Contemporary accounts on fictional emotions, i.e., emotions experienced towards objects we know to be fictional, are mainly concerned with explaining their rationality or lack thereof. In this context dominated by an interest in the role of belief, questions regarding their phenomenal quality have received far less attention: it is often assumed that they feel “similar” to emotions that target real objects. Against this background, this paper focuses on the possible specificities of fictional emotions’ qualitative feel. It starts (...) by presenting what I call the “phenomenological question” about the qualitative feel of fictional emotions (section 1) and by showing that this is irreducible to questions about their cognitive, intentional, evaluative, and embodied nature (section 2). Drawing on some insights from early phenomenologists, the next two sections elaborate criteria to distinguish between real and sham emotions on the one side (section 3) and between genuine and non-genuine emotions on the other (section 4). Finally, I apply this orthogonal distinction to the particular case of fictional emotions (section 5). The paper argues that fictional emotions are neither sham emotions nor quasi-emotions, but full-fledged emotional experiences, despite them displaying the distinctive phenomenology of emotions experienced as non-genuine. In the particular case of fictional emotions, they are non-genuine because our psychology is in fact in a state dominated by aesthetic enjoyment. (shrink)

BackgroundDuring the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had (...) considered to uptake at least one social egg freezing cycle in Belgium.MethodsTo understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis.ResultsWe identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free.ConclusionsThis research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance. (shrink)

Nursing students face various ethical issues, which may cause stress, that require coping strategies. This study investigated the thoughts and feelings underlying the coping behaviors adopted by nursing students when addressing ethical issues. Semi-structured interviews were conducted from September to October 2011 with 11 students enrolled at University A who had completed basic nursing and specialty practicums and consented to participate in the study. Data were analyzed using qualitative methods. The participant narratives about ethical issues encountered during clinical practicums (...) were organized into four themes and 20 scenarios. The ethical issues concerned the attitudes and conduct of nurses, doctors, physical therapists, and other medical professionals. Seven coping behaviors were identified. The results revealed that nursing students waver between valuing their relationships with nurses and their relationships with patients when they encounter an ethical issue. When their relationships with nurses were emphasized, their ethical values were restructured. These findings suggest the need to address the affective domain early on in lectures and in-class practice, and to create an environment in which students taking practicums can easily express their feelings and internal value system changes. (shrink)

Background In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim of understanding (...) awareness and support of the change. This paper analyses the free-text responses from the survey. Methods The #options survey was registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992] 14 February 2020, and was completed between July and December 2020 across NHS organisations in the North-East and North Cumbria, and North Thames. The survey contained 16 questions of which three were free-text, covering reasons against, additional information required and family discussions. The responses to these questions were thematically analysed. Results The #options survey received 5789 responses from NHS staff with 1404 individuals leaving 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses (66%), followed by those against the legislation (19%), and those requiring more information (15%). Analysis revealed six main themes with 22 sub-themes. Conclusions The overall #options survey indicated NHS staff are supportive of the legislative change. Analysis of the free-text responses indicates that the views of the NHS staff who are against the change reflect the reasons, misconceptions, and misunderstandings of the public. Additional concerns included the rationale for the change, informed decision making, easy access to information and information regarding organ donation processes. Educational materials and interventions need to be developed for NHS staff to address the concepts of autonomy and consent, organ donation processes, and promote family conversations. Wider public awareness campaigns should continue to promote the positives and refute the negatives thus reducing misconceptions and misunderstandings. Trial registration National Institute of Health Research (NIHR) [IRAS 275992]. (shrink)

In an article published in Prolegomena 2006, Christoph Schmidt-Petri has defended his interpretation and attacked mine of Mill’s idea that higher kinds of pleasure are superior in quality to lower kinds, regardless of quantity. Millian qualitative superiorities as I understand them are infinite superiorities. In this paper, I clarify my interpretation and show how Schmidt-Petri has misrepresented it and ignored the obvious textual support for it. As a result, he fails to understand how genuine Millian qualitative superiorities determine (...) the novel structure of Mill’s pluralistic utilitarianism, in which a social code of justice that distributes equal rights and duties takes absolute priority over competing considerations. Schmidt-Petri’s own interpretation is a non-starter, because it does noteven recognize that Mill is talking about different kinds of pleasant feelings, such that the higher kinds are intrinsically more valuable than the lower. I conclude by outlining why my interpretation is free of any metaphysical commitment to the “essence” of pleasure. (shrink)

Barbara Montero considers whether or not we are able to remember what pain feels like. In order to properly answer this question, she introduces a new type of memory called 'qualitative memory', which seems common to exteroceptive sensations. Having concluded that there is arguably no qualitative memory for pain and other bodily sensations, Montero considers possible philosophical implications for areas including rational choice-making and empathy. In addressing the relationship between pain and memory, the paper raises an issue that (...) has not received much attention and indicates various interesting fields of research for which the apparent inability to remember pain might prove relevant. My comment primarily focuses on the core concepts of pain and qualitative memory which are foundational for the paper. I argue that a deeper engagement with some key aspects of these concepts is necessary. A more fine-grained discussion could have made Montero's argument more convincing. (shrink)

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and (...) experiences of physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

I continue my argument that Millian qualitative superiorities are infinite superiorities: one pleasant feeling, or type of pleasant feeling, is qualitatively superior to another in Mill's sense if and only if even a bit of the superior is more pleasant (and thus more valuable) than any finite quantity of the inferior, however large. This gives rise to a hierarchy of higher and lower pleasures such that a reasonable hedonist always refuses to sacrifice a higher for a lower irrespective of (...) the finite amounts of each. Some indication of why this absolute refusal may be reasonable is provided in the course of outlining the content of the Millian hierarchy. It emerges that Mill's hedonistic utilitarianism has an extraordinary structure because it gives absolute priority over competing considerations to a code of justice that distributes equal rights and correlative duties for all. His utilitarianism also recognizes that certain aesthetic and spiritual pleasures may be qualitatively superior even to the pleasant feeling of security associated with the moral sentiment of justice. Thus, for instance, a noble individual may reasonably choose to waive his own rights so as to perform beautiful supererogatory actions that provide great benefits for others at the sacrifice of the right-holder's own vital interests. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate (...) and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. (shrink)

