Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

Cherche à mettre en évidence les principes théoriques qui peuvent être au fondement de toute recherche ou réflexion en sociologie de la musique.

Ce livre présente une lecture globale du corpus kantien sous un angle particulier : comment "penser" le mal? Comme simple absence du bien? Comme erreur? Ou, ainsi que Kant l'a mis en évidence, comme une "grandeur négative", qui appartient à...

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

This book explores five Platonic dialogues: Lysis, Charmides, Protagoras, Euthydemus, and the Republic. This book uses Socrates’ narrative commentary as its primary interpretive framework. No one has engaged in a sustained attempt to explore the Platonic dialogues from this angle. As a result, it offers a unique contribution to Plato scholarship. The portrait of Socrates that emerges challenges the traditional view of Socrates as an intellectualist and offers a holistic vision of philosophical practice.

In "Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?," Bayefsky and Berkman argue in favor of establishing three categorie...

This paper forms part of a wider study examining the history and sociology of nursing education in England between 1860 and 1948. It argues that the question of whether nursing was an art, science and/or social science has been at die ‘heart’ of a wider debate on die occupational status and disciplinary identity of nursing. The view that nursing was essentially an art and a ‘calling’, was championed by Florence Nightingale. Ethel Bedford Fenwick and her allies insisted that nursing, like (...) other professions, was a ‘scientific’ and technical enterprise. Social scientists later came to challenge nursing's claim to professionalism by analysing nursing work first within die context of industrial psychology. But they also advocated a rapprochement between nursing, health services and social science research, a challenge which we are in nursing, still striving to meet This paper argues for a strong coalition of nursing with its former nineteenth century ally, social science, in die continuing struggle for change within nursing and health care policy. Rather than searching for some rarified and purified essence of nursing knowledge, it argues that nurses need to join forces with sociologists and economists in striving to shape die agenda for health services research and provide die evidential basis for health policy transformation more generally. (shrink)

Anne-Marie Søndergaard Christensen presents a new account of the role of moral philosophy and its relationship to our ordinary moral lives. She challenges the idea that moral theories have an authoritative explanatory or action-guiding role, and develops instead a descriptive, pluralistic, and elucidatory conception of moral philosophy.

The aim of this article is to add to the research surrounding nurses' work in hospitals. Throughout history, nurses have faced adverse working conditions, an aspect of their work that remains remarkably unchanged today. Prevailing historical ideologies and sociopolitical conditions influences the context of nurses' work in contemporary hospitals. This research revealed how ruling patriarchal power and nurses' altruistic ways normalize the conditions in hospitals as nurses' work. Moving discourses further add to the work of nurses in hospitals. For example, (...) cost containment strategies, overcapacity and short staffing have resulted in practices to accommodate these problems. While contemporary hospitals may look different, clearly, inside, little has changed since the early days; hospital issues have clearly become an ordinary part of nurses' work. This article discusses how the conditions in hospitals have become an ordinary part of nurses' work. The research in this article emphasizes how prevailing ideologies and institutional discourses make invisible and taken‐for‐granted, how this normalizing of nurses' work contributes to sustaining the hospital's power. (shrink)

A virtue centred approach to ethics has been criticized for being vague owing to the nature of its central concept, the paradigm person. From the perspective of the practitioner the most damaging charge is that virtue ethics fails to be action guiding and, in addition to this, it does not offer any means of act appraisal. These criticisms leave virtue ethics in a weak position vis-à-vis traditional approaches to ethics. The criticism is, however, challenged by Hursthouse in her analysis of (...) the accounts of right action offered by deontology, utilitarianism and virtue ethics. It is possible to defend the action guiding nature of virtue ethics: there are virtue rules and exemplars to guide action. Insights from Aristotle’s practical approach to ethics are considered alongside Hursthouse’s analysis and it is suggested that virtue ethics is also capable of facilitating action appraisal. It is at the same time acknowledged that approaches to virtue ethics vary widely and that the challenges offered here would be rejected by those who embrace a radical replacement virtue approach. (shrink)

