Background:Several studies have investigated the experiences of first-generation immigrant nurses in new workplaces. Yet, little is known about how native nurses and newcomers collaborate in their care for aging residents in European nursing homes.Objective:To gain a deeper understanding of interactions between first-generation immigrant nurses and native nurses in their care for aging residents in a Dutch nursing home.Methods:Ethnography, including 105 h of shadowing immigrant and native nurses, 8 semi-structured interviews with 4 immigrant and 4 established nurses, and 2 focus group (...) discussions with 8 immigrant and 6 established nurses in a Dutch nursing home. Data were analyzed by a post-positivist grounded theory coding approach.Ethical consideration:The Medical Ethical Review Committee of the Leiden University Medical Center approved this study.Results:The interactions between established staff and newcomers were influenced by norms, rules and regulations, policies and protocols. In daily practice and institutional structure, we observed both opportunities and challenges. The strict time schedules and the requisite standards of care were opportunities related to nurses’ expectations. Residents’ needs were sometimes challenging and inhibited newcomers’ active participation. However, sometimes new practices were developed where nurses created common ground, tinkered, and formed an inclusive playing field to enact good care.Conclusion/ discussion:This study shows that despite obstacles, there was room to make small changes in the rules of the game of nursing. These moments of tinkering may be sufficient to establish a stable, inclusive workforce for first-generation immigrants and give room to the evolvement of hybrid professional identities.Implications:The findings of this Dutch study are relevant for nursing ethics related to “good care” and nurses in other cultural contexts on how the integration of immigrant nurses in European countries in general could be facilitated. (shrink)

Medical terminology collects and organizes the many different kinds of terms employed in the biomedical domain both by practitioners and also in the course of biomedical research. In addition to serving as labels for biomedical classes, these names reflect the organizational principles of biomedical vocabularies and ontologies. Some names represent invariant features (classes, universals) of biomedical reality (i.e., they are a matter for ontology). Other names, however, convey also how this reality is perceived, measured, and understood by health professionals (i.e., (...) they belong to the domain of epistemology). We analyze terms from several biomedical vocabularies in order to throw light on the interactions between ontological and epistemological components of these terminologies. We identify four cases: 1) terms containing classification criteria, 2) terms reflecting detectability, modality, uncertainty, and vagueness, 3) terms created in order to obtain a complete partition of a given domain, and 4) terms reflecting mere fiat boundaries. We show that epistemology-loaded terms are pervasive in biomedical vocabularies, that the “classes” they name often do not comply with sound classification principles, and that they are therefore likely to cause problems in the evolution and alignment of terminologies and associated ontologies. (shrink)

Formalisms such as description logics (DL) are sometimes expected to help terminologies ensure compliance with sound ontological principles. The objective of this paper is to study the degree to which one DL-based biomedical terminology (SNOMED CT) complies with such principles. We defined seven ontological principles (for example: each class must have at least one parent, each class must differ from its parent) and examined the properties of SNOMED CT classes with respect to these principles. Our major results are: 31% of (...) the classes have a single child; 27% have multiple parents; 51% do not exhibit any differentiae between the description of the parent and that of the child. The applications of this study to quality assurance for ontologies are discussed and suggestions are made for dealing with multiple inheritance. (shrink)

Background Clinical Ethics Committees are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data (...) were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics. All participants were familiar with Research Ethics Committees, and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. (shrink)

Formalisms based on one or other flavor of Description Logic (DL) are sometimes put forward as helping to ensure that terminologies and controlled vocabularies comply with sound ontological principles. The objective of this paper is to study the degree to which one DL-based biomedical terminology (SNOMED CT) does indeed comply with such principles. We defined seven ontological principles (for example: each class must have at least one parent, each class must differ from its parent) and examined the properties of SNOMED (...) CT classes with respect to these principles. Our major results are: 31% of these classes have a single child; 27% have multiple parents; 51% do not exhibit any differentiae between the description of the parent and that of the child. The applications of this study to quality assurance for ontologies are discussed and suggestions are made for dealing with the phenomenon of multiple inheritance. The advantages and limitations of our approach are also discussed. (shrink)

