Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

Retrospective rule-making has few supporters and many opponents. Defenders of retrospective laws generally do so on the basis that they are a necessary evil in specific or limited circumstances, for example to close tax loopholes, to deal with terrorists or to prosecute fallen tyrants. Yet the reality of retrospective rule making is far more widespread than this, and ranges from ’corrective’ legislation to ’interpretive regulations’ to judicial decision making. The search for a rational justification for retrospective rule-making necessitates a reconsideration (...) of the very nature of the rule of law and the kind of law that can rule, and will provide new insights into the nature of law and the parameters of societal order. This book examines the various ways in which laws may be seen as retrospective and analyses the problems in defining retrospectivity. In his analysis Dr Charles Sampford asserts that the definitive argument against retrospective rule-making is the expectation of individuals that, if their actions today are considered by a future court, the applicable law was discoverable at the time the action was performed. The book goes on to suggest that although the strength of this ’rule of law’ argument should prevail in general, exceptions are sometimes necessary, and that there may even be occasions when analysis of the rule of law may provide the foundation for the application of retrospective laws. (shrink)

In addition to ensuring that appropriate standards of evidence are employed when attempting to identify adaptations, researchers should investigate all nonevolutionary factors that could potentially explain their results. Evolutionary analyses may be undermined by alternative, non-evolutionary explanations either because not all relevant information is included in an evolutionary analysis, or because inappropriate methods incapable of detecting an adaptation are employed.

AbstractBackgroundEthical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. In prehospital emergency medicine, decision-making commonly takes place in everyday life, under time pressure, with limited information about a patient and with few possibilities of consultation with colleagues. This paper explores the ethical challenges experienced by prehospital emergency personnel. MethodsThe study was grounded in the tradition of action research related to interventions in health care. Ethical challenges were explored in three focus groups, each attended by (...) emergency medical technicians, paramedics, and prehospital anaesthesiologists. The participants, 15 in total, were recruited through an internal information network of the emergency services. Focus groups were audio-recorded and transcribed verbatim.ResultsThe participants described ethical challenges arising when clinical guidelines, legal requirements, and clinicians’ professional and personal value systems conflicted and complicated decision-making processes. The challenges centred around treatment at the end of life, intoxicated and non-compliant patients, children as patients—and their guardians, and the collaboration with relatives in various capacities. Other challenges concerned guarding the safety of oneself, colleagues and bystanders, prioritising scarce resources, and staying loyal to colleagues with different value systems. Finally, challenges arose when summoned to situations where other professionals had failed to make a decision or take action when attending to patients whose legitimate needs were not met by the appropriate medical or social services, and when working alongside representatives of authorities with different roles, responsibilities and tasks.ConclusionFrom the perspective of the prehospital emergency personnel, ethical challenges arise in three interrelated contexts: when caring for patients, in the prehospital emergency unit, and during external collaboration. Value conflicts may be identified within these contexts as well as across them. A proposed model of analysis integrating the above contexts can assist in shedding light on ethical challenges and value conflicts in other health care settings. The model emphasises that ethical challenges are experienced from a particular professional perspective, in the context of the task at hand, and in a particular, the organisational setting that includes work schedules, medical guidelines, legal requirements, as well as professional and personal value systems. (shrink)

When a chimpanzee stockpiles rocks as weapons or when a frog sends out mating calls, we might easily assume these animals know their own motivations--that they use the same psychological mechanisms that we do. But as Beyond the Brain indicates, this is a dangerous assumption because animals have different evolutionary trajectories, ecological niches, and physical attributes. How do these differences influence animal thinking and behavior? Removing our human-centered spectacles, Louise Barrett investigates the mind and brain and offers an alternative (...) approach for understanding animal and human cognition. Drawing on examples from animal behavior, comparative psychology, robotics, artificial life, developmental psychology, and cognitive science, Barrett provides remarkable new insights into how animals and humans depend on their bodies and environment--not just their brains--to behave intelligently. Barrett begins with an overview of human cognitive adaptations and how these color our views of other species, brains, and minds. Considering when it is worth having a big brain--or indeed having a brain at all--she investigates exactly what brains are good at. Showing that the brain's evolutionary function guides action in the world, she looks at how physical structure contributes to cognitive processes, and she demonstrates how these processes employ materials and resources in specific environments. Arguing that thinking and behavior constitute a property of the whole organism, not just the brain, Beyond the Brain illustrates how the body, brain, and cognition are tied to the wider world. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) (...) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