Although non-profit organisations typically have high representation of females on their boards, relatively little is known about the effects of gender diversity in these organisations particularly in relation to financial management. In this archival study, resource dependency theory and agency analysis are combined to provide theoretical insight and empirical analysis of gender diversity on effective financial management in member-governed, community financial institutions. The investigation is possible due to the unique characteristics of the organisational form and region being examined—credit unions in (...) Northern Ireland. The sector has not been subject to external regulation on board gender, yet a wide array of gender mix on boards ranging from 100 % male to 100 % female are in existence. In addition, effective financial management is crucial to their survival and their ability to meet member objectives. Boards with higher female representation exhibit superior financial management first, in respect of loan book quality in the period of austerity following the financial crisis and second when measured against return on assets. (shrink)

Depuis près d'un demi-siècle, Madame Hélène ACKERMANS a coopéré très activement à l'organisation de l'École des sciences philosophiques et religieuses des F.U.S.L. Avec Monseigneur Henri van Camp, elle a donné à la tribune des leçons publiques sa renommée internationale ; auprès de l'actuel comité de direction, elle n'a cessé de prodiguer ses multiples compétences et ses conseils avisés. En hommage à son travail, il a été demandé à quelques-uns des penseurs avec lesquels Madame Hélène ACKERMANS a noué des liens d'amitié, (...) de réfléchir au rôle de la philosophie dans la Cité. (shrink)

The death of a research participant raises numerous ethical and legal issues regarding the return of research results to related family members. This question is particularly acute in the context of genetic research since the research results from an individual may be relevant to each of the biological relatives. This paper first investigates the ethical and legal frameworks governing the return of a deceased participant's individual research results to his or her related family members. Then, it weighs the rights and (...) interests of both the deceased individual and related family members in an attempt to identify key ethical considerations underlying the return of such results. This analysis of international guidelines and national laws and regulations reveals that though the legal framework regarding privacy and confidentiality of clinical and research information is well established (albeit not homogenous), guidelines are generally absent in the post-mortem context. Nevertheless, a brief analysis of this issue through two ethical perspectives (principlism and consequentialism) allows us to identify six key elements to be taken into consideration when returning a deceased participant's research results. (shrink)

Until the mid-20th century, biomedical research centered on the study of specific diseases, concerned with short periods of time and small groups of living research participants. However, the growth of longitudinal population studies and long-term biobanking now forces the research community to examine the possibility of the death of their research participants.The death of a research participant raises numerous ethical and legal issues, including the return of deceased individuals’ research results to related family members. As with the return of individual (...) research results for living research participants, the question of the obligation to return a deceased person’s research results to family members has yet to be settled. This question is particularly acute in the context of genetic research since the research results from one individual may have health implications for all biological relatives. (shrink)

This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The doctor's (...) action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached. (shrink)

After receiving a copy of Metaphysics as a Guide to Morals, Murdoch’s friend Brian Medlin writes back: ‘So far I think I disagree with what you say in “Wittgenstein and the Inner Life,” but I’ll have to make sure that I’ve understood you aright before I launch into a complaint.’ Here, I reconstruct Murdoch’s reading of Wittgenstein and show its ambivalence. While Murdoch acknowledges Wittgenstein’s aim to dissolve illusionary ideas about the inner, she also thinks he presents substantial theses threatening (...) the reality of inner life. Murdoch’s misreading of Wittgenstein as a constructive philosopher may be what worries Medlin, and it also prevents Murdoch from seeing Wittgenstein as an ally in the endeavour to demonstrate the morally transformative potential of our inner lives. (shrink)

This article examines whether a training program in ethical decision making can change young athletes’ doping attitudes. Fifty-two young elite athletes were randomly assigned to either an ethical decision-making training group or a standard-knowledge-based educational program group. Another 17 young elite athletes were recruited for no-treatment control purposes. The ethical decision-making training comprised six 30-min online sessions in which the participants had to work through 18 ethical dilemmas related to doping. The standard-knowledge-based educational program was also conducted in six online (...) sessions of comparable length to that of the ethical training. A short version of the Performance Enhancement Attitude Scale was administered to measure the effects of the trainings on doping attitude. Prior to as well as after the intervention, the mean doping attitude scores of the young athletes were low to very low, indicating vehement rejections of doping. The results of our experiment showed that the ethical training led to an attenuation of these rejections. No intervention effect was found in the standard education group. The observed slight increase in the doping attitude score could be an indication that the ethical decision-making training was successful in breaking up the athletes’ stereotypical style of reasoning about doping. (shrink)