Despite considerable growth in understanding of various aspects of sporting and exercise embodiment over the last decade, in-depth investigations of embodied affectual experiences in running remain limited. Furthermore, within the corpus of literature investigating pleasure and the hedonic dimension in running, much of this research has focused on experiences of pleasure in relation to performance and achievement, or on specific affective states, such as enjoyment, derived after completing a run. We directly address this gap in the qualitative literature on (...) sporting and exercise embodiment by contributing novel insights on the mind-body pleasures of running via focusing analytic attention towards the pleasures recalled by runners as experienced during positive, rewarding running experiences. Applying conceptual insights drawn from sociological phenomenology, we analyse data from an in-depth, event-focused interview study with distance runners who reported positive, rewarding experiences in recent recreational runs. Through reflexive thematic analysis, we present findings in relation to three themes: (1) ‘running feels like it should’; (2) sensory engagements; and (3) time out. The study contributes fresh perspectives, both conceptually and in relation to data-collection approach, to a small literature on the lived experience of pleasure in sport, exercise and physical cultures. (shrink)

I continue my argument that Millian qualitative superiorities are infinite superiorities: one pleasant feeling, or type of pleasant feeling, is qualitatively superior to another in Mill's sense if and only if even a bit of the superior is more pleasant than any finite quantity of the inferior, however large. This gives rise to a hierarchy of higher and lower pleasures such that a reasonable hedonist always refuses to sacrifice a higher for a lower irrespective of the finite amounts of (...) each. Some indication of why this absolute refusal may be reasonable is provided in the course of outlining the content of the Millian hierarchy. It emerges that Mill's hedonistic utilitarianism has an extraordinary structure because it gives absolute priority over competing considerations to a code of justice that distributes equal rights and correlative duties for all. His utilitarianism also recognizes that certain aesthetic and spiritual pleasures may be qualitatively superior even to the pleasant feeling of security associated with the moral sentiment of justice. Thus, for instance, a noble individual may reasonably choose to waive his own rights so as to perform beautiful supererogatory actions that provide great benefits for others at the sacrifice of the right-holder's own vital interests. (shrink)

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the (...) qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of “Breaking Point,” in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. (shrink)

Despite the prevalence of beliefs across religions regarding repentance and divine forgiveness and their recognition in theoretical and religious studies, these constructs are relatively understudied phenomena in the social sciences. Furthermore, in recent years, multiple scholars have argued for the need for research to systematically study and highlight the experience and processes of repentance and divine forgiveness. Subsequently, this study explored processes of repentance, antecedents and motivations of repentance, resources to aid in repentance, and outcomes of repentance that should be (...) further examined. This analysis was done using in-depth qualitative interviews with 15 emerging adult religious exemplars identifying with the Church of Jesus Christ of Latter-day Saints. The authors used NVivo 12 and team-based qualitative coding processes to identify themes. Repentance processes included personal change, took various lengths of time, were a part of participants’ religious identity, were recurrent processes, and were influenced by participants’ view of God. Antecedents and motivations included religious practices and rituals, emotions, interpersonal interactions, and their relationship with God. Resources that aided in repentance included religious practices and rituals, interpersonal relationships, and a relationship with God. Finally, participants reported experiencing personal changes in their behavior and character, positive emotions (including feelings of divine forgiveness), improved interpersonal relationships, and a better relationship with God. These processes align with some previously discovered and theorized findings on repentance, contribute a number of novel findings, and offer future direction regarding the motivations, resources, and transformative experiences that participants reported in their personal repentance and experience of forgiveness. (shrink)

Although the concept of uncertainty is as old as Epicurus’s writings, and an excellent quantitative theory, with entropy as the measure of uncertainty having been developed in recent times, there has been little exploration of the qualitative theory. The purpose of the present paper is to give a qualitative axiomatization of uncertainty, in the spirit of the many studies of qualitative comparative probability. The qualitative axioms are fundamentally about the uncertainty of a partition of the probability (...) space of events. Of course, it is common to speak of the uncertainty, or randomness, of a random variable, but only the partition defined by the values of the random variable enter into the definition of uncertainty, not the actual values. It is straightforward to add axioms for decision making following the general line of Savage from the 1950s. Indeed, in the spirit of Epicurus, it is really our intuitive feeling about the uncertainty of the future that motivates much of our thinking about decisions. Here, the distinction between the concepts of probability and uncertainty can be made by citing many familiar examples. Without spelling out the technical details, the axiomatization of qualitative probability with uncertainty as the most important primitive concept, it is possible to raise a different kind of question about bounded rationality. This new question is whether or not one should bound the uncertainty in thinking and investigating any detailed framework of decision making. Discussion of this point is certainly different from the question of bounding rationality by not maximizing expected utility. In practice, we naturally bound uncertainty in our analysis of decision-making problems. As in the case of formulating an alternative for maximizing expected utility, so is the case of rational alternatives to maximizing uncertainty. There are several issues to consider. In the spirit of my other work in qualitative probability, I explore alternatives rather than attempt to give a definitive argument for one single solution. (shrink)

Previous studies have shown that misperceptions and illusory experiences can occur if sensory stimulation is withdrawn or becomes invariant even for short periods of time. Using a perceptual deprivation paradigm, we created a monotonous audiovisual environment and asked participants to verbally report any auditory, visual or body-related phenomena they experienced. The data (analysed using a variant of interpretative phenomenological analysis) revealed two main themes: (1) reported sensory phenomena have different spatial characteristics ranging from simple percepts to the feeling of immersion (...) in a complex multisensory environment and (2) the active contribution of the perceiver where participants report engaging in exploratory processes even when there is nothing to find. Detailed analysis of the qualitative data further showed that participants who reported more perceptual phenomena were more likely to report internal bodily sensations, move more during the experiment and score higher on the Revised Hallucination Scale than those reporting fewer percepts explicitly linking perceptual deprivation to somatic phenomena. The results demonstrate how the variety of sensory experiences induced by perceptual deprivation can give further insight into the factors mediating conscious awareness and may suggest ways in which the brain imposes meaning on the environment under invariant sensory conditions. (shrink)

