Background: Although attention to healthcare ethics in rural areas has increased, specific focus on rural palliative care is still largely under-studied and under-theorized. The purpose of this study was to gain a deeper understanding of the values informing good palliative care from rural individuals' perspectives. Methods: We conducted a qualitative ethnographic study in four rural communities in Western Canada. Each community had a population of 10, 000 or less and was located at least a three hour travelling distance by car (...) from a specialist palliative care treatment centre. Data were collected over a 2-year period and included 95 interviews, 51 days of field work and 74 hours of direct participant observation where the researchers accompanied rural healthcare providers. Data were analyzed inductively to identify the most prevalent thematic values, and then coded using NVivo. Results: This study illuminated the core values of knowing and being known, being present and available, and community and mutuality that provide the foundation for ethically good rural palliative care. These values were congruent across the study communities and across the stakeholders involved in rural palliative care. Although these were highly prized values, each came with a corresponding ethical tension. Being known often resulted in a loss of privacy. Being available and present created a high degree of expectation and potential caregiver strain. The values of community and mutuality created entitlement issues, presenting daunting challenges for coordinated change. Conclusions: The values identified in this study offer the opportunity to better understand common ethical tensions that arise in rural healthcare and key differences between rural and urban palliative care. In particular, these values shed light on problematic health system and health policy changes. When initiatives violate deeply held values and hard won rural capacity to address the needs of their dying members is undermined, there are long lasting negative consequences. The social fabric of rural life is frayed. These findings offer one way to re-conceptualize healthcare decision making through consideration of critical values to support ethically good palliative care in rural settings. (shrink)
This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Toolâa dialogical (...) and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)
A number of articles and empirical studies over the past decade, most by Paul Robinson and co-authors, have suggested a relationship between the extent of the criminal law's reputation for being just in its distribution of criminal liability and punishment in the eyes of the community – its "moral credibility" – and its ability to gain that community's deference and compliance through a variety of mechanisms that enhance its crime-control effectiveness. This has led to proposals to have criminal liability (...) and punishment rules reflect lay intuitions of justice – "empirical desert" – as a means of enhancing the system's moral credibility. In a recent article, Christopher Slobogin and Lauren Brinkley-Rubinstein (SBR) report seven sets of studies that they argue undermine these claims of empirical desert and moral credibility and instead support SBR's proposed distributive principle of "individual prevention," a view that focuses on an offender's future dangerousness rather than on his perceived desert. -/- The idea that there is a relationship between the criminal law's reputation for justness and its crime-control effectiveness did not originate with Robinson and his co-authors. Rather, it has been a common theme among a wide range of punishment theory scholars for many decades. A particularly important conclusion of recent Robinson studies, however, is their confirmation that this relationship is a continuous one: even small nudges in moral credibility can produce corresponding changes in the community's deference to the criminal law. This is important because it shows that even piecemeal changes or changes at the margin – as in reforming even one unjust doctrine or procedure – can have real implications for crime-control. SBR's studies, rather than contradicting the crime-control power of empirical desert, in fact confirm it. Further, SBR's studies do not provide support for their proposed "individual prevention" distributive principle, contrary to what they claim. -/- While SBR try to associate their principle with the popular "limiting retributivism" adopted by the American Law Institute in its 2007 amendment of the Model Penal Code, in fact it is, in many respects, just the reverse of that principle. With limiting retributivism, the Model Code's new provision sets desert as dominant, never allowing punishment to conflict with it. SBR would have "punishment" essentially always set according to future dangerousness; it is to be constrained by desert only when the extent of the resulting injustices or failures of justice is so egregious as to significantly delegitimize the government and its law. This ignores the fact that even minor departures from justice may have an important cumulative effect on the system as a whole. What SBR propose – essentially substituting preventive detention for criminal justice – promotes the worst of the failed policies of the 1960s, where detention decisions were made at the back-end by "experts," and conflicts with the trend of the past several decades of encouraging more community involvement in criminal punishment, not less. (shrink)
Data are lacking with regard to participants' perspectives on return of genetic research results to relatives, including after the participant's death. This paper reports descriptive results from 3,630 survey respondents: 464 participants in a pancreatic cancer biobank, 1,439 family registry participants, and 1,727 healthy individuals. Our findings indicate that most participants would feel obligated to share their results with blood relatives while alive and would want results to be shared with relatives after their death.
Alienation and Connection addresses social constructs that perpetuate alienation through suffering. The contributors discuss how alienation through suffering in a variety of contexts can be transformed into connection and reconnection: human relationship with the environment, economic and social systems that disconnect and reconnect, cultural constructs that divide or can heal, encountered difference that brings opportunity, and various manifestations of personal pain that can be survived and even overcome.
Plochmann and Robinson closely analyze this great dialogue in the first two-thirds of their book, turning in the final four chapters to a broader discussion of its unity, sweep, and philosophic implications.
Genius is highly individual and unique yet it shares a compelling quality. In this intriguing introduction Andrew Robinson uses the life and work of familiar geniuses - and some less familiar - to consider what their achievements have in common; whether its heredity, education, hard work, intelligence or just plain luck.
The assumption of materialism Howard Robinson believes is false. In his book he presents a very forceful critique of the modern forms that materialism has taken. In telling discussions of the theory of supervenience put forward by Davidson and Peacocke, the central state materialism attributable to Smart, Armstrong and others, Putnam's functionalism, and Rorty's disappearance theory, he shows that, whatever their local inconsistencies, these forms of materialism all overlook or quite inadequately explain elementary and unimpeachable intuitions about our own (...) mental experiences. Robinson concludes with a consideration of the alternative views of the matter of which the mind is held to consist. These arguments will either serve to crystallise for the most part inchoate opposition to materialism among a number of philosophers, and will challenge its proponents to find a more secure defence for the basis of their view. (shrink)
Philosophy and Mystification is a work of philosophy in and of itself as much as it is a book about philosophy. Its reflections on the nature, methods and resources of philosophic enquiry are carefully grounded in the central problems that have dogged Western philosophy in the modern era: logical necessity, machine intelligence, the relation of science and religion, determinism, skepticism and the question of foundations and origins. Guy Robinson argues that a conception of philosophy was adopted in the 17th (...) century that required us to see the "world upside-down", creating abstract and mystified entities to explain the ordinary and concrete, requiring us to explain the social in terms of the individual, and the human and purposive in terms of the mechanical, and not only to see nature as a vast mechanism but science as a mechanical activity whose rules it was the business of the philosopher to discover. (shrink)