The paper presents a comparison of the two most commonly used diagnostic tests for orthorexia – ORTO-15 Questionnaire and BOT (Bratman Orthorexia Test) – that use data-mining methods. Orthorexia nervosa is perceived as a new, unclassified eating disorder, which is characterized with pathological fixation on the consumption of healthy foods. In order to assess the coherence of the aforementioned tests, a method from the data-mining group, i.e. correspondence analysis, was used in addition to traditional statistical methods. On the basis of (...) the obtained results, only average correlation between ORTO-15 Questionnaire and BOT test was found. More cases of orthorexia were diagnosed with the use of ORTO-15 Questionnaire, which may result from its higher sensitivity. It was also noted that the coherence of tests increases with increasing BMI values, despite no relationship between BMI and the presence of orthorexia having been proved. Diagnosis of an orthorexia case with the use of BOT test implies that there is a high probability that it will also be diagnosed with the use of ORTO-15 test, but not necessarily the other way around. The performed correspondence analysis confirmed a not very strong coherence of the results of both tests. (shrink)

Safeguarding GenAI models against threats and aligning them with security requirements is imperative yet challenging. This chapter provides an overview of the security landscape for generative models. It begins by elucidating common vulnerabilities and attack vectors, including adversarial attacks, model inversion, backdoors, data extraction, and algorithmic bias. The practical implications of these threats are discussed, spanning domains like finance, healthcare, and content creation. The narrative then shifts to exploring mitigation strategies and innovative security paradigms. Differential privacy, blockchain-based provenance, quantum-resistant algorithms, (...) and human-guided reinforcement learning are analyzed as potential techniques to harden generative models. Broader ethical concerns surrounding transparency, accountability, deepfakes, and model interpretability are also addressed. The chapter aims to establish a conceptual foundation encompassing both the technical and ethical dimensions of security for generative AI. It highlights open challenges and lays the groundwork for developing robust, trustworthy, and human-centric solutions. The multifaceted perspective spanning vulnerabilities, implications, and solutions is intended to further discourse on securing society’s growing reliance on generative models. Frontier model security is discussed using Anthropic proposed approach. (shrink)

Evidence for one or more loci on the human X chromosome influencing social cognition was recently presented by Skuse et al.(1). The imprinted locus is only expressed from a paternally inherited X chromosome, which means that boys do not express it because their only X chromosome comes from their mother. This raises the possibility of genetic as well as cultural influences on sex differences in behaviour and cognition. It may also offer some explanation for why boys are more vulnerable to (...) developmental disorders that affect social behaviour, such as autism. (shrink)

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, (...) interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

Can the government stick us with privacy we don't want? It can, it does, and according to this author, may need to do more of it. Privacy is a foundational good, she argues, a necessary tool in the liberty-lover's kit for a successful life. A nation committed to personal freedom must be prepared to mandate inalienable, liberty-promoting privacies for its people, whether they eagerly embrace them or not. The eight chapters of this book are reflections on public regulation of privacy (...) at home; isolation and confinement for punitive and health reasons; religious modesty attire; erotic nudity; workplace and professional confidentiality; racial privacy; online transactions; social networking; and the collection, use and storage of electronic data. (shrink)

One of the most intriguing of philosophical puzzles concerns other minds. How do you know there are any? Yes, you're surrounded by living organisms that look and behave much as you do. They even say they have minds. But do they? Perhaps other humans are mindless zombies: like you on the outside, but lacking any inner conscious life, including emotions, thoughts, experiences and even pain. What grounds do you possess for supposing that other humans aren't zombies? Perhaps less than you (...) think. Anita Avramides tackles this fascinating question. (shrink)

If our theology about the human condition correctly underscores our brokenness, and our understanding of the world as being fallen indeed reflects reality, then our poetry of worship should express that brokenness as well as our longing for healing. However, the Church in North America neglects laments because we have essentially lost the art and practice of grieving in the West, the Church silently condones some bad theology about Christian living, and we lack a robust philosophy of language in Christian (...) practices and disciplines. As this article explores, Job's curse and the lament of Psalm 22 offer healthy correctives to these and other missteps. The article emphasizes the important place of lament in Christian community, particularly as it functions in worship. (shrink)

'Anita L. Allen breaks new ground...A stunning indictment of women's status in contemporary society, her book provides vital original scholarly research and insight.' |s-NEW DIRECTIONS FOR WOMEN.

