In lieu of an abstract, here is a brief excerpt of the content:Cry of the CaregiverLeilani RoseberryMy story is about the work-related grief I've experienced while working as a certified nurse assistant (CNA). I'll begin with my first days as a newly hired CNA. It was day two of my first week, and while I walked down the hallway I noticed something unusual lying on the floor near the opposite side of building. The hall of the retirement community was quite (...) long and it wasn't until I was halfway down the hall before I realized it was a resident lying on the floor. I ran the rest of the way, only to discover the person was dead. I was very shaken.I hadn't received proper orientation in regards to this facility and I didn't know whom I should contact. It didn't help that I wasn't carrying a cell phone (I had been taught that we shouldn't keep our cell phones with us while on duty). There were no emergency phones and no pull cords available in the halls. I was very shaky and nervous. I admit that I was scared. There was no one around but the body and myself. It was after hours and the staff at the reception desk had already clocked out, so I thought. I had no resort but to knock on the door of a nearby resident and ask to use the phone. This created a commotion in the hall and drew a crowd of residents from their apartments and the atmosphere then became extremely sorrowful. [End Page 151]It was only then that I learned that a night staff person was on duty and how I could contact them. I had to learn this from a resident who was not my client. The person on staff that night provided me with a thorough tour and orientation of the building. I believe that my agency should have been the one to provide such an orientation. It took me a few weeks or more before I could close my eyes at night without seeing the body lying in the hallway. I wasn't offered any support from the agency; the next day was business as usual.About two weeks later, another resident I cared for passed away. Then another, and another, and so on, but I wasn't actually present when the deaths occurred. They passed away while I was off work. It bothered me just the same to know they were gone. I cared about my clients, but for the agency the clients meant money and I had to remain focused and keep on working.At this retirement community the residents were not cared for in a one-to-one fashion by the agency I worked for, but were visited during intervals throughout the course of my shift. I was on call for emergencies and other needs as well. Again, I cared for all those in my run, but I never became as close to any client as when I changed agencies and accepted the following assignment.The new homecare agency I worked for provided one-to-one care. It was shift work, eight hours, one-to-one with one client or a married couple. One day, just after I began my morning shift, my client suffered respiratory distress, his pulse raced while his oxygen level dropped, despite the O2 he used. My client died while gasping for air. This was the first time I had been present and witnessed the fear in a dying person's eyes or experienced losing a client like this, but my emotions had to be set aside. I had work to do. I assisted the hospice team with the post-mortem care and other tasks, plus cared for the spouse.After the post-mortem care was completed, I took a step back as the family gathered into the little room and surrounded my client. The room was silent except for the sighs, the sobs, and the wailing. It was heartbreaking to stay in the room. I bit my lip and tried to hold back tears. Not to mention the weak-in-the-knees floating feeling I experienced. I felt like... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Gaining a Heart But Missing MyselfLeilani R. GrahamI gathered it in my hands as it fell from my hair-brush, too saturated to hold anymore. It felt as if I were inside a movie and waiting for someone to yell “Cut!” but no call came. It continued to fall, feather-like onto the ground, individual strands glinting in the light of the bathroom window. My hair, nearly all of it, was (...) gone.Between the time of my heart transplant and the moment my hair began to fall out, I arguably had suffered enough. Transplant brought four open-heart surgeries, ten days on ECMO, an intra-aortic balloon pump, delirium, necrotizing pneumonia, and so much muscular atrophy that I had to re-learn how to walk. CPR, broken ribs, and the scar of a tricuspid clip from a botched biopsy: it was not the miracle I was hoping for.The internal trauma had certainly taken its toll. I no longer knew how I really felt, thanks to copious pain meds that altered my mind and body. Each limb was foreign as I re-acclimated to how one grabs hold of a cup, signs their name, touches their legs. Externally, I was a mess: covered in deep purple bruises across my torso from the diabetes treatments, dead skin pooling in unwashed pores, my ankles swollen and indiscernible from my legs. But lacking a good mirror (or the desire to find one), I still felt like “myself” during my forty-five day hospital stay. I could feel my cheekbones protruding from thinning skin, saw through unfocused eyes from the tempestuous blood sugars, and my hair sat in a rat’s nest atop my head; but I was still me.Arriving home, I felt like a newborn being brought into the real world for the first time. I needed help with everything—showers, sitting up, putting on shoes, even going to the bathroom. At age twenty-four, I felt I had regressed to the point of no return as I relied on others to do the simplest tasks. In addition, I was quarantined inside for three months, due to the risk of obtaining a fungal infection from the outside. Caged, and alone in my body, I a trapped and wounded tiger: angry, hurting, and scared. [End Page 109]When I had been prepared for transplant—and I use “prepared” loosely because the information packet I was handed was insulting at best—I knew to expect the scars. I had no issue with that, having been cut open at my throat and chest for previous surgeries. I knew to expect a 12-inch line from neck to navel: the most evident sign I would now carry that I was disabled.What I did not expect were the bullet holes— the sealed entrances of thick chest tubes that now dotted my lower torso. I did not anticipate the bruises on my arms and groin from arterial pokes. I felt violated as if I had walked into some kind of abduction and was rolled out, beaten, bruised, and, worst, touched.But it wasn’t the physical trauma that hurt the most. It was that no one seemed surprised.Immediately after transplant, the team’s focus is purely on survival. Survive the 30 days post-surgery. Survive the year. Metrics, uncomfortably tied to transplant center success statistics, funding, and clout have little to do with the patients themselves. What did I care to only survive a year? I wanted years. I wanted decades. It felt I wanted more than anyone was willing to pay attention to.The conversation was narrowed to high-risk issues: infection, rejection, or other life-threatening conditions. While this makes sense on a clinical level, what constitutes a major event for a clinician may not be of the same emotional value to the patient. In my case, I was less occupied by how the steroids were working and more obsessed with their side effects, such as how much weight I was rapidly gaining. I walked into the clinic one day with the beginnings of stretch marks and a week later had claw-like ripples down my sides. My mood swings were explosive... (shrink)