Objective: Illness perceptions are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors and examine the impacts of IP on perceived stress and preventive behaviors.Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed (...) considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution. (shrink)

Whatever the answer to Molyneux's question is, it is certainly not obvious that the answer is ‘yes’. In contrast, it seems clear that we should answer affirmatively a temporal variation on Molyneux's question, introduced by Gareth Evans. I offer a phenomenological explanation of this asymmetry in our responses to the two questions. This explanation appeals to the modality-specific spatial structure of perceptual experience and its amodal temporal structure. On this explanation, there are differences in the perception of spatial properties in (...) different modalities, but these differences do not stand in the way of the objectivity of perceptual experience. (shrink)

This paper discusses the relationship between internationalisation, mobility, quality and equality in the context of recent developments in research policy in the European Research Area (ERA). Although these developments are specifically concerned with the growth of research capacity at European level, the issues raised have much broader relevance to those concerned with research policy and highly skilled mobility. The paper draws on a wealth of recent research examining the relationship between mobility and career progression with particular reference to a recently (...) completed empirical study of doctoral mobility in the social sciences (Ackers et al. Doctoral Mobility in the Social Sciences. Report to the NORFACE ERA-Network, 2007). The paper is structured as follows. The first section introduces recent policy developments including the European Charter for Researchers and Code of Conduct for the Recruitment of Researchers and the European Commission’s Green Paper on the ERA. The discussion focuses on concerns around the definition of ‘mobility’ and the tendency (in both policy circles and academic research) to conflate different forms of mobility and to equate these with notions of excellence or quality. Scientific mobility is shaped as much by ‘push’ factors (limited opportunity) as it is by the ‘draw’ of excellence. Scientists are exercising a degree of ‘choice’ within a specific and individualised framework of constraints. The following sections consider some of the ‘professional’ and ‘personal’ factors shaping scientific mobility and the influence that these have on the relationship between mobility, internationalisation and excellence. The paper concludes that mobility is not an outcome in its own right and must not be treated as such (as an implicit indicator of internationalisation). To do so contributes to differential opportunity in scientific labour markets reducing both efficiency and equality. (shrink)

BackgroundDealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the (...) inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process.MethodsSeventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically.ResultsOur results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants.ConclusionThe broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately. (shrink)

Abstract: In this paper I offer an account of a particular variety of perception of absence, namely, visual perception of empty space. In so doing, I aim to make explicit the role that seeing empty space has, implicitly, in Mike Martin's account of the visual field. I suggest we should make sense of the claim that vision has a field—in Martin's sense—in terms of our being aware of its limitations or boundaries. I argue that the limits of the visual field (...) are our own sensory limitations, and that we are aware of them as such. Seeing empty space, I argue, involves a structural feature of experience that constitutes our awareness of our visual sensory limitations, and thus, in virtue of which vision has a field. (shrink)

Eighty years after de Broglie’s, and a little more than half a century after Bohm’s seminal papers, the de Broglie–Bohm theory (a.k.a. Bohmian mechanics), which is presumably the simplest theory which explains the orthodox quantum mechanics formalism, has reached an exemplary state of conceptual clarity and mathematical integrity. No other theory of quantum mechanics comes even close. Yet anyone curious enough to walk this road to quantum mechanics is soon being confused by many misleading signposts that have been put up, (...) and not just by its detractors, but unfortunately enough also by some of its proponents. This paper outlines a road map to help navigate ones way. (shrink)

For anyone acquainted with Reid’s works and the literature on them, the idea of proposing a hypothesis to explain contradictory comments on his philosophy, and the further idea of borrowing this hypothesis from Hume’s threefold account of scepticism will not only appear ironical but quite unlikely. Yet, this is what I propose to do in showing that Reid’s sceptical admissions can be seen as a form of “mitigated scepticism.” And while I acknowledge the irony of my hypothesis, I do not (...) grant that it lacks plausibility. (shrink)

I question the notion that we need to understand affordances in terms of Rylean non-factualist dispositions. This is not because I disagree with Herlas-Escribano’s analysis; on the contrary, I ….