Studies that have explored the wish to hasten death (WTHD) in patients with advanced illness have found that the feeling of being a burden may trigger WTHD. Research suggests that both the feeling and the wish are indicators of multidimensional suffering whose meaning may depend on the patient's biographical background. Therefore, we carried out a systematic review and meta‐ethnography. Fourteen qualitative studies, reported in 16 articles, met the inclusion criteria. The analysis identified two themes: the personal and social dimensions (...) that could help to explain the feeling of being a burden in these patients. These dimensions reveal how this feeling is linked to physical, psychological/emotional, existential and social factors. The feeling of being a burden cannot be understood without considering patients’ personal interpretation of their dependency or care needs, and hence it is also necessary to understand their biographical background. Such an understanding is crucial to inform clinical policies based on the moral duty to provide all patients with humane care. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using (...) in-depth face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Although the concept of uncertainty is as old as Epicurus’s writings, and an excellent quantitative theory, with entropy as the measure of uncertainty having been developed in recent times, there has been little exploration of the qualitative theory. The purpose of the present paper is to give a qualitative axiomatization of uncertainty, in the spirit of the many studies of qualitative comparative probability. The qualitative axioms are fundamentally about the uncertainty of a partition of the probability (...) space of events. Of course, it is common to speak of the uncertainty, or randomness, of a random variable, but only the partition defined by the values of the random variable enter into the definition of uncertainty, not the actual values. It is straightforward to add axioms for decision making following the general line of Savage from the 1950s. Indeed, in the spirit of Epicurus, it is really our intuitive feeling about the uncertainty of the future that motivates much of our thinking about decisions. Here, the distinction between the concepts of probability and uncertainty can be made by citing many familiar examples. Without spelling out the technical details, the axiomatization of qualitative probability with uncertainty as the most important primitive concept, it is possible to raise a different kind of question about bounded rationality. This new question is whether or not one should bound the uncertainty in thinking and investigating any detailed framework of decision making. Discussion of this point is certainly different from the question of bounding rationality by not maximizing expected utility. In practice, we naturally bound uncertainty in our analysis of decision-making problems. As in the case of formulating an alternative for maximizing expected utility, so is the case of rational alternatives to maximizing uncertainty. There are several issues to consider. In the spirit of my other work in qualitative probability, I explore alternatives rather than attempt to give a definitive argument for one single solution. (shrink)

Transfers of critically ill neonates are frequent phenomena. Even though parents’ participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents’ experiences of neonatal transfer is lacking. This paper describes a meta‐study addressing qualitative research about parents’ experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological (...) issues of qualitative studies concerning parents’ experiences of neonatal transfer over the course of this meta‐study (2000–2017). Meta‐theory and meta‐method analyses showed that caring, transition, and family‐centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta‐data‐analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified ‘wavering and wandering’ as a metaphoric representation of the parents’ experiences. The findings add knowledge about meta‐study as an approach for comprehensive qualitative research and point at the value of meta‐theory and meta‐method analyses. (shrink)

A sense of belonging is an integral feature of an online community of learners. This article explores the ways in which digital technologies in an online teacher education programme can facilitate social presence and in turn nurture a sense of belonging in an OCL. A sense of belonging can lower attrition rates in distance programmes that attract learners who are marginalised from on campus education. This can help address issues of social justice by supporting equitable access and participation in higher (...) education. Findings from a qualitative case study indicate the power that digital technologies can have in facilitating social presence and a sense of belonging in an OCL. This study identifies the importance of several factors in this. Firstly, the importance of pedagogical understandings that digital technologies have different affordances in nurturing an OCL, and secondly, that each participant had a different perspective on the affordances of each digital technology in their usefulness for fostering social presence and a sense of belonging. (shrink)

Mother-to-child transmission of the Human Immunodeficiency –Virus is a serious public health problem, contributing up to 90% of childhood HIV infections. In Tanzania, the prevention-of-mother-to-child-transmission feature of the HIV programme was rolled out in 2000. The components of PMTCT include counselling and HIV testing directed at antenatal clinic attendees. It is through the process of Provider Initiated Counseling and Testing that counselling is offered participant confidentiality and voluntariness are upheld and valid consent obtained. The objective of the study was to (...) explore antenatal clinic attendees’ experiences of the concept of voluntariness vis- a- vis the implementation of prior counseling and subsequent testing for HIV under the PITC as part of their antenatal care. In-depth interviews were conducted with17 antenatal clinic attendees and 6 nursing officers working at the Muhimbili National Hospital antenatal clinic. The study data were analyzed using qualitative content analysis. Antenatal clinic attendees’ accounts suggested that counselling and testing for HIV during pregnancy was voluntary, and that knowledge of their HIV status led them to access appropriate treatment for both mother and her newborn baby. They reported feeling no pressure from nursing officers, and gave verbal consent to undergo the HIV test. However, some antenatal clinic attendees reported pressure from their partners to test for HIV. Healthcare providers were thus faced with a dilemma of disclosure/ nondisclosure when dealing with discordant couples. Antenatal clinic attendees at MNH undertook the PITC for HIV voluntarily. This was enhanced by their prior knowledge of HIV, the need to prevent mother- to- child transmission of HIV, and the effectiveness of the voluntary policy implemented by nursing officers. (shrink)

Do we remember what pain feels like? Investigations into this question have sometimes led to ambiguous or apparently contradictory results. Building on research on pain memory by Rohini Terry and colleagues, I argue that this lack of agreement may be due in part to the difficulty researchers face when trying to convey to their study’s participants the type of memory they are being tasked with recalling. To address this difficulty, I introduce the concept of ‘qualitative memory’, which, arguably, is (...) the sort of memory we have of what red looks like yet lack with respect to pain. I also briefly address a number of consequences the acknowledgment of qualitative memory would potentially have for philosophy, arguing that if we fail to have qualitative memories of certain sensations, such as pain, the standard philosophical accounts of experience, rational choice, and the sources of moral action may all need revision. (shrink)

