage communities affected by health issues. Although much has been written about the benefits of using CBPR with diverse groups, this research has usually taken place in community-based organizations which offer social services and programs. The purpose of this article is to explore the opportunities and challenges encountered during a CBPR project conducted in a small hospital serving people living with HIV and addictions issues. The structure of hospital-based (...) care delivery required the team to account for participants’ health-related limitations, including adopting recruitment strategies built on clinical care, and modifying the original research design to better protect participant confidentiality in a small space. Although CBPR offers an important strategy for researching with members of hospitalized communities, it requires research teams to develop context-relevant approaches to ethically engaging community members that recognize the ways clinical space mediates the research process. (shrink)

In the Philippines, all transplant centers are mandated by the Department of Health (DOH) to have a Hospital Transplant Ethics Committee (HTEC) to ensure that donations are altruistic, voluntary and free of coercion/commercial transactions. This study was undertaken primarily to describe the organizational and functional profile of existing HTECs and identify areas for improvement. This is a descriptive cross‐sectional study. There was variation in their logistical arrangements (support from hospital, filing systems, office spaces), operations (length and frequency of meetings, (...) number of referrals) and membership (composition, qualifications, occupation, training). The approval rate for donor‐recipient pairs is high with the majority of cases made by living non‐related donors. Appropriate reasons were cited for rejection. The perception of HTECs is that they are competent and confident in their decision‐making. However, there is a need to standardize HTEC composition, provide operating procedures and additional training which can be done by the DOH. (shrink)

Margaret Urban Walker argues that hospital ethics committees should think of their task as "keeping moral space open." I develop her suggestion with analogies: Enlarge the windows (i.e., expand what counts as an ethical issue); add rooms and doors (i.e., choose particular issues to engage). Examples include confidentiality defined as information flow, and moral distress in the healthcare workplace.

In an effort to address healthcare disparities in lesbian, gay, bisexual, transgender, and queer populations, many hospitals and clinics institute diversity training meant to increase providers’ awareness of and sensitivity to this patient population. Despite these efforts, many healthcare spaces remain inhospitable to LGBTQ patients and their loved ones. Even in the absence of overt forms of discrimination, LGBTQ patients report feeling anxious, unwelcome, ashamed, and distrustful in healthcare encounters. We argue that these negative experiences are produced by a (...) variety of subtle, ostensibly insignificant features of healthcare spaces and interpersonal interactions called microaggressions. Healthcare spaces and providers often convey heteronormative microaggressions, which communicate to LGBTQ—and, we suggest, intersex and asexual —people that their identities, experiences, and relationships are abnormal, pathological, unexpected, unwelcome, or shameful. We identify heteronormative microaggressions common to healthcare settings and specify how they negatively impact LGBTQIA patients. We argue that standard diversity training cannot sufficiently address heteronormative microaggressions. Despite these challenges, healthcare institutions and providers must take responsibility for heteronormative microaggressions and take steps to reduce their frequency and mitigate their effects on LGBTQIA care. We conclude by offering strategies for problem-solving at the level of medical education, institutional culture and policy, and individual awareness. (shrink)

This article explores the often-disparate commitments the chaplain has made to both the institutional church as well as the hospital system through the lens of the baptismal rite. As baptism is primarily a religious act meant to initiate new members into the Christian faith and a specific community, the chaplain must grapple with the meaning of baptism in the hospital system, a place of crisis and transient community. It is the numinous presence that binds the chaplain’s disparate commitments together in (...) the liminal space between the clinical and ecclesial within which the chaplain exists. The numinous expands the boundaries of institutions often at odds. The chaplain finds meaning and purpose by bearing witness and remaining committed to this numinous presence that binds. (shrink)

In this paper, we pay attention to the impact on staff of what was a new place, Ko Awatea, within a large New Zealand hospital. The place became a space from within which a particular mood arose. This paper seeks to capture that mood and its impact. Using a Heideggerian hermeneutic approach, the study reported on drew on data from interviews with 20 staff. Philosophical notions about the nature and mood of place/space are explored. As staff claimed this space, the (...) mood that emerged was of liveliness, buzz and comfort. It became a space where people wanted to be, where they met others, where conversations unfolded, where thinking happened in new ways. Staff places tend to be sacrificed or poorly resourced in resource-tight environments. We argue that creating a space that feels home-like, where staff come, linger and engage in community is a priority for generating the mood and thinking of an organization. Such spaces do not happen by chance; it takes forethought and intentionality. The gift of such space is the thinking that is sparked and grown. (shrink)

While the concept of internationalization plays a key role in contemporary discussions on the activities and outcomes sought by universities, it is commonly argued that it is poorly understood or realised in practice. This has led some to argue that more work is needed to define the dimensions of the concept, or even to plot out stages of its achievement. This paper aims not to provide a definition of internationalisation for those working in higher education. On the contrary, it seeks (...) to open up discussion on internationalisation by considering Derrida's reflections on hospitality and the metaphysics of presence. In so doing, it will be shown that internationalisation is an ethical demand that is as much about being unsettled by thinking about ourselves and others, as it is about mobility programs and online education, and about being ‘late’ rather than surrendering to the space‐time compression of modernity. (shrink)

Lesbian, gay, bisexual, trans and/or queer (LGBTQ) people experience profound health and social care inequalities. Research suggests that staff with negative attitudes towards LGBTQ people, are more likely to hold strong, traditional, religious beliefs. This article reports on a single case study with a newly qualified UK nurse who has since left the National Health Service. This is based on a single interview taken from a larger dataset derived from a funded scoping research study exploring religious freedoms, sexual orientation and (...) gender identity rights in older age care spaces. The interviewee described a toxic nursing culture on a hospital ward for older people. She recounted various incidents involving homophobic and transphobic practice and LGBTQ microaggressions which reportedly impacted the quality of nursing care. The findings are considered in relation to standards for anti-oppressive practice in nursing care, and how nursing students and staff can be supported in addressing practice relating to equality and diversity issues, specifically LGBTQ issues. They confirm the direct significance of addressing the needs and circumstances of LGBTQ people in nursing curricula and ongoing professional practice, and the need to further research, evaluate and progress translation of learning into improved quality care for diverse populations. (shrink)

This paper explores the notion of hospitality and faith in Derrida and Kierkegaard. The aim is to trace the topological core of existence in relation to an ongoing debate in contemporary continental philosophy of religion about khôra. The paper shows how khôral traces are at work in Kierkegaard’s thinking in relation to the topological proximity of love. The claim is, that Kierkegaard emphasizes, not a hostility but a vulnerability of what I coin khôral love – the vibrating space between the (...) anonymous and the amorous, call and response. The unknown X of the khôral becomes the topos of existence – the “stepping out”, the “you are here (X)”. A “you” called forth by the commandment of love or the visitation of the stranger. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There is little (...) systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)