L’interprétation d’un acte de violence de masse est toujours délicate puisqu’elle confère un certain statut au groupe visé. Ce statut peut devenir un facteur important dans la décision de la communauté internationale de reconnaître ou non l’indépendance d’un groupe et de son territoire. Cet article examine le cas de la reconnaissance du Kosovo par la communauté internationale, en février 2008, et soutient que cette reconnaissance a été rendue possible par l’utilisation d’arguments basés sur le statut collectif de victime de nettoyage (...) ethnique détenu par la population albanaise du Kosovo. L’article comble le fossé entre, d’un côté, la théorie de la sécession comme réparation, et de l’autre, les travaux sur la violence de masse contre les groupes ethnonationaux. L’analyse montre que la pratique de la reconnaissance étatique a été réorientée vers un critère restrictif lié au type de violence subie par le groupe réclamant l’indépendance. Dans cette optique, le territoire devient une forme tangible de compensation pour les injustices subies, ce qui tranche par rapport à la pratique antérieure de la reconnaissance étatique dans l’ex-Yougoslavie et ailleurs.The interpretation of an act of mass violence is always a contentious issue since it confers a certain status to the targeted group. This status may become an important factor in the international community’s decision to recognize or not the independence of a group and its territory. This article examines the case of Kosovo’s February 2008 recognition by the international community and argues that this recognition was made possible by the summoning of arguments based on Kosovo Albanians’ collective status as victims of ethnic cleansing. The article bridges the gap between on the one hand the Remedial Right theory of secession, and on the other hand, works on mass violence against ethnonational groups. The article shows that the practice of state recognition was reoriented towards a restrictive criterion linked to the type of violence sustained by the group claiming independence. Under this interpretation, territory becomes a tangible form of compensation for suffered injustices, which contrasts with earlier practice of state recognition in the former Yugoslavia and elsewhere. (shrink)

To be a prisoner either in Plato's cave or in the Beast's castle is a form of existence no one would desire. And yet the story of Disney's Beauty and the Beast – in particular, the spell that imprisoned the Beast and his servants – is a tale as old as time. It is one's common human experience: one's recognition that he/she is shackled by ignorance and unfulfilled potential, and his/her desperate desire to escape. Unfortunately, however, breaking the chains and (...) ending the spell is no easy feat. For just as the Beast and his household companions represent a cave‐like imprisonment, Belle represents in her person the two ideals necessary to break the spell: love (which drew her to the castle to find her father) and beauty (which can compel the love of another). Love never happens without an encounter with beauty. (shrink)

The aim of this thoroughly unconventional work is to demonstrate that Herman Melville's Moby Dick and Ludwig Wittgenstein's Philosophical Investigations share the same projects and are, in effect, one and the same book.