Coastal environments are increasingly shown to have a positive effect on our health and well-being. Various mechanisms have been suggested to explain this effect. However, so far little focus has been devoted to emotions that might be relevant in this context, especially for people who are directly or indirectly exposed to the coast on a daily basis. Our preregistered qualitative study explored how coastal residents experience the emotions they feel at the coast and how they interpret the effect (...) these emotions have on them. We conducted semi-structured interviews with a purposive sample of eight Belgian coastal residents aged 21–25 years old. The interviews were analyzed with the approach of interpretative phenomenological analysis. Five superordinate themes were identified and indicate that, for our participants, the coast represents a safe haven in which they can experience emotional restoration, awe, and nostalgia. These emotional states are accompanied with adaptive emotion regulating strategies, such as reflection and positive reappraisal, that may facilitate coping with difficult thoughts and feelings. Our study demonstrates the importance of investigating specific emotions and related processes triggered at the coast and how these could contribute to the therapeutic value of the coast. (shrink)

Social egg freezing has become an expanding clinical practice and there is a growing body of empirical literature on women's attitudes and the sociocultural implications of this phenomenon. Yet, its impact remains subject to ethical controversy. This article reports on a qualitative study, drawing on 18 interviews with women who had elected to initiate at least one egg freezing cycle in Belgium. Our findings, facilitated by a ‘symbiotic empirical ethics’ approach, shed light on the concerns and perceptions that accompany (...) women's decisions while supporting a more context-sensitive reading of the ethical debate. We identified three key themes: feeling overwhelmed with uncertainty and a threatening future, bodily discomfort and distress during the medical process, and the endless pursuit of peace of mind. One of the issues that emerges from these findings is the risk ritual function of social egg freezing, referring to routine actions of risk anticipation that mitigate uncertainty and express a sense of individual responsibility. While more research is needed, this conceptualisation provides a starting point to flesh out the wider context of this moral practice and its symbolic meaning for women. (shrink)

Adam Morton, Stephen de Wijze, Hillel Steiner, and Eve Garrard have defended the view that evil action is qualitatively distinct from ordinary wrongdoing. By this, they do not that mean that evil actions feel different to ordinary wrongs, but that they have motives or effects that are not possessed to any degree by ordinary wrongs. Despite their professed intentions, Morton and de Wijze both offer accounts of evil action that fail to identify a clear qualitative difference between evil (...) and ordinary wrongdoing. In contrast, both Steiner's and Garrard's accounts of evil do point to qualitative distinctions between kinds of action, but it is implausible that either account correctly characterizes evil. The most plausible accounts maintain that evil actions have a necessary connection to extreme harms, and this suggests that evil is not qualitatively distinct from ordinary wrongdoing. (shrink)

Feelings are conscious mental events that represent body states as they undergo homeostatic regulation. Feelings depend on the interoceptive nervous system (INS), a collection of peripheral and central pathways, nuclei and cortical regions which continuously sense chemical and anatomical changes in the organism. How such humoral and neural signals come to generate conscious mental states has been a major scientific question. The answer proposed here invokes (1) several distinctive and poorly known physiological features of the INS; and (2) a unique (...) interaction between the body (the ‘object’ of interoception) and the central nervous system (which generates the 'subject' of interoception). The atypical traits of the INS and the direct interactions between neural and non‐neural physiological compartments of the organism, neither of which is present in exteroceptive systems, plausibly explain the qualitative and subjective aspects of feelings, thus accounting for their conscious nature. (shrink)

One of the explicit goals of the 1996 welfare reform in the United States was to create conditions that would encourage marriage as a means of reducing poverty and welfare “dependency.” With the exception of a few notable studies that examine reliance on abusive partners and former partners, relatively little scholarly attention has been given to the contours of partnering after welfare reform. Using a feminist lens on data from two qualitative studies, the author examines the partnership experiences of (...) a sample of mostly white women three to four years after they had left welfare. An exploration of women’s views of their transitions into and their experiences with partnering reveals that women align with a logic of heterosexual partnering that holds the potential to complicate their lives. The analysis sounds a precautionary note and provides empirical evidence that partnering in the context of the reduced options of welfare reform can diminish women’s long-term stability and that encouraging partnering is, ultimately, an unsustainable policy direction for the support of lone mothers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"But I Don’t Feel It":Values and Emotions in the Assessment of Competence in Patients With Anorexia NervosaJochen Vollmann (bio)Keywordscompetence assessment, mental capacity, informed consent, psychiatry, anorexia nervosaThe respect of the self-determination of patients obliges physicians to obtain the patient's consent before providing medical treatment. One important condition for a valid informed consent is the patient's competence to make autonomous health care decisions. Therefore, a proper assessment of competence (...) to make health care decisions is crucial particularly in patients with mental disorders (Vollmann 2000; Helmchen and Vollmann 2001). In recent years, several empirical studies on the assessment of competence in patients suffering from different mental disorders have been performed using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; Grisso and Appelbaum1998). This assessment tool is based on legal standards of competence such as understanding, reasoning, appreciation, and expressing a choice. Since its first publication, the MacCAT-T has been widely accepted as a "gold standard" of competence assessment in the psychiatric literature. In recent years the MacCAT-T has been applied to patients suffering from depression, schizophrenia, dementia, angina pectoris, and normal controls (for overview, see Welie [2001] and Bauer and Vollmann [2002]).Tan and her colleagues (2006) use the MacCAT-T the first time to assess competence to make treatment decisions in patients with anorexia nervosa. Coming from clinical practice, the authors have noticed that the MacCAT-T might not work in this group of patients. Therefore, they use semi-structured interviews in addition to the MacCAT-T to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. They use grounded theory techniques for a qualitative analysis of the data as well as five brief, self-administered questionnaires to ascertain levels of psychopathology.The results of the study show that anorexia nervosa can have complex and variable effects on concentration, beliefs, and thought processing without affecting the ability to perform well on the MacCAT-T. At the same time, participants also report a change in their value system as well as in their personal identity. The authors argue that the results of their studies suggest that the competence to refuse treatment might be compromised in [End Page 289] people with anorexia nervosa in ways that are not captured by the MacCAT-T. This is an interesting finding in patients with anorexia nervosa, because in all other studies with patients suffering from mental disorders such as dementia, depression, and schizophrenia, the MacCAT-T identified more patients as limited in their competence to make health care decisions in comparison with other methods of competence assessment such as clinical judgment (Vollmann et al. 2003). The authors argue on the basis on their qualitative, semistructured interviews that anorexia nervosa–specific difficulties with a thought process and the change of values are missed by the MacCAT-T.Furthermore, Tan and her associated could not find a relationship between the participants' scores on the psychopathological scales, the MacCAT-T scores, and their difficulties expressed during the qualitative interviews, although the small size of the study precludes statistical analysis. In an earlier study, clinical dementia scales but not neuropsychological testing correlated with formal (MacCAT-T) and clinical assessment of competence. Therefore, psychopathological factors might play a different role in different subgroups of patients suffering from different mental problems. However, the idea of an objective neuropsychological model of competence assessment, again, finds no support in the presented empirical data.The qualitative data from patients with anorexia nervosa underline the problem of the cognitive bias of the MacCAT-T assessment and the illusion of value-free categories. It has been argued that the cognitive focus for the MacCAT-T is in itself a normative convention and that the MacCAT-T is missing the complexity of the process to make health care decisions in real life. Therefore, values and emotions should be considered in addition to cognitive functions in assessing competence to make health care decisions (Breden and Vollmann 2004; see also "Mental capacity" 2004). Although many authors agree that the cognitive approach of capacity assessment is important but not sufficient for the assessment of competence to make health care decisions, it remains an... (shrink)