This essay proposes that Socrates practiced various spiritual exercises, including meditation, and that this Socratic practice of meditation was habitual, aimed at cultivating emotional self-control and existential preparedness. Contemporary research in neurobiology supports the view that intentional mental actions, including meditation, have a profound impact on brain activity, neuroplasticity, and help engender emotional self-control. This impact on brain activity is confirmed via technological developments, a prime example of how technology benefits humanity. Socrates attains the balanced emotional self-control that Alcibiades describes (...) in the Symposium because of the sustained mental effort he exerts that directly impacts his brain and his emotional and philosophical life. The essay concludes that Socratic meditative practices aimed at manifesting true dignity as human beings within the complexities of a technological world offer a promising model of self-care worthy of embracing today. (shrink)

Hannah James makes a persuasive case for the use of donated bodies and body parts in surgical training, enabling high fidelity training, improved competency of surgeons and reduced risk of harm to patients from trainees ‘learning on the job’.1 She also identifies some pertinent ethical questions that arise from this practice that should be considered by training organisations, regulatory authorities and the trainees themselves. Many countries throughout the world have regulated programmes, governed by strict ethical principles, for donating bodies, usually (...) to academic institutions for the purposes of medical education.2 In the UK the Human Tissue Authority sets out guiding principles for institutions licensed to handle human tissue including donation of bodies for anatomical examination, education and research; consent, dignity, quality, and honesty and openness.3 The Nuffield Council on Bioethics, in its 2011 report, Human Bodies: donation for medicine and research, identified a number of relevant ethical values including autonomy, altruism, justice, dignity, reciprocity, maximising welfare, and honesty and respect.4 While this report did not focus specifically on donation of human tissue for education and training the principles identified are equally relevant in this context. In terms of maximising welfare whole body donation for education and training provides benefit to many patients over a relatively short time frame …. (shrink)

This article analyses the short performances of Drag Sethlas at the yearly Gran Canaria Drag Queen Contest in Spain (2017–20) from the perspective of religious studies and gender studies, following on from an earlier article in which this case was explored in light of the severe blasphemy accusations (by local and national bishops and lay organisations) against the 2017 show. These short performances consist of remarkable representations of Roman Catholic texts, saints, symbols and rituals acted out as prize-winning drag-queen shows (...) that were aired on national television. At the same time, these acts are situated, by reference to famous earlier controversial acts by the pop artists Madonna, Lady Gaga and Ariana Grande, in a genealogy of provocations and blasphemy accusations that are currently made in North American and Western European countries. In exploring the forms of ritualisation (cf. Bell 1989) in the provocation that this type of popular artistic performance with strong religious connotations evokes, I show the presence of a double theatricality in Sethlas’s first and most controversial performance: on the one hand a ‘holy drama’ centred around a religious pattern of penance, repentance and redemption, and on the other hand a specific drag theatricality, with its parodies, mockery and daring erotic scenes. It is precisely the connection between both forms of theatricality, especially the representation of the Virgin Mary and Jesus, who play a large and special role in both forms of theatricality, that contributes most to the provocativeness of this scene. (shrink)

Although previous studies have found that video games induce stress, studies have not typically measured all salient indicators of stress responses including stress appraisals, cardiovascular indicators, and emotion outcomes. The current study used the Biopsychosocial Model of Challenge and Threat (Blascovich & Tomaka, 1996) to determine if video games induce a cardiovascular stress response by comparing the effects of threat and challenge appraisals across two types of video games that have shown different cardiovascular outcomes. Participants received challenge or threat appraisal (...) instructions, and played a fighting game (Mortal Kombat) or a puzzle game (Tetris). Study outcomes were heart rate variability, systolic and diastolic blood pressure, and positive and negative emotion ratings measured before, during and after gameplay. Results indicated that threat appraisal instructions increased negative emotion ratings and decreased heart rate variability, but not blood pressure, which is an essential marker for cardiovascular stress responses. Increased blood pressure and decreased heart rate variability was associated with fighting game players when compared with the puzzle game players, indicating a cardiovascular stress response; however, fighting game players also reported higher positive emotion ratings. Based on the study findings, video games do not induce stress responses like mental stressors used in previous research, demonstrating that the interactive player experience in video gaming may have more complex effects on stress outcomes. Future research should comprehensively measure biopsychosocial stress indicators and multiple emotional states over time to fully examine the relationship between video games and stress. (shrink)

Ce colloque devenu livre comble une lacune. Alors que le sujet a été labouré pour le xviiie siècle, aucune synthèse n’existait jusque-là sur le mariage dans la littérature du xixe siècle. Or, la rupture avec les Lumières est frappante comme l’attestent, par exemple, les réécritures d’Inès de Castro étudiées par Maurizio Melai. Le thème du « mariage interdit », inspiré par la tragédie d’Houdar de la Motte (1723) mais subverti un siècle plus tard, illustre le passage de l’Ancien Régime aristocr...

