Dementia is a growing issue at the end of life that presents unique challenges for advance care planning. Advance directives are a useful and important component of end-of-life planning, but standard advance directives have less utility in cases of loss of capacity due to dementia. An advance directive designed to specifically address end-of-life issues in the setting of dementia can provide patients with increased autonomy and caregivers with improved information about the desires of the individual in question. The Dartmouth Dementia (...) Directive is a dementia-specific advance directive, available online, that seeks to address common concerns of individuals who are planning for dementia-related end-of-life care. This directive was piloted in a community-based workshop, which provided important details and perspective on the best use of dementia-specific advance directives in the greater population. (shrink)

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

Animals do a wide range of work in our society, but they are rarely recognized as workers or accorded any labour rights, and their working conditions are often oppressive and exploitative. Drawing on law, ethics, and labour studies, the essays in this volume explore the potential and dangers of animal labour.

In order to protect nonhuman animals effectively, animal law must overcome many hurdles, be it the balance of human and nonhuman interests, the use paradigm, or narrow definitions of legal personhood or basic rights. A fact often overlooked in this uphill struggle is that the laws of most states recognize that animals must be protected because and to the extent that they are sentient. The legal recognition of animal sentience seems to nullify all and any attempts to deny them legal (...) protection simply because they are not sufficiently appealing, emotionally close, or economically useful to us. However, the legal recognition of animal sentience does not overcome all our cognitive prejudices about animals. Using a comparative law method and insights from moral philosophy, this article analyzes the nature and scope of the legal recognition of animal sentience. It identifies its advantages in challenging arbitrariness and inconsistency and championing intrinsic animal protection and points to the most pressing shortcomings, including some states’ refusal to commit themselves to animal sentience and remaining prejudices in society and science. In concluding, the article offers ways to address and remedy these shortcomings and points to ways in which the concept can be used more effectively by academics and practitioners. (shrink)

Switzerland is internationally known for its progressive animal laws and for its innovative tools in law enforcement. In 1992, the Canton of Zurich introduced a public lawyer vested with the task of representing animals’ interests in criminal procedure, known as the Animal Protection Lawyer. The APL had the power to access information about court proceedings, study pending court cases, and intervene on behalf of victim animals. This enforcement tool set a precedent across the world. It amounted to a recognition of (...) animals as de facto victims and created an “equality of arms” for human and animal parties in criminal procedure. In a historic move in 2014, the Zurich parliament removed the APL from office—by mistake, as some maintain. Meanwhile—unnoticed by many—the Canton of Berne maintained a state agency vested with the very same powers as those the APL had, called the Dachverband Berner Tierschutzorganisationen. Though the DBT operated as an established agency for over 2 decades, in August 2017, a criminal court in Berne denied the DBT standing, arguing that the laws conferring on it the right to represent animals violate the federal law on criminal procedure. In July 2018, the Supreme Court delivered its judgment, and effectively stripped the DBT of its rights to represent animals in criminal proceedings. This article describes these recent shifts in criminal animal law in detail and analyzes the sociopolitical factors that gave rise to them. Special attention is paid to the question of what is left for Switzerland as a role model in animal law given ongoing deregulations, particularly as recent cases in the United States point to an incremental emancipation of animals as victims. The article discusses current alternatives to the APL and the DBT and puts their promises under scrutiny. The analysis reveals that these alternatives skirt the main obstacles faced by animals in criminal procedure and threaten the democratic will of the Swiss people. Two alternatives are discussed that can help Switzerland overcome its insufficiencies: the organizational right to appeal and victim rights for animals in criminal procedure. Using these alternatives, the article calls for the global emancipation of animals as the proper victims of crimes and for furnishing them with correlating rights to enforcement, including rights to representation. (shrink)

Graphical AbstractDriving patterns of coral bleaching over reefs are a suite of biophysical interactions where the physical environment modulates organism response through an interplay with intrinsic biological functioning. Flow conditions over reefs can mitigate the physiological impacts of thermal stress across multiple spatial scales. More details can be found in article number 1800226 by Charlotte E. Page et al., Seeking Resistance in Coral Reef Ecosystems: The Interplay of Biophysical Factors and Bleaching Resistance under a Changing Climate, DOI: 10.1002/bies.201800226.

