Many publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK.

In lieu of an abstract, here is a brief excerpt of the content:The Little Way:Ferdinand Ulrich on AccidentsRachel M. ColemanWe live in a material reality. Obviously it is not the case that we live in a merely material reality, but it is worth remembering that we are corporeal substances given to be in a corporeal reality. Our materiality informs every aspect of our being, everything about us—including how we come to know.The German philosopher Ferdinand Ulrich never forgets this about the (...) human being or the reality in which the human is given to be—indeed, Ulrich, like his intellectual mentor and constant dialogue partner Thomas Aquinas, is a realist. That is to say that, like Thomas, Ulrich is always thinking about the world as it is given to man to inhabit and understand. This then includes thinking about matter, which, because of its status as lowest rung on the ladder of creation, is often overlooked in our thinking. Our materiality, with all of its implications for man, the world, and the task of man that is philosophy—that is, thinking and knowing being itself—is a touchstone for Ulrich's metaphysics and indeed all of his work.1Ulrich's dense and textured metaphysics can be approached in many ways, but perhaps none is so crucial as his attention to the small and seemingly insignificant, which is why he gives so much time and attention to matter throughout his corpus—for what could be more insignificant than that which does not exist in itself? Ulrich's attention to matter, however, is not simply in the speculative mode, wondering about the nature of potentia pura (though this is also included), but rather this kind of speculation leads [End Page 377] Ulrich to thinking through the implications of materiality for man's being and knowing. One of these is what Ulrich refers to repeatedly throughout Homo Abyssus, his great work of metaphysics and meta-anthropology, as "the little way." In the first chapter of that book, Ulrich writes:The light of being, since it doesn't cling to itself or allow reason to come to an end "next to" God, is therefore precisely what compels speculative reason to transcend beings into the absolute ground. This act of transcendence enraptures reason, which has been illuminated by being, elevating reason into the light of absolute truth, while reason precisely thereby enters onto the "little way" in the multiplicity of finite being.2According to Ulrich, in order to know and understand being itself, or "absolute truth," as quoted just above, human reason must enter onto this "little way," which can be reached only "in the multiplicity of finite being."The materiality of the world and the multiplicity of finite being therein have everything to do with each other, and Ulrich claims that, in order to know and understand absolute truth or being itself, precisely this multiplicity must be our starting point. Already then, at the beginning of Homo Abyssus, Ulrich draws our attention to the significance of matter.Ulrich receives this phrase, "the little way," from none other than St. Thérèse of Lisieux, who, in accepting her littleness, so to speak, not as a burden but as a gift, was given to work great acts.3 We have a clue already, [End Page 378] then, for beginning to understand how Ulrich conceives of matter and multiplicity: as that which, though nothing in itself, allows us to know the greatest truths—indeed, the "absolute truth." [End Page 379]Here we cannot explore every aspect of what Ulrich means when he uses the phrase "the little way," nor can we outline the entirety of how Ulrich's thinking about matter and materiality informs his metaphysics.4 We can, however, approach this topic in Ulrich's thinking through one particular implication of material being: accidents, or accidental being. Accidents do not subsist in themselves, but rather only in another—that is, substance—and as such, according to Ulrich, often get passed over in our thinking in favor of what we think of as more important subjects. And yet, in a certain sense, accidents are all we ever encounter in the world: while the tree could theoretically be any color at all, it... (shrink)

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26% versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22% versus 59%). The odds of public (...) support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources. (shrink)

A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain’s point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the risk of (...) damaging them beyond repair? (shrink)

_Discourse, Dialogue and Technology Enhanced Learning_ is invaluable to all those wanting to explore how dialogic processes work and how we facilitate them. Dialogue is an important learning tool and it is by understanding how language affects us and how we use language to encourage, empathise, inquire, argue and persuade that we come closer to understanding processes of change in ourselves and our society. Most researchers in Education will find themselves interpreting some form of data in the form of words; (...) whether these words be explanations, conversations, narrations, reflections, debates or interviews and whether they are conducted through digital media or face-to-face. Discourse, textual or spoken, is therefore central to researching education. Each chapter focuses on the ways in which alternative levels of discourse analysis provide tools for the researcher, enabling insights into the way language works in learning, teaching practice and wider society. Drawing on the author’s own ‘DISCOUNT’ discourse analysis coding scheme and including a wide range of dialogue examples, this book covers: Why Dialogue? The Role of Dialogue in Education. Debate: Learning to Argue and Arguing to Learn Towards Meaning-Making: Inquiry, Narrative and Experience The Role of the Significant Other: Facilitation, Scaffolding and Mediation Inclusion, Collaboration and Community Media, Mode and Digital Literacy Researching Voices and Texts Discourse, Dialogue and Technology Enhanced Learning will be an essential resource for all students, educators and educational researchers who have an interest in the role of discourse in educational contexts. (shrink)