Based on a qualitative study with 124 participants we explore what is in ordinary language referred to as 'suicidal feelings'. We identify four interrelated aspects of this experience, which together suggest that 'suicidal feelings' is in fact a 'feeling of being suicidal', an existential feeling. Although each experience is unique in its presentation, it is also the case that people who are suicidal tend to experience a combination of the following: 1) loss of consistency and/ or coherence in their (...) sense of self; 2) a disruption in the reciprocal action between self and world; 3) serious depletion of their mental resources; and 4) a disturbance of embodiment. We then argue that 'the feeling of being suicidal' should be understood as a disruption in the experience of the self as an agent and that this forms the appropriate background for interpreting suicidal thoughts and intentions. (shrink)

Moral injury has primarily been studied from a clinical perspective to assess, diagnose and treat the outcomes of morally injurious experiences in healthcare and military settings. Little is known about the lived experiences of those who have had their moral values transgressed in business settings. Public scandals such as Enron suggest that moral injury may also occur in for-profit business settings. In this qualitative study, we examine the lived experiences of 16 employees in for-profit business organisations who identified as (...) having suffered moral injury. Using semi-structured narrative interviews, our findings offer insights into the values that employees feel are transgressed and the pathways between morally injurious experiences and the long-term outcomes. Based on our findings, we propose a conceptual pathway to moral injury, which suggests that experiencing moral transgressions has a profound impact on employees as they feel a threat to their “good-me” identity, however, employees employ various coping strategies to minimise the impact during the event. Employees exited the organisation and often changed career paths to protect themselves from further injury and to make up for moral failure. This study advances our understanding of the experience of moral injury in business settings and the pathway explaining how and why people react differently to moral transgressions. (shrink)

Autistic children do not consistently show conventional signs of social engagement, which some have interpreted to mean that they are not interested in connecting with other people. If someone does not act like they are interested in connecting with you, it may make it difficult to feel connected to them. And yet, some parents report feeling strongly connected to their autistic children. We conducted phenomenological interviews with 13 mothers to understand how they experienced connection with their 5- to 14-year-old (...) nonspeaking autistic children. Mothers of nonspeaking autistic children represent a unique group in which to study connection because their children both may not seem interested in connecting with them and have limited ability to communicate effectively using speech, a common way people connect with each other. The mothers in this study interpreted a range of child behaviors—some unconventional, but many conventional—as signs that their children were interested in connecting with them, (re)framed child behaviors that could undermine connection as caused by factors unrelated to the relationship, and expressed several convictions that may help build and sustain connection in the face of uncertainty about the meaning of their children’s behavior. Even though their autistic children may not consistently act in conventional socially oriented ways, these mothers reported perceiving their children’s behavior as embedded within an emotionally reciprocal relationship. (shrink)

A change in sense of self is an outcome commonly associated with Buddhist meditation. However, the sense of self is construed in multiple ways, and which changes in self-related processing are expected, intended, or possible through meditation is not well understood. In a qualitative study of meditation-related challenges, six discrete changes in sense of self were reported by Buddhist meditators: change in narrative self, loss of sense of ownership, loss of sense of agency, change in sense of embodiment, change (...) in self-other or self-world boundaries, and loss of sense of basic self. Changes in sense of self could be transient or enduring, positive or distressing, enhancing or impairing. These changes were also given varied appraisals, ranging from insights associated with Buddhist doctrines to psychopathologies such as depersonalization. In this study of practitioners reporting meditation-related challenges, more global changes in sense of self were associated with higher levels of impairment. These results have implications for both Buddhist meditation as well as mindfulness-based interventions. (shrink)

This qualitative case study examines early career social studies educators’ knowledge of the role of emotion in teaching and learning. More specifically, we examine how our efforts to expand social studies educators’ understanding of emotion, shifted their perception of the role of emotion in learning social studies content and how they can use this knowledge to plan instruction. Prior to beginning their “emotion education,” all participants described the role of emotion in teaching and learning as important for relationship-building and (...) as something to be carefully managed. They focused their efforts in the classroom on creating a welcoming environment for their students and managing their students’ emotions. Though they described their classrooms as emotional spaces, none had explicitly considered the role of emotion in learning content.As they learned about the role of emotion in cognitive processes like memory and problem-solving, participants began to recognize the need to rethink their pedagogical choices. However, none of the participants embraced or accepted an expanded view of emotions as social and political forces. Reluctant to consider how emotions shape our identities, our communities and our politics, these social studies educators did not meaningfully engage in a critical examination of how social studies curriculum can contribute to “schooling” students’ emotions. Findings from this initial study suggest it is important to engage social studies educators in critical awareness of their own emotions and critical examination of what emotions “do” in the world and how the social studies content we teach can contribute to the “schooling” of our students’ emotions. (shrink)