Behavioral evidence for the COVIS dual‐process model of category learning has been widely reported in over a hundred publications (Ashby & Valentin, ). It is generally accepted that the validity of such evidence depends on the accurate identification of individual participants' categorization strategies, a task that usually falls to Decision Bound analysis (Maddox & Ashby, ). Here, we examine the accuracy of this analysis in a series of model‐recovery simulations. In Simulation 1, over a third of simulated participants using an (...) Explicit (conjunctive) strategy were misidentified as using a Procedural strategy. In Simulation 2, nearly all simulated participants using a Procedural strategy were misidentified as using an Explicit strategy. In Simulation 3, we re‐examined a recently reported COVIS‐supporting dissociation (Smith et al., ) and found that these misidentification errors permit an alternative, single‐process, explanation of the results. Implications for due process in the future evaluation of dual‐process theories, including recommendations for future practice, are discussed. (shrink)

Coral bleaching has impacted reefs worldwide and the predictions of near‐annual bleaching from over two decades ago have now been realized. While technology currently provides the means to predict large‐scale bleaching, predicting reef‐scale and within‐reef patterns in real‐time for all reef users is limited. In 2020, heat stress across the Great Barrier Reef underpinned the region's third bleaching event in 5 years. Here we review the heterogeneous emergence of bleaching across Heron Island reef habitats and discuss the oceanographic drivers that (...) underpinned variable bleaching emergence. We do so as a case study to highlight how reef end‐user groups who engage with coral reefs in different ways require targeted guidance for how, and when, to alter their use of coral reefs in response to bleaching events. Our case study of coral bleaching emergence demonstrates how within‐reef scale nowcasting of coral bleaching could aid the development of accessible and equitable bleaching response strategies on coral reefs. Also see the video abstract here: https://youtu.be/N9Tgb8N-vN0. (shrink)

This is an essay based on a story with observations, about present and sparkling moments from everyday life coexisting with a mother living with dementia. The story is used to begin philosophical underpinnings reflecting on ‘how it could be otherwise’. Dementia deploys brutal existential experiences such as cognitive deterioration, decline in mental functioning and often hurtful social judgements. The person living with dementia goes through transformation and changes of self. Cognitive decline progressively disrupts the foundations upon which social connectedness is (...) built, often creating a profound sense of insecurity. The challenge for carers and healthcare professionals is therefore to find ways of clarifying a concept of agency. It will be worthwhile developing the ability of attuning into ‘what is there’ arising from every corner of the care situation. Understanding and practicing this can strengthen existence and the experience of connectedness and meaning, empowering the person with dementia. It is important to find ways, relational moves, in which carers and healthcare professionals can embed the creativity appearing in mundane everyday situations filled with surplus of meaning, sharing mental landscapes (and embodied relational understanding) with the person living with dementia – seizing and sharing aesthetic moments (verbal and nonverbal) being present together. We argue that carers and healthcare professionals may find this understanding of care useful. This implies looking into a phenomenological‐hermeneutic perspective developing competences as well as practical wisdom understanding and being aware of the creative and innovative possibilities (often preverbal and unnoticed small things) in everyday life of what we, inspired by psychoanalyst Daniel Stern, call sparkling moments of meeting, creating experience with the other that is personally undergone and lived through in the present. (shrink)

Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and (...) power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs. (shrink)

In this article, I discuss a trivialization worry for Hartry Field’s official formulation of the access problem for mathematical realists, which was pointed out by Øystein Linnebo (and has recently been made much of by Justin Clarke-Doane). I argue that various attempted reformulations of the Benacerraf problem fail to block trivialization, but that access worriers can better defend themselves by sticking closer to Hartry Field’s initial informal characterization of the access problem in terms of (something like) general epistemic norms of (...) coincidence avoidance. (shrink)