Robert Burton's The Anatomy of Melancholy is one of the last great works of English prose to have remained unedited. The present volume inaugurates an authoritative edition of the work, which is being prepared by scholars on both sides of the Atlantic. It will be followed by two further volumes of text with textual apparatus, and two volumes of commentary. Burton concentrated a lifetime of inquiry into the Anatomy, describing and analysing melancholy and its causes - devoting especial attention to (...) love and religion - and recording possible cures. Primarily a scholarly study of morbid psychology, it is also a compendium of curious facts and anecdotes, and combines seriousness of purpose with a marked satirical vein. First published in 1621, it was a great success: four more editions were published in Burton's lifetime, in each of which new material was added, and a sixth, containing his final revisions, was published in in 1651, eleven years after his death. The textual complexity and Burton's extraordinary range of reference have hitherto deterred editors: this is the first scholarly edition to appear. The text is based on a complete collation of all six authoritative editions. (shrink)

The literature on the aetiology of serial killing has benefited from analyses which offer an alternative perspective to individual/psychological approaches and consider serial murder as a sociological phenomenon. The main argument brought to bear within this body of work identifies the socio-economic and cultural conditions of modernity as enabling and legitimating the motivations and actions of the serial killer. This article interrogates this work from the standpoint of a gendered reading of modernity. Using the Yorkshire Ripper case, it emphasizes how (...) in addition to the political economy, gender relations and masculinity shape the dynamics of serial murder and its representation. (shrink)

Using multisource data and multilevel analysis, we propose that the ethical stance of supervisors influences subordinates’ perceptions of corporate social responsibility which in turn influences subordinates’ trust in the organization resulting in their taking increased personal social responsibility and engagement in organizational citizenship behaviors oriented toward both the organization and other individuals. Using a multilevel model, we assessed the extent to which ethical leadership and CSR at the work unit level impacts subordinates’ behaviors mediated by organizational trust at the individual (...) level. We employed a sample of 71 work unit supervisors and 308 subordinates from five businesses of a conglomerate company located in mainland China. Subordinates were asked to rate supervisory ethical leadership practices, CSR, and their extent of organizational trust. Supervisors were asked to rate the personal social responsibility taking and OCB of their respective subordinates. A multilevel path analysis revealed that ethical leadership has a positive effect on CSR at the work unit level and that CSR has a positive cross-level effect on organizational trust at the individual level, which in turn significantly and positively impacts OCB through the mediating effect of taking personal social responsibility. Results are discussed in the context of China’s manufacturing sector. (shrink)

We argue that claims of racial progress rest upon untenable teleological assumptions founded in Enlightenment discourse. We examine the theoretical and methodological focus on progress and its historical roots. We argue research should examine the concrete mechanisms that produce racial stability and change, and we offer three alternative frameworks for interpreting longitudinal racial data and phenomena. The first sees racism as a “fundamental cause,” arguing that race remains a “master category” of social differentiation. The second builds on Glenn’s “settler colonialism (...) as structure” framework to describe race relations as a mutually constituted and place-based system of resource allocation. The third framework draws attention to racialized agency. (shrink)

Although Gramsci's notions of hegemony and subalternity may seem outdated in this 21st century, a critical examination of the literature shows that these concepts apply in this global pandemic and political context. Racialization is a form of structural violence. In this paper, I also explore Gramsci's’ notion of engaged intellectuals to support the idea of social and political activism in nursing. Nurse scholars call for the decolonization of the discipline. Gramsci's philosophical approach to hegemony can be extended to racialization in (...) nursing. Gramsci's notions of civil society and state can help nurses to see the structures that create racism in nursing and society. (shrink)

Through its social and political activism goals, postcolonial feminist theoretical approaches not only focus on individual issues that affect health but encompass the examination of the complex interplay between neocolonialism, neoliberalism, and globalization, in mediating the health of non-Western immigrants and refugees. Postcolonial feminism holds the promise to influence nursing research and practice in the 21st century where health remains a goal to achieve and a commitment for humanity. This is especially relevant for nurses, who act as global citizens and (...) as voices for the voiceless. The commitment of nursing to social justice must be further strengthened by relying on postcolonial theories to address issues of health inequities that arise from marginalization and racialization. In using postcolonial feminist theories, nurse researchers locate the inquiry process within a Gramscian philosophy of praxis that represents knowledge in action. (shrink)