This article examines the experience of online worship among 13 participants ‘attending’ virtual services in Cambridge. We focus upon an online formal Eucharistic service and a more informal Sunday evening non-Eucharistic service. After providing an overview of the literature on online religion, more specifically the possibility of a virtual religious community and the performance of online Eucharist, we present data from semi-structured interviews which were analysed through thematic analysis. The interviews reveal that virtual services, while better than nothing, have significant (...) limitations in terms of participation, belonging, and the kind of religious experience engendered. While only two participants expressed the view that the virtual service was better than the live service, the majority found that the virtual service lacked a sense of connectedness. However, everyone agreed that it was different from a television broadcast in several important ways. The overall view was that celebrating the Eucharist was not possible online, because congregants could not actually partake of the bread and wine blessed by the priest which, for them, was an essential aspect of the ritual. For most people there was neither spiritual communion, nor a belief in consecration at a distance, leaving them feeling they were not really participating in the Eucharist. The participants in the study who engaged with both the Eucharist in the morning and the non-Eucharistic service in the evening generally seem to have preferred the latter. The data from this study are congruent with studies of diverse faiths which reveal the perceived importance of physical presence, contact and connection as being important for ritual effectiveness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Somatic Knowledge and Qualitative Reasoning:From Theory to PracticeRichard Siegesmund"Elliot Eisner is a writer to be reckoned with" is how my undergraduate student, Cheyenne, opened her final essay on The Arts and the Creation of Mind. After a semester of using his text in my art education methods class, reckoned seemed an apt word. The dictionary gives the definitions of reckoned as to settle accounts, make calculation, judge, and (...) take into consideration.1 The ideas in The Arts and the Creation of Mind are challenging on multiple levels, and Eisner does not provide any easy answers. There are no pithy how-to-do-it bullet points in the text. The issues he addresses are complex: nonlinguistic meaning, somatic knowledge, qualitative reasoning, the arts as habits of mind that guide experience and inquiry into the world — just to name a few. Nevertheless, in this text he brings these ideas into a format that is accessible to undergraduates entering the profession of teaching and experienced professionals, who wish to reflect on their own practice.The lucidity of Eisner's text can belie the complexity of the issues he addresses. Regrettably, some students only saw the outer shell of the content: the discussion of conceptual approaches to arts education or the delineation of the developmental stages of children's drawing. Yet for these aspects alone, they considered the text to be valuable; however, I was disappointed that they did not go deeper. Some just could not synthesize the big point: that the arts are not simply about mastery of technical skills, but that technical skills are merely a gateway into non-linguistic thinking. Educational objectives that are limited to content and skills are mundane.However, for more thoughtful and reflective students like Cheyenne, who was in her last semester of course work before student teaching in Guadalajara, the book was an inspiration. It provided a more robust conception of arts education that spoke to her feelings that compelled her to be a teacher. She reflected on what she read in The Arts and the Creation of Mind, and saw how an arts educator was more than an activities manager. She discovered she was embarking on a calling that could change minds — and [End Page 80] by changing minds, transform lives. For a young idealist, Eisner articulated her passion to serve. He said what up until that moment she had only felt. She discovered what she had previously sensed — known in her bones — but had not articulated. Eisner was a voice she wanted to take for her own. He provided a vision of the teacher she hoped to be. Indeed, Elliot Eisner is a writer to be reckoned with.Two ideas that my art students want to discuss when they first encounter The Arts and the Creation of Mind are the concepts of somatic knowing and qualitative reasoning. Somatic knowledge is a felt reaction of rightness within an experience. Qualitative reasoning is the ordering of relationships of qualities. Qualitative reasoning produces somatic knowledge. Using my students' questions and classroom discussions as inspiration, I want to explore these ideas for I believe they represent the essence of what is distinctive about learning in the arts. Furthermore, I share Eisner's belief that they provide the foundation on which to make an enduring case for the importance of the arts in education. These ideas reside at the heart of the process of education, which is, as he states, "learning to create ourselves."2It is immensely satisfying as a teacher to see the ah-ha moments in class discussion when students begin to integrate Eisner's ideas into their own experience. It is an even greater satisfaction to work with teachers who find these ideas illuminating for their educational aims and objectives and to see them played out in real classrooms where students flourish. In this essay, I want to try to build on my own experience with these moments to more deeply explore the significance of Eisner's work.To begin, I will briefly revisit the work of John Dewey. I will then discuss how Eisner's previous thinking sets a foundation for The Arts and the Creation of Mind. Finally, on a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Somatic Knowledge and Qualitative Reasoning:From Theory to PracticeRichard Siegesmund"Elliot Eisner is a writer to be reckoned with" is how my undergraduate student, Cheyenne, opened her final essay on The Arts and the Creation of Mind. After a semester of using his text in my art education methods class, reckoned seemed an apt word. The dictionary gives the definitions of reckoned as to settle accounts, make calculation, judge, and (...) take into consideration.1 The ideas in The Arts and the Creation of Mind are challenging on multiple levels, and Eisner does not provide any easy answers. There are no pithy how-to-do-it bullet points in the text. The issues he addresses are complex: nonlinguistic meaning, somatic knowledge, qualitative reasoning, the arts as habits of mind that guide experience and inquiry into the world — just to name a few. Nevertheless, in this text he brings these ideas into a format that is accessible to undergraduates entering the profession of teaching and experienced professionals, who wish to reflect on their own practice.The lucidity of Eisner's text can belie the complexity of the issues he addresses. Regrettably, some students only saw the outer shell of the content: the discussion of conceptual approaches to arts education or the delineation of the developmental stages of children's drawing. Yet for these aspects alone, they considered the text to be valuable; however, I was disappointed that they did not go deeper. Some just could not synthesize the big point: that the arts are not simply about mastery of technical skills, but that technical skills are merely a gateway into non-linguistic thinking. Educational objectives that are limited to content and skills are mundane.However, for more thoughtful and reflective students like Cheyenne, who was in her last semester of course work before student teaching in Guadalajara, the book was an inspiration. It provided a more robust conception of arts education that spoke to her feelings that compelled her to be a teacher. She reflected on what she read in The Arts and the Creation of Mind, and saw how an arts educator was more than an activities manager. She discovered she was embarking on a calling that could change minds — and [End Page 80] by changing minds, transform lives. For a young idealist, Eisner articulated her passion to serve. He said what up until that moment she had only felt. She discovered what she had previously sensed — known in her bones — but had not articulated. Eisner was a voice she wanted to take for her own. He provided a vision of the teacher she hoped to be. Indeed, Elliot Eisner is a writer to be reckoned with.Two ideas that my art students want to discuss when they first encounter The Arts and the Creation of Mind are the concepts of somatic knowing and qualitative reasoning. Somatic knowledge is a felt reaction of rightness within an experience. Qualitative reasoning is the ordering of relationships of qualities. Qualitative reasoning produces somatic knowledge. Using my students' questions and classroom discussions as inspiration, I want to explore these ideas for I believe they represent the essence of what is distinctive about learning in the arts. Furthermore, I share Eisner's belief that they provide the foundation on which to make an enduring case for the importance of the arts in education. These ideas reside at the heart of the process of education, which is, as he states, "learning to create ourselves."2It is immensely satisfying as a teacher to see the ah-ha moments in class discussion when students begin to integrate Eisner's ideas into their own experience. It is an even greater satisfaction to work with teachers who find these ideas illuminating for their educational aims and objectives and to see them played out in real classrooms where students flourish. In this essay, I want to try to build on my own experience with these moments to more deeply explore the significance of Eisner's work.To begin, I will briefly revisit the work of John Dewey. I will then discuss how Eisner's previous thinking sets a foundation for The Arts and the Creation of Mind. Finally, on a... (shrink)