Resilience factors have been suggested as key mechanisms in the relation between symptoms and disability among individuals with chronic pain. However, there is a need to better operationalize resilience and to empirically evaluate its role and function. The present study examined psychological flexibility as a resilience factor in relation to symptoms and functioning among 252 adults with chronic pain applying for participation in a digital ACT-based self-help treatment. Participants completed measures of symptoms (pain intensity, anxiety), functioning (pain interference, depression), as (...) well as the hypothesized resilience factor psychological flexibility (measured as avoidance, value obstruction, and value progress). As expected, symptoms, functioning and resilience factors were significantly associated. Hierarchical linear regression analyses showed that psychological flexibility significantly contributed to the prediction of pain interference and depression when adjusting for age, pain and anxiety. Also, participants with low levels of psychological flexibility were more likely to be on sick leave. Furthermore, a series of multiple mediation analyses showed that psychological flexibility (avoidance, value obstruction, value progress) had a significant indirect effect on the relationship between symptoms and functioning. Avoidance was consistently shown to contribute to the indirect effect. Results support previous findings and suggest the importance of psychological flexibility as a resilience factor among individuals with chronic pain and anxiety. (shrink)

Researchers have recently documented the unexpected opportunities war can present for women. While acknowledging the devastating effects of mass violence, this burgeoning field highlights war’s potential to catalyze grassroots mobilization and build more gender sensitive institutions and legal frameworks. Rwanda and Bosnia-Herzegovina serve as important examples of this phenomenon, yet a closer examination of both cases reveals the limits on women’s capacity to take part in and benefit from these postwar shifts. This article makes two key contributions. First, it demonstrates (...) how the postwar political settlement created hierarchies of victimhood that facilitated new social divisions and fractured women’s collective organizing. Second, it argues that while war creates certain opportunities for women, a revitalization of patriarchy in the aftermath can undermine these gains. Drawing on more than 250 interviews with women in both countries, this article ultimately questions the extent to which postwar mobilization can be maintained or harnessed for genuine gender emancipation. (shrink)

If we are to ensure the persistence of species in an increasingly warm world, of interest is the identification of drivers that affect the ability of an organism to resist thermal stress. Underpinning any organism's capacity for resistance is a complex interplay between biological and physical factors occurring over multiple scales. Tropical coral reefs are a unique system, in that their function is dependent upon the maintenance of a coral–algal symbiosis that is directly disrupted by increases in water temperature. A (...) number of physical factors have been identified as affecting the biological responses of the coral organism under broadscale thermal anomalies. One such factor is water flow, which is capable of modulating both organismal metabolic functioning and thermal environments. Understanding the physiological and hydrodynamic drivers of organism response to thermal stress improves predictive capabilities and informs targeted management responses, thereby increasing the resilience of reefs into the future. (shrink)

This note points out a conflict between some common intuitions about metaphysical possibility. On the one hand, it is appealing to deny that there are robust counterfactuals about how various physically impossible substances would interact with the matter that exists at our world. On the other hand, our intuitions about how concepts like MOUNTAIN apply at other metaphysically possible worlds seem to presuppose facts about ‘solidity’ which cash out in terms of these counterfactuals. I consider several simple attempts to resolve (...) this conflict and note they all fall short. (shrink)

This article is a critical and interpretive examination of moral and ethical issues that have emerged as the Internet and other digital information forms have evolved. It considers individual expectations of privacy for one's cyberspace communications against the greater public good for unencumbered access, by government and other organizations, to information that may be harmful to others. I argue for the need to find a reasonable balance between the individual's "right" not to disclose information that might be self-incriminating, as codified (...) in the Miranda Rules, and the open communication principles advocated by professional journalists that are essential to a democratic society. (shrink)

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the (...) recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions. (shrink)

The concept of legitimacy is often used and emphasized in the context of setting limits in health care, but rarely described is what is actually meant by its use. Moreover, it is seldom explicitly stated how health-care workers can contribute to the matter, nor what weight should be apportioned to their viewpoints. Instead the discussion has focused on whether they should take on the role of the patients’ advocate or that of gatekeeper to the society’s resources. In this article, we (...) shed light on the role of health-care workers in limit setting and how their conferred legitimacy may support subordinators’ (i.e. citizens’) conferred legitimacy. We argue that health-care workers have an important role to play as both moral and political agents in limit setting, and delineate normative conditions that justify and facilitate health-care workers in conferring legitimacy on this kind of decision. Their role and potential impact on political limit setting does not—theoretically—affect the idea of democratic legitimacy negatively. Rather, as we suggest, by designing for limit-setting policymaking accordingly, health-care workers, as well as citizens, are more justified in conferring democratic legitimacy to health-care limit-setting decisions than if these concerns were not addressed. (shrink)

