The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...) the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

Fashion design is a feminized occupation, but there is a widespread perception that gay male designers are advantaged in receiving awards, publicity, and praise. This article develops the notion of a “glass runway” to explain this inequality. First, using design canons and lists of award recipients, I show that men, especially gay men, receive more consecration than women. Second, I show how men and women are consecrated differently by analyzing the content of 157 entries in Voguepedia’s design canon and 96 (...) fashion media articles. Attributions of value and legitimacy construct a gendered image of the ideal fashion designer through discourses of art and culture that reinforce essentialist ideas about gender difference. Because cultural value is ambiguous, processes of valorization are shaped by gender essentialism, pushing male cultural producers down the glass runway and into the spotlight of fame, consecration, and legitimation. Finally, the case of fashion design offers insights into how intersecting inequalities can shape the glass runway. Gay designers experience both valorization and discrimination from intersections of gender and sexuality. (shrink)

In debates about the proper analysis of demonstrative expressions, ostensive gestures and speaker intentions are often seen as competing for primary importance in securing reference. Underlying some of these debates is the mistaken assumption that ostensive gestures always make the demonstrated object maximally salient to interlocutors. When we abandon this assumption and focus on an object’s mutually-recognized salience itself, rather than on how the object came to be salient, we can work towards a more promising analysis with a uniform treatment (...) of demonstrative reference whether or not there is an ostensive gesture, and whether reference is ordinary or deferred. (shrink)

Within the class of indexicals, a distinction is often made between “pure” or “automatic” indexicals on one hand, and demonstratives or “discretionary” indexicals on the other. The idea is supposed to be that certain indexicals refer automatically and invariably to a particular feature of the utterance context: ‘I’ refers to the speaker, ‘now’ to the time of utterance, ‘here’ to the place of utterance, etc. Against this view, I present cases where reference shifts from the speaker, time, or place of (...) utterance to some other object, time, or place. I consider and reject the claim that these counterexamples to the automatic indexical theory all involve non-literal uses of indexicals and argue that they cannot be explained away on the grounds that they involve conversational implicature or pretense. (shrink)

There is an expectation that all researchers will act ethically and responsibly in the conduct of research involving humans and animals. While research ethics is mentioned in quality indicators and codes of responsible researcher conduct, it appears to have little profile in doctoral assessment. There seems to be an implicit assumption that ethical competence has been achieved by the end of doctoral candidacy and that there is no need for candidates to report on the ethical dimensions of their study nor (...) for examiners to assess this integral aspect of researcher development. In the context of ensuring that institutions are fulfilling their responsibility of producing ethically sensitive and competent researchers, it is salient to investigate whether doctoral thesis examiners make comment about ethical issues in their reports. This study analysed an archive of examiner reports to identify the frequency, magnitude and nature of examiner comment about ethics. Although comment was rare examiners provided: prescriptive instruction on ethical review processes; formative instruction on the design, conduct, and reporting of research projects; and positive or negative judgments about a candidate's ethical competence, the latter often aligned with meeting, or not meeting, 'doctoral standards'. The scarcity of ethics in examination criteria and examiner reports implies a silence that needs to be addressed to ensure graduating candidates are prepared to conduct ethical and responsible research. (shrink)

Denunciations of child sexual abuse in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process (...) of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: pathway to understanding, pathway to disclosure, and pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process. (shrink)

A collection of original comics engaging fundamental issues in medical ethics, including patient autonomy, informed consent, unconscious bias, mandated reporting of suspected abuse, confidentiality, medical mistakes, surrogate decision-making, and futility.

Davidson's theory of radical interpretation, and his principle of charity, are well known in their application to beliefs and meanings, but rarely discussed in their application to desires and values. This is a pity, for they provide the makings of an argument for normative realism that is definitely worth exploring. After introducing Davidson's interpretation argument, I work through some familiar grounds for doubting that it applies to desires and values. Foremost among these are doubts about the extent to which holism (...) is true of desires and about the sense in which values or reasons could be thought to be objective. I conclude that while Davidson does not always address these doubts as thoroughly or as carefully as one might wish, he clearly sees how the argument here has to go, and he has at his disposal plausible responses to a good number of the challenges that are likely to arise. (shrink)

Empathy is widely touted as a springboard for social change. Within the academy, ‘identification’ is often used to promote the social value of literary and cultural studies. But to what degree have scholars, in seeking to defend the value of literary and cultural studies, conceived the act of reading in problematic ways? ‘An Ethics of Reading’ argues that adopting a Lacanian paradigm of self (reader) and text (other) to discuss the act of textual interpretation reduces a complex event involving multiple (...) actors to a simple dualism, while ineluctably consigning any act of interpretation to simple projection. Turning instead to psychoanalyst Jean Laplanche’s concept of the enigmatic signifier, this article rethinks the relation between reader and cultural text – reconceiving the act of interpretation by situating it within a dynamic of transference, as opposed to projection. When conceived via this Laplanchian framework, reading becomes not only an effective path to cognition and knowledge, but a radical means of subjective transformation. (shrink)