Conversations about the past can involve voicing and silencing; processes of validation and invalidation that shape recall. In this experiment we examined the products and processes of remembering a significant autobiographical event in conversation with others. Following the death of Australian celebrity Steve Irwin, in an adapted version of the collaborative recall paradigm, 69 participants described and rated their memories for hearing of his death. Participants then completed a free recall phase where they either discussed the event in groups of (...) three or wrote about the event on their own. Finally, participants completed the original questionnaire again, both 1 week and 1 month after the free recall phase. Discussion influenced later memories for hearing of Irwin’s death, particularly memories for emotion and shock. Qualitative analysis of the free recall phase suggested that during conversation a shared understanding of the event developed, but that emotional reactions to the event were silenced in ways that minimised the event’s impact. These findings are discussed in terms of the processes and consequences of sharing public and personal memories in conversation. (shrink)

This qualitative study was positioned within an emerging scientific field concerned with the interaction between biblical text and the psychological profile of the preacher. The theoretical framework was provided by the sensing, intuition, feeling and thinking approach to biblical hermeneutics, an approach rooted in reader-perspective hermeneutical theory and in Jungian psychological type theory that explores the distinctive readings of sensing perception and intuitive perception, and the distinctive readings of thinking evaluation and feeling evaluation. The empirical methodology was provided by (...) developing a research tradition concerned with applying the SIFT approach to biblical text. In the present study, a group of 17 Anglican clergy were invited to work in psychological type-alike groups to explore two of the biblical passages identified by Year B of the Revised Common Lectionary for the Feast of Christ the King. Dividing into three workshops, according to their preferences for sensing and intuition, the clergy explored Psalm 93. Dividing into three workshops, according to their preferences for thinking and feeling, the clergy explored John 18:33–37. The rich data gathered from these workshops supported the hypothesis that biblical interpretation and preaching may be shaped by the reader’s psychological type preference and suggested that the passages of scripture proposed for the Feast of Christ the King may be a joy for intuitive thinking types, but a nightmare for sensing feeling types.Contribution: Situated within the reader perspective approach to biblical hermeneutics, the SIFT method is concerned with identifying the influence of the psychological type of the reader in shaping the interpretation of text. Employing this method, the present study contributes to the fields of homiletics and hermeneutics by demonstrating how some readers may struggle more than others to interpret the scripture readings proposed by the lectionary for the Feast of Christ the King. (shrink)

BackgroundThe Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent (...) and potential limitations to the principle of respect for autonomy in African communities.MethodsWe conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.ResultsBased on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.ConclusionsWe conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities. (shrink)

Context: The current study of emotions is based on theoretical models that limit the emotional experience. The collection of emotional data is through self-report questionnaires, restricting the description of emotional experience to broad concepts or induced preconceived qualities of how an emotion should be felt. Problem: Are the emotional experiences responding exclusively to these concepts and dimensions? Method: Music was used to lead participants into an emotional experience. Then a micro-phenomenological interview, a methodology with a phenomenological approach, was used to (...) guide their descriptions. Results: The descriptions of emotional experiences revealed a temporal structure that could have a linear or circular development. Moreover the qualitative aspects disclosed that these experiences are characterized by corporal sensations and marked variations of emotional intensity. Additionally, the emotional experience was embodied. Implications: The emotional experience is a dynamic process in which bodily sensations take a primary role, allowing the identification of such emotions. The integration of these first-person features of emotional experience with third-person data could lead to a better understanding and interpretation of emotional processes. Constructivist content: This article highlights the need to integrate first-person and third-person methodologies to study and explain human behavior in a comprehensive manner. Key Words: Emotion, experience, micro-phenomenological interview, body, music, affective neuroscience. (shrink)