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the (...) recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions. (shrink)

This article reviews recent developments in health care law, focusing on controversy at the intersection of health care law and culture. The article addresses: emerging issues in federal regulatory oversight of the rapidly developing market in direct-to-consumer genetic testing, including questions about the role of government oversight and professional mediation of consumer choice; continuing controversies surrounding stem cell research and therapies and the implications of these controversies for healthcare institutions; a controversy in India arising at the intersection of abortion law (...) and the rights of the disabled but implicating a broader set of cross-cultural issues; and the education of U.S. health care providers and lawyers in the theory and practice of cultural competency. (shrink)

L'Aufklärung allemande s'est réapproprié polémiquement le concept rousseauiste de perfectibilité, souvent avec d'importants déplacements. Théologie, philosophie, histoire naturelle, pédagogie, anthropologie concourent à un débat critique par lequel cette anthologie montre la pluralité des Lumières. --.

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

The way a rational agent changes her belief in certain propositions/hypotheses in the light of new evidence lies at the heart of Bayesian inference. The basic natural assumption, as summarized in van Fraassen's Reflection Principle, would be that in the absence of new evidence the belief should not change. Yet, there are examples that are claimed to violate this assumption. The apparent paradox presented by such examples, if not settled, would demonstrate the inconsistency and/or incompleteness of the Bayesian approach, and (...) without eliminating this inconsistency, the approach cannot be regarded as scientific. The Sleeping Beauty Problem is just such an example. The existing attempts to solve the problem fall into three categories. The first two share the view that new evidence is absent, but differ about the conclusion of whether Sleeping Beauty should change her belief or not, and why. The third category is characterized by the view that, after all, new evidence is involved. My solution is radically different and does not fall into either of these categories. I deflate the paradox by arguing that the two different degrees of belief presented in the Sleeping Beauty Problem are in fact beliefs in two different propositions, i.e., there is no need to explain the change of belief. The Sleeping Beauty Problem The Problem Deflated 2.1 From contradiction to consistency 2.2 The inanimate version 2.3 Back to SB Summary CiteULike Connotea Del.icio.us What's this? (shrink)

Previous research suggests that exposure to nature may reduce delay discounting and thereby facilitate healthier dietary intake. This pre-registered study examined the impact of online exposure to images of natural scenes on delay discounting and food preferences. It was predicted that exposure to images of natural scenes would be associated with: lower delay discounting; higher desirability for fruits and vegetables ; and delay discounting would mediate the effect of nature-image exposure on food desirability. Adult participants were recruited to an online (...) between-subjects experiment in which they viewed a timed sequence of six images either showing natural landscape scenes or urban scenes. They then completed measures of mood, delay discounting and rated their momentary desire to eat four fruits and vegetables, and four energy-dense foods. There was no statistically significant effect of experimental condition on delay discounting or food desirability. Bayes factors supported the null hypothesis for discounting, and energy-dense food desirability, but provided no strong evidence for either hypothesis for F&V desirability. These findings indicate that brief online exposure to images of nature does not affect momentary impulsivity or energy-dense food preference, whereas for preference for less-energy dense foods, the evidence was inconclusive. (shrink)

resumo É possível distinguir ao menos três etapas principais nas abordagens filosóficas da noção de sujeito: na etapa metafísica a estrutura do sujeito é pens a da em termos de substância; na etapa transcendental , o sujeito é visto como polarida de unificadora de horizontes; na etapa psic a na l í t ica, o sujeito é de f i n ido como estrutura vazia. O sujeito tra ns c e nde ntal é uma estrutura para o mu ndo, enqua (...) nto o sujeito psicanalítico precisa ter uma estrutura em si me s mo para estruturar sua ausênc ia ontológica. Para Lacan, essa ausênc ia ont o l ó g ica se torna manifesta me d ia nte a ling ua gem. A estrutura do sujeito é concebida como uma estrutura de significação. Este artigo compara esses três pontos de vista sobre o sujeito e discute que relevância a idéia de estrutura pode ter para a compreensão do conceito. palavras-chave Sujeito metafísico; sujeito transcendental; sujeito psic a nalítico; estrutura; Platão; Kant; Fichte; Lacan. (shrink)

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)