La pratique de la divination, telle que Xénophon l’expose tout au long de l’Anabase, est la mise en œuvre d’un mode de communication avec les dieux qui peut emprunter des formes diverses, mais dont la principale est le sacrifice et l’observation des signes positifs ou négatifs, offerts par les victimes. Elle suppose une bienveillance de la divinité toujours prête, semble-t-il, à répondre aux questions posées par les hommes, dans le domaine public comme dans le privé, pourvu que ces questions soient (...) légitimes. Le reste de l’œuvre relève de la même conception, influencée par Socrate, comme le suggèrent les Mémorables, et trouve son origine dans la consultation de l’oracle de Delphes, au moment de son départ pour l’expédition organisée par Cyrus et qui deviendra l’expédition dite des Dix Mille.Divination, as described by Xenophon in the Anabasis, represents a means of communication with the gods, which can take several forms. The offer of a sacrifice is the first of these, with the observation of the signs given by the victims. This practice assumes that the gods are kind and that they are always ready to respond to questions posed by people either in public or in private, if these questions are legitimate. The same idea, influenced by Socrates, is found in all Xenophon’s works, as evidenced in the Memorabilia, beginning with Xenophon’s consultation of the Delphic oracle on joining Cyrus’ expedition, which would known as the “Ten Thousand” expedition. (shrink)

The term "Philosophic lyric".--Introductory chapter.--The "return to nature"; Wordsworth's "philosophy of nature".--The period between Wordsworth and Meredith.--Wordsworth and Meredith as poets of nature.--Browning and Meredith as poets of man.--Conclusion.

The way in which educators choose to engage with learners and to offer opportunities to share knowledge of both the physical world and the world of ideas is an ongoing area of international research interest but remains diffuse and difficult to systematise. This idiosyncratic quality underscores the privileged position of teachers as creative professionals. By exploring Claude Lévi-Strauss’s conception of how and for what purpose we share knowledge within society, this paper explores the relationship between perceptions of teachers’ professional role (...) and the challenges they face working within formal education systems. The artisan quality of teachers’ practice, gained through experience, association and personal commitment, makes possible a visualisation of teacher professionalism as bricolage that, when read alongside theories of teacher agency, generates an affirmative picture of how teacher professionalism may be reframed as creative and responsive rather than homogenous and mechanistic. (shrink)

This research explores the experiences of UK NHS healthcare professionals working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic. Using a critical understanding of the concept of moral resilience as a theoretical framework, we explore how the difficult circumstances in which they worked were navigated, and the extent to which moral suffering led to moral transformation. Ten staff from a general practice participated in semistructured interviews. Encountering the harms endured by people seeking asylum prior to arrival in (...) the UK and through the UK’s ‘Hostile Environment’ caused healthcare staff moral suffering. They responded to this in several ways, including: (1) feeling grateful for their own fortunes; (2) defining the limitations of their professional obligations; (3) focusing on the rewards of work and (4) going above and beyond usual care. Although moral resilience is reflected in much of the data, some participants described how the work caused ideological transformations and motivated challenges to systems of oppression. We show how current moral resilience theory fails to capture these transformative political and social responses, warning of how, instead, it might encourage healthcare staff to maintain the status quo. We caution against the widespread endorsement of current formulations of moral resilience in contemporary social and political climates, where the hostile and austere systems causing suffering are the result of ideological political decisions. Future work should instead focus on enabling working conditions to support, and developing theory to capture, collective resistance. (shrink)

It has become increasingly common for philosophers to make use of the concept of artistic value, and, further, to distinguish artistic value from aesthetic value. In a recent paper, ‘The Myth of (Non-Aesthetic) Artistic Value’, Dominic Lopes takes issue with this, presenting a kind of corrective to current philosophical practice regarding the use of the concept of artistic value. Here I am concerned to defend current practice against Lopes's attack. I argue that there is some unclarity as to what aspect (...) of this practice Lopes is objecting to, and I distinguish three kinds of objection that he could be read as making. I argue that none of these is adequately supported by Lopes's arguments, and that the corresponding three aspects of current philosophical practice are on firmer footing than Lopes's paper suggests. A new, plausible characterisation of artistic value will emerge from this discussion. (shrink)