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

This paper relates Donaldson and Dunfee’s Integrative Social Contracts Theory to the problem of gender discrimination. We make the assumption that multinational managers might seek some guidance from ISCT to resolve ethical issues of gender discrimination in countries indifferent or hostile to gender equaIity. The role of Donaldson and Dunfee’s “hypernorms” seems especially cruciaI, and we find that, under their writings thus far, no “hypernorms” exist to make unethical the most blatant acts of sex discrimination in a host country whose (...) local norms tolerate such discrimination. The genesis of “hypernorms” as “global moral minimums” is recounted, and specific application of ISCT to a familiar ethics case (“A Foreign Assignment”) is provided. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Anita Chari revives the concept of reification from Marx and the Frankfurt School to spotlight the resistance to neoliberal capitalism now forming at the level of political economy and at the more sensate, experiential level of subjective transformation. Reading art by Oliver Ressler, Zanny Begg, Claire Fontaine, Jason Lazarus, and Mika Rottenberg, as well as the politics of Occupy Wall Street, Chari identifies practices through which artists and activists have challenged neoliberalism's social and political logics, exposing its inherent tensions (...) and contradictions. (shrink)

Disagreement about the properattitude toward disability proliferates. Yetlittle attention has been paid to an importantmeta-question, namely, whether ``disability'' isan essentially contested concept. If so, recentdebates between bioethicists and the disabilitymovement leadership cannot be resolved. Inthis essay I identify some of the presumptionsthat make their encounters so contentious. Much more must happen, I argue, for anydiscussions about disability policy andpolitics to be productive. Progress depends onconstructing a neutral conception ofdisability, one that neither devaluesdisability nor implies that persons withdisabilities are inadequate. So, (...) first, I clearaway the conceptual underbrush that makes usthink our idea of disability must bevalue-laden. Second, I sketch someconstituents of, and constraints upon, aneutral notion of disability. (shrink)

How do I know whether there are any minds beside my own? This problem of other minds in philosophy raises questions which are at the heart of all philosophical investigations--how it is that we know, what is in the mind, and whether we can be certain about any of our beliefs. In this book, Anita Avramides begins with a historical overview of the problem from the Ancient Skeptics to Descartes, Malebranche, Locke, Berkeley, Reid, and Wittgenstein. The second part of (...) the book investigates the views of influential contemporary philosophers such as Strawson, Davidson, Nagel and Searle. (shrink)

Today, more corporations disclose information about their environmental performance in response to stakeholder demands of environmental responsibility and accountability. What information do corporations disclose on their websites? This paper investigates the environmental management policies and practices of the 200 largest corporations in the world. Based on a content analysis of the environmental reports of Fortune’s Global 200 companies, this research analyzes the content of corporate environmental disclosures with respect to the following seven areas: environmental planning considerations, top management support to (...) the institutionalization of environmental concerns, environmental structures and organizing specifics, environmental leadership activities, environmental control, external validations or certifications of environmental programs, and forms of corporate environmental disclosures. (shrink)

This article engages Axel Honneth’s recent work on Georg Lukács’ concept of reification in order to formulate a politically relevant and historically specific critique of capitalism that is applicable to theorizing contemporary democratic practice. I argue that Honneth’s attempt to reorient the critique of reification within the terms of a theory of recognition has done so at the cost of sacrificing the core of the concept, which forged a connection between the socio-political analysis of capitalist domination and an analysis of (...) the unengaged, spectatorial stance of human beings toward the world, showing how they together impede emancipatory social transformation. In order to accomplish the unfinished task of rendering the critique of reification applicable to contemporary critical theory, I seek to synthesize the advantages of Honneth’s approach, which focuses on the normative aspects of the critique of reification, with Lukács’ emphasis on the practical, political-economic dimensions of reification and the historically specific pathologies of the capitalist social form. (shrink)

Uncertainty is inherent in new and unexpected viral outbreaks such as the current COVID-19 pandemic. It imposes challenges for health officials in soliciting cooperative behavioural changes based on incomplete information. In this paper, we use evolving mask recommendations in the United States as an example to analyse the ethical importance and practical demonstration of trustworthiness in pandemic messaging and decision-making. We argue that responsible public health interventions in the time of uncertainties requires explicit intersecting ethical considerations both in action and (...) in communication to promote trustworthiness. First, as public health decisions have to be made in the face of incomplete and evolving data, health officials need to exhibit competence while committing to epistemic humility. They can explain the methods used in making and updating mask recommendations as well as explicitly acknowledge the need to incorporate sociocultural and other contextual considerations in translating scientific data into mask recommendations. Second, officials and agencies must uphold and communicate decisional transparency as part of their effort to demonstrate accountability and promote the public’s understanding of the evolving pandemic. Third, especially since both the pandemic and mask recommendations may have disparate impact on different populations, officials should start with the fair implementation of the least restrictive measures that can help reduce harm. (shrink)