This article presents narratives from 13 Indigenous early career academics (ECAs) at one university in Auckland, New Zealand. These experiences are likely to represent those of Indigenous Māori and Pasifika ECAs nationally, given the small, centralised nature of the national academy of Aotearoa New Zealand. The narratives contain testimony, fictionalised vignettes of experience, and poetic expressions. Meeting the demands of an academic role in one’s first years of working at a university is a big deal for anyone; the extra pressures (...) and challenges for Indigenous Māori and Pacific staff are immense, yet little understood by White ‘others.’ A writing workshop was the initial catalyst of this collective writing project. Through these insider narratives, this article presents a collective description of, and response to, the experience of Māori and Pasifika early career academics. (shrink)

In this paper, we outline a new method for evaluating the human impact of machine-learning applications. In partnership with Underwriters Laboratories Inc., we have developed a framework to evaluate the impacts of a particular use of machine learning that is based on the goals and values of the domain in which that application is deployed. By examining the use of artificial intelligence in particular domains, such as journalism, criminal justice, or law, we can develop more nuanced and practically relevant understandings (...) of key ethical guidelines for artificial intelligence. By decoupling the extraction of the facts of the matter from the evaluation of the impact of the resulting systems, we create a framework for the process of assessing impact that has two distinctly different phases. (shrink)

This is a report on the Doctoral Consortium co-located with the 17th International Conference on Artificial Intelligence and Law in Montreal.

In lieu of an abstract, here is a brief excerpt of the content:Bedside VoicesJacqueline J. GloverThis issue of Narrative Inquiry in Bioethics features ten stories of Certified Nursing Assistants (CNAs) who work primarily in long-term care. This is a voice of direct care at the bedside that is not often heard. The addition of these stories in the literature is long overdue and I am honored to be asked to comment. There is much to learn from these bedside caregivers. All (...) of these stories reflect the deep struggle to be respected as a member of the health care team. But I also hear the pain of being caught in the tension between the desire to be skilled, qualified, and professional and the desire to be present in a way that emphasizes service, caring and common human touch. My commentary is informed by my experience in Rural Bioethics and my work at the Center for Bioethics and Humanities at the University of Colorado which has a commitment to Interprofessional Education. The CNAs' stories reveal much that they share with other health care professionals, but also some unique features that can teach us much.CommonalitiesSelf Care and Being Cared ForThe voice of the CNA is a voice that is echoed in a way by all health care professionals. Each of the stories bears witness to the need to take care of yourself and to be cared for in order to be able to continue to care for others. Leilani Roseberry writes "This unresolved grief and constant exposure to dying and death had me looking at every day, even every moment, through the eyes of a dying person. This is an emotion that is very difficult to put into words." She continues elsewhere, "I believe that if I had grief support opportunities available to me in my professional life, my level of care and compassion would have been much more resilient from the very beginning of my work as a CNA. Instead, only after sorting through emotions affecting my personal life and learning they were a compilation of what I experienced professionally, only then have I become much more resilient in the face of grief and mourning." Danny Reed writes, "Caregivers benefit from the same thing patients and residents do: genuine kindness. Take care of the caregivers because one day they will be all you have left in the world." And from James Bradley, "The work itself can be very draining, but to beat the stress of it, you can follow all the usual stuff like going for walks, playing with your kids, watch TV etc. The best advice though is to, as far as possible, leave the work behind when you walk off at the end of your shift. That may be the hardest thing to do but it is the only way to retain the correct professional approach."Self care can certainly be about boundaries and stress management. Health care institutions, including professional schools, increasingly have wellness programs (Johnson, 2000). It was once thought that [End Page 159] professional and emotional distance was necessary to maintain healthy relationships and avoid burn out. But current thinking seems to indicate the opposite. If a health care professional views his or her work only in terms of tasks to be performed without some connection to the meaning of what he or she is doing for the patient as a human being, that person is more likely to burn out (Halpern, 2003). Bradley's use of "correct professional approach" prompted me to think beyond wellness and health to the need to nurture meaning in one's work. The CNAs' essays are filled with the call to recognize the deeper meaning of their work. Tracy Dudzinski writes, "Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know that it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done."There is increasing attention to the use of reflective writing in... (shrink)