This paper develops a theory of analog representation. We first argue that the mark of the analog is to be found in the nature of a representational system’s interpretation function, rather than in its vehicles or contents alone. We then develop the rulebound structure theory of analog representation, according to which analog systems are those that use interpretive rules to map syntactic structural features onto semantic structural features. The theory involves three degree-theoretic measures that capture three independent ways in which (...) a system can be more or less analog. We explain how our theory improves upon prior accounts of analog representation, provides plausible diagnoses for novel challenge cases, extends to hybrid systems that are partially analog and partially symbolic, and accounts for some of the advantages and disadvantages of representing analogically versus symbolically. (shrink)

Core indexicals like ‘I’, ‘here’, and ‘now’ sometimes appear to refer to an object, place, or time other than the speaker, location, or time of utterance. This presents well-known problems for Kaplan's view, which treats reference shifting as a violation of the character rules that give the meaning of indexicals. I propose a view according to which indexical reference is essentially a matter of the mutually-accepted perspective of interlocutors. It follows that contexts need not be ‘proper’ in Kaplan's sense, and (...) a successful convergence of perspectives is needed for indexical reference to succeed. I provide reasons for embracing these conclusions. (shrink)

Background Despite the growth of biomedical research in South Africa, there are few insights into the operation of Research Ethics Committees (RECs) in this setting. We investigated the composition, operations and training needs of health RECs in South Africa against the backdrop of national and international guidelines. Methods The 12 major health RECs in South Africa were surveyed using semi-structured questionnaires that investigated the composition and functions of each REC as well as the operational issues facing committees. Results Health RECs (...) in SA have an average of 16 members and REC members are predominantly male and white. Overall, there was a large discrepancy in findings between under-resourced RECs and well resourced RECs. The majority of members (56%) are scientists or clinicians who are typically affiliated to the same institution as the health REC. Community representatives account for only 8% of membership. Training needs for health REC members varied widely. Conclusion Most major health RECs in South Africa are well organized given the resource constraints that exist in relation to research ethics in developing countries. However, the gender, racial and occupational diversity of most of these RECs is suboptimal, and most RECs are not constituted in accordance with South African guidelines. Variability in the operations and training needs of RECs is a reflection of apartheid-entrenched influences in tertiary education in SA. While legislation now exists to enforce standardization of research ethics review systems, no provision has been made for resources or capacity development, especially to support historically-disadvantaged institutions. Perpetuation of this legacy of apartheid represents a violation of the principles of justice and equity. (shrink)

The COVID-19 pandemic introduced significant disruptions and challenges to the learning environment for many post-secondary students with many shifting entirely to remote online learning. Barriers to academic success already experienced in traditional face-to-face classes may be compounded in the online environment and exacerbated by stressors related to the pandemic. In 2020–2021, post-secondary institutions were faced with the reality of rolling out fully online instruction with limited access to resources for assisting students in this transition. Instructional interventions that target students’ ability (...) to self-regulate their learning have been shown to improve academic performance and self-regulated learning competencies have also been found to mediate the effect of SRL interventions on higher education. However, few studies have examined the efficacy of fully online SRL intervention on mitigating the impact of psychological distress and academic challenges on academic success. This study examined the moderating roles of self-regulatory practices and SRL intervention in buffering the influence of COVID-related psychological distress and academic challenges on academic outcomes and academic challenges) in a Canadian sample of undergraduate students. We found levels of metacognitive and motivational challenges fully mediated the impact of COVID distress on GPA, SRL adapting practices moderated the impact of metacognitive challenges on GPA, and semester-long SRL intervention buffered the impact of COVID distress on academic challenges and resulted in lower levels of social-emotional, cognitive, and metacognitive challenges for first year undergraduate students. (shrink)

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both. In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show (...) that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice. (shrink)

Unlike many of his contemporaries John Henry Newman was comfortable with evolution. Newman had also, of course, thought deeply about religion. When, in the late 1850s and early 1860s, he began speculating about the nature of reality he saw the need to combine a scientific understanding of the physical universe with a Christian understanding of the human person. The Notes he left about this difficult topic are hard to make sense of. This book presents a readable version of the Notebook (...) and locates them in the cultural and intellectual context of the age. (shrink)