The issue of abortion has been the topic of heated and frequent debate in post-Communist Poland. Parliamentary debate in 1998—9 centred around a legislative attempt to restrict prenatal testing, specifically amniocentesis, in order to further reduce the numbers of abortions carried out, as it was argued to inevitably result in the termination of pregnancy. Medical professionals are rarely visible as subjects of and authorities on the abortion debate in the Polish context. However, in this debate around prenatal testing, the medical (...) community appear as key commentators and meaning-makers. This article asks the following questions: What role do the medical profession and biomedical knowledge play in the debate around prenatal testing, when abortion is highly politicized? Second, what social meanings and consequences are attributed to prenatal testing? How do these construct the relationship between foetus, pregnant woman and doctor, and what agency and 'rights' are attributed to women in the process of prenatal testing? (shrink)

‘Gender’, understood as the social construction of sex, is a key concept for feminists working at the interface of theory and policy. This article examines challenges to the concept which emerged from different groups at the UN Fourth World Conference on Women in Beijing, September 1995, an important arena for struggles over feminist public policies. The first half of the article explores contradictory uses of the concept in the field of gender and development. Viewpoints from some southern activist women at (...) the NGO Forum of the Beijing Conference are presented, Some of them argued that the way ‘gender’ has been deployed in development institutions has led to a depoliticization of the term, where feminist policy ambitions are sacrificed to the imperative of ease of institutionalization. ‘Gender’ becomes a synonym for ‘women’, rather than a form of shorthand for gender difference and conflict and the project of transformation in gender relations. ‘Gender sensitivity’ can be interpreted by non-feminists as encouragement to use gender-disaggregated statistics for development planning, but without consideration of relational aspects of gender, of power and ideology, and of how patterns of subordination are reproduced. A completely different attack on ‘gender’ came from right-wing groups and was battled out over the text of the Platform for Action agreed at the official conference. Six months prior to the conference, conservative groups had tried to bracket for possible removal the term ‘gender’ in this document, out of opposition to the notion of socially constructed, and hence mutable, gender identity. Conservative views on gender as the ‘deconstruction of woman’ are discussed here. The article points out certain contradictions and inconsistencies in feminist thinking on gender which are raised by the conservative backlash attack on feminism and the term ‘gender’. (shrink)

A fundamental tenet of hermeneutic phenomenology is that people seek to create meaning of their experience from the response sited within human consciousness. The focus of this study is on the world of the lived experience as it is interpreted by participants through memory and language as accessed by interviews in order to produce an understanding of the participants’ experience. Three participants were interviewed whose adult children had died as a result of an AIDS-related illness. The interviews were recorded and (...) transcribed, and interwoven analyses sought to illustrate the participants’ lived experience of the phenomenon. An attempt was made to understand how the various phenomena relating to parental bereavement were reflected by participants in the interviews. Common themes included reactions to the knowledge of the illness, the experience of being with their dying child, coping with the pain of the loss, and spiritual and existential concerns. There are references to how others judge their grieving behaviour. Issues of retribution and punishment are prominent and these appear to place a particular burden of sorrow on the grieving parent. The study provided insight into the lived experience of bereavement and the forging of new meaning structures that can accommodate the loss. (shrink)

In an historic first, two ethics committees - one from Laos, the other from France - met in Vientiane in October 2015. Researchers examined a multitude of ethical issues related to health, the environment, and societies in countries in the Mekong region. Urgent, universal questions were discussed in local contexts ; productive debates illustrated a complex array of possible solutions. This book, born out of that meeting, serves as a guide for those working across the spectrum of scientific fields on (...) paths to promote justice and reduce suffering. Like the Mekong River, the field of research ethics does not run in a straight line ; and like that river, everyone it touches discovers that what may initially appear to separate us ultimately serves to bring us together. (shrink)

Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia. For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: (...) beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’. This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community. The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths. (shrink)