In a landmark legal case in 1996, eugenics survivor Leilani Muir successfully sued the province of Alberta for wrongful confinement and sterilization. The legal finding implied that Ms. Muir should never have been institutionalized at the Provincial Training School of Alberta as a “moron” and sterilized under the Sexual Sterilization Act of Alberta. The trial itself revealed many unsettling features of the province’s practice of eugenics, raising questions about how a seemingly large number of people, like Ms. Muir, who (...) were not mentally defective, could have been wrongfully confined at an institution for the feeble-minded, and subsequently sterilized on eugenic grounds. Employing a three-agent model of wrongful accusation and conceiving of eugenics as wrongful more generally may help in understanding the operation of eugenic practices, such as institutionalization and sterilization, both in Western Canada and elsewhere. Eugenic practice involves a form of wrongful accusation that marks a significant departure from eugenic ideology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:preface The essays in this special issue on Indigenous Feminisms in Settler Contexts engage feminist politics from multiple Indigenous geographies, histories, and standpoints. What emerges is a panoramic view of Indigenous feminist scholarship’s conceptual, linguistic, and artistic activism at this moment in time. We learn of praxis aimed at reclaiming Indigenous languages and ecological perspectives and the varied modes of resistance, survivance, and persistence. We also unpack the complex (...) racial/gender politics of colonial encounters in contexts where white women cared intimately for Indigenous children, or where they helped to recover Indigenous oral traditions, and we note how modes of help can also reproduce imperial power relations. Some essays, art works, and poems extend the geographic ambit of critiques of settler colonialism beyond American contexts: they deploy feminist rubrics to critique the continuing violent settlement of Palestine and Kashmir to demonstrate that the occupation of “marginal” places is constitutive of state-​ society relations; others describe how Australian Aboriginal and Sámi artists engage the question of Indigenous visibility. In different ways, they each show how staying in place, against all odds, can be radical. Our first two articles examine the politics of praxis. Michelle M. Jacob, Virginia R. Beavert, Regan Anderson, Leilani Sabzalian, and Joana Jansen analyze Indigenous feminist praxis surrounding Ichishkíin Indigenous language education. The “artivism” of Sámi artists Maxida 284Preface and Timimie Märak, which expresses concern for land and water rights, gender and sexuality, and Indigenous rights in Northern Europe takes center stage in Kyle Bladow’s essay. The next three articles interrogate historical records shaping Indigenous lives in northern Canada, southwest Pacific, and southwestern United States and Mexico. Val Marie Johnson examines how white women staff members’ intimate care relations at residential schools for Inuvialuit, Inuinnait, and Iñupiat peoples in Canada were bound up with the latter’s dispossession. Carolyn J. Eichner recounts the encounter between the Indigenous Kanak people and Louise Michel, a feminist and participant in the revolutionary Paris Commune of 1871 who was banished to New Caledonia for seven years; Eichner argues that although Michel was staunchly anti-imperialist, her liberatory political project bore the temporal logics of colonization. Drawing on examples of Nahua reconfigurations of Christian scripture, Kenna Neitch proposes the language of “persistence” as a heuristic for avoiding the reactive, relational connotations that can pervade scholarly usages of “resistance” rhetoric. Next, our review essay by Jennifer McLerran describes recent Indigenous feminist scholarship that recasts the concept of sovereignty. Our News and Views piece focuses on modalities of occupation in the context of Kashmir: Nosheen Ali, Mona Bhan, Sahana Ghosh, Hafsa Kanjwal, Zunaira Komal, Deepti Misri, Shruti Mukherjee, Nishant Upadhyay, Saiba Varma, and Ather Zia argue that occupation is foundational to the making and reproduction of nationstates, and not exceptional to state power. The varied forms of resistance to occupation are examined by Sara Ihmoud in her article about how a group of Palestinian women, the Murabitat al-Haram, agitate for religious freedom simply by “staying in place.” Rabab Abdulhadi comments on shifts in contemporary settler colonial discourse in Israel, noting the increasingly overt and unapologetic deployment of highly sexualized and gendered images. Marina Tyquiengco examines the art of Australian Aboriginal artist Fiona Foley, specifically her Black Velvet series. Art and myth are also fused in Shantell Powell’s textual and visual rendering of Inuit memory. This issue features a range of poetry on topics such as language loss, human-land relationships, and sexual violence, written by Katherine Agyemaa Agard, Kei Kaimana, and Kai Minosh Pyle, and curated by our creative writing editor, Alexis Pauline Gumbs. In “Átaw Iwá Ichishkíin Sínwit: The Importance of Ichishkíin Language in Advancing Indigenous Feminist Education,” Michelle M. Jacob, Preface 285 Virginia R. Beavert, Regan Anderson, Leilani Sabzalian, and Joana Jansen examine Indigenous feminist praxis surrounding Ichishkíin-language education. They critique how Western education systems inflict pernicious forms of violence within Native communities, engaging in practices of linguistic genocide and alienating Indigenous peoples from their homelands. In response, Native peoples, along with non-Native allies, are engaging in educational and political activism to reclaim and revitalize Indigenous languages and ecological perspectives. In examining the foundational teaching of Ichishk... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)