Twelve essays in literary theory, philosophy, and religion--about atheism, freedom, and "the Jesus thought experiment"--connect, but don't conclude. A recurring theme is the "nothing" at the heart of the deep atheism of George Eliot, Walter Pater, Oscar Wilde, Rudyard Kipling, and Thomas Hardy, who approach "nothing" with a directness lacking in their English-speaking philosophical contemporaries. How does being in the world--Thomas Nagel's "what-it's-likeness"--and how do values--Alasdair MacIntyre's justice and misericordia--fare in the face of the mindless "It" that Hardy finds at (...) the heart of things? A pivotal essay compares the theism of Paul Ricoeur and the atheism of Daniel Dennett--the subtitle is a response to the latter's latest book. Writing and Freedom defends (a strong version of) free will as necessarily interpersonal: my freedom is nothing but my acceptance of yours. This is how Milton, Rossetti, and Dickinson treat their readers, and how scientists and philosophers ideally treat each other. The book's open-ended essays model freedom so understood. Moreover, both "nothing" and "freedom" are fundamental to biblical and religious narratives (Mark and Newman). God, being "out of all relation" with the finite, cannot be known from the text of the world. Yet as "nothing," God may be said to grant unconditional autonomy to his creatures, and therefore to be present in his absence. It is round "nothing," therefore, that atheists and theists endlessly circulate. But that is what the deep atheism of European thinkers--Nietzsche, Freud, Lacan, and Zizek--say we all do anyway, however excitedly we pretend to ourselves that we don't. (shrink)

In the clinical setting, not enough attention is paid to the role that emotion plays. It is at worst ignored or avoided, isolating those who are suffering, at best treated as something to help another to endure. This is the result, in part, of an impoverished idea that views emotion as mere feelings. However, emotions are not just feelings, they are cognitive. If we look beneath the surface, emotions can provide information about values and beliefs, some of which may be (...) false or unreasonable. When they are motivating decisions that seriously affect the lives of others, there is a moral obligation to ferret them out and correct or deal with them. Attention needs to be paid to the emotions of healthcare providers as well as to the emotions of patients and their loved ones, and more done to train healthcare providers to deal effectively and productively with emotion – their own and others’. A son tearfully requests everything be done for his dying father. He fears limiting treatment means his father will be ignored. A physician orders another course of chemotherapy because she cannot bear for this patient to die. The patient, fearing he will painfully suffocate to death, agrees. Paying attention to emotions and bringing to light the beliefs and values behind them can only enhance the care and consideration of all involved. (shrink)

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding racial admixture, similar policies existed (...) in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent—or informed refusal—is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to (...) serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. (shrink)

This article provides a history of private sector tracking technologies, examining how the advent of commercial surveillance centered around a logic of data capitalism. Data capitalism is a system in which the commoditization of our data enables an asymmetric redistribution of power that is weighted toward the actors who have access and the capability to make sense of information. It is enacted through capitalism and justified by the association of networked technologies with the political and social benefits of online community, (...) drawing upon narratives that foreground the social and political benefits of networked technologies. I examine its origins in the wake of the dotcom bubble, when technology makers sought to develop a new business model to support online commerce. By leveraging user data for advertising purposes, they contributed to an information environment in which every action leaves behind traces collected by companies for commercial purposes. Through analysis of primary source materials produced by technology makers, journalists, and business analysts, I examine the emergence of data capitalism between the mid-1990s and mid-2000s and its central role in the contemporary information economy. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Robert Myers presents an original moral theory which charts a course between the extremes of consequentialism and contractualism. He puts forward a radically new case for the existence of both agent-neutral and agent-relative values, and gives an innovative answer to the question how such disparate values can be weighed against each other. Practical judgement is shown to be guided in this by two very different ideals: an ideal of cooperation, which is held to shape the content of morality's demands, (...) and one of self-governance, which is held to determine the nature of reason's requirements. Examination of the ideal of cooperation reveals that principles of impartial beneficence and rights protecting individual freedoms are equally fundamental to morality. Examination of the ideal of self-governance reveals that morality's dictates, though not necessarily overriding, are always in an important sense inescapable. The result is a theory of morality which combines a balanced account of its content with a ringing affirmation of its authority. (shrink)

This article explores how the Crash Course video series are being used as a content-focused resource in the social studies classroom. It argues that the Crash Course series, alongside its YouTube competitors, has significantly stepped in to fill a vacuum left by criticisms and the unpopularity of lectures, textbooks, and feature films. With over 15 million subscribers and accumulated views over 1.9 billion, Crash Course has become an important and ubiquitous force in history and social studies classrooms and represents a (...) new genre of educational media found on YouTube. However, the dramatic rise in the popularity of educational videos online has not coincided with a growth in educational research, particularly in social studies and history education. This article explores the findings of a mixed-methods study that examines how and why history and social studies teachers are using Crash Course videos in their teaching and planning. In particular, it analyses descriptive statistics derived from the results of a teacher survey ( n = 181) and semi-structured interviews with seven social studies teachers who have used Crash Course in their classrooms. The authors found that teachers in the study are regularly using the Crash Course video series to deliver content which is clearly meeting a need many social studies teachers have. The videos–short, easily accessible, and fun–fit nicely with demands to keep students engaged, reduce reliance on textbooks, and explore new content that teachers have little time to learn themselves. This study also found that rarely, if ever, are teachers inviting students to evaluate or assess the content, trustworthiness, or perspective of Crash Course videos. This article discusses what is gained and what are the risks of embracing Crash Course in the social studies and history classroom. (shrink)