The aim of this article is to generate knowledge about parents’ participation in life-and-death decisions concerning their very premature and/or critically ill infants in hospital neonatal units. The question is: what are parents’ attitudes towards their involvement in such decision making? A descriptive study design using in-depth interviews was chosen. During the period 1997-2000, 20 qualitative interviews with 35 parents of 26 children were carried out. Ten of the infants died; 16 were alive at the time of the interview. (...) The comparative method (grounded theory) was used to analyse the data. The analysis was carried out continuously and in parallel with data collection. Six categories were revealed by the analysis: indecision and uncertainty (ambivalence); information and communication; participate, but do not decide; seeming to be included; the parents’ child; and individual consideration. The findings appear to indicate that parents agree that they should not have the final word in decisions concerning their infants’ future life or death. Such a responsibility would put too heavy a burden on parents who lack the medical knowledge and the professional experience needed to make such a decision, and would be likely to lead to them experiencing strong feelings of guilt. The findings show that parents should be well informed and listened to during the whole decision-making process. Their primary concern was how nurses and physicians communicate with parents who are experiencing a crisis, and how this serious information is presented. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Background The COVID-19 pandemic has influenced the approach to the health-disease system, raising the question about the principles of bioethics present in physician–patient relations. The principles while widely accepted may not be sufficient for a comprehensive ethical analysis. Therefore, the aim of this study was to explore the perception of these principles and the physician–patient relationship during a hospital stay through a qualitative approach. Method Sixteen semi-structured interviews took place to know the patients’ perception during their 2020 hospitalization for (...) COVID-19. The data was analyzed through the constant comparison method, creating categories and comparing them. In the end, seven categories were established and were grouped in three: bioethical principles (dignity, charity, vulnerability, autonomy), doctor-patient relationship (participant commitment, informed consent, health staff-patient relationship) and the experience of the disease (illness, the role of the family). Results The research found that most patients described a positive experience, with the feeling of having been well cared for with no sense of discrimination or injustice done. The majority also reported that their autonomy was respected in the treatment decisions. The evaluation of these attitudes is an area of opportunity, especially when the patients' vulnerability is at risk. Conclusions The ethics of virtue offers a better reflection of how human beings manifest themselves by emphasizing the development of virtuous character and behaviors that allow them to realize their values in life. Authorized by the Research Ethics Committee with registration: DI/18/105-B/3/308. (shrink)

The concept of _feeling trusted_, which has received far less attention from researchers than _trusting_, refers to the trustee’s awareness of trustor’s exposed vulnerability and positive expectations. Previous research has merely centered on employees’ feeling of being trusted by their leaders and its influences on their work-related outcomes, but there is little work about the impact of leader feeling trusted by employees. Grounded in social exchange theory and moral licensing theory, the current research centers on explaining why leaders’ sense of (...) being trusted by employees brings about both positive and negative reactions and considering how leaders’ moral identity moderates these effects. One qualitative study and two quantitative studies were conducted to examine the benefits and drawbacks of leader feeling trusted. Results demonstrated that leader feeling trusted has two main consequences: trusted leaders are more likely to have strong feelings of obligation toward their subordinates, and further engage in benevolent leadership behavior to repay the kindness; and leaders’ sense of being trusted may be conducive to the accumulation of moral credits, thereby stimulating leaders to display laissez-faire leadership behavior. Additionally, our findings indicate that the leader’s moral identity would affect the decisions of the trusted leader to behave better or worse, which promotes benevolent leadership behavior through enhanced felt obligation, and lessens laissez-faire leadership behavior via reduced moral credits. (shrink)

The emotions play a crucial role in our apprehension of meaning, value, or significance — and their felt quality is intimately related to the sort of awareness they provide. This is exemplified most clearly by cases in which dispassionate cognition is cognitively insufficient, because we need to be emotionally agitated in order to grasp that something is true. In this type of affective experience, it is through a feeling of being moved that we recognize or apprehend that something is the (...) case. And that is why our emotions are epistemically indispensable: namely, because they give us access to significant truths. In this essay, I explain how the phenomenally felt character of an emotion is intimately linked with its intentionality. Intellectual activity divorced from affective feeling is profoundly lacking — not only in its qualitative feel, but also in its epistemic import, or its ability to inform us about matters of significance. A better appreciation of how the living body is involved in affective experience should help us to understand the distinctive kind of embodied cognition that emotional responses involve. It also ought to resolve confusions about phobic responses and other “recalcitrant” emotions, which are not divorced from cognition as many have claimed. (shrink)

BackgroundThe need for an ethical debate about the use of coercion in intensive care units (ICU) may not be as obvious as in other areas of medicine, such as psychiatry. Coercive measures are often necessary to treat critically ill patients in the ICU. It is nevertheless important to keep these measures to a minimum in order to respect the dignity of patients and the cohesion of the clinical team. A deeper understanding of what patients and their relatives perceive during their (...) ICU stay will shed different light on intensive care management. Patients' experiences of loss of control, dependency and abandonment may lead to a new approach towards a broader approach to the concept of coercion in intensive care. The aim of our research is to explore the experiences of patients and relatives in the ICU and to determine when it might be possible to reduce feelings and memories of coercion.MethodsWe conducted and analysed 29 semi-structured interviews with patients and relatives who had been in the ICU a few months previously. Following a coding and categorisation process in MAXQDA™, a rigorous qualitative methodology was used to identify themes relevant to our research.ResultsFive main themes emerged: memory issues; interviewees’ experiences of restricting measures and coercive treatment; patients’ negative perception of situational and relational dependency with the risk of informal coercion; patients’ perceptions of good care in a context of perceived dependency; progression from perception of coercion and dependency to respect for the person. All patients were grateful to have survived. However, coercion in the form of restraint, restriction of movement, and coercive treatment in the ICU was also acknowledged by patients and relatives. These included elements of informal coercion beyond restraints, such as a perceived negative sense of dependence, surrender, and asymmetrical interaction between the patient and health providers.ConclusionsTo capture the full range of patients' experiences of coercion, it is necessary to expand the concept of coercion to include less obvious forms of informal coercion that may occur in dependency situations. This will help identify solutions to avoid or reduce negative recollections that may persist long after discharge and negatively affect the patients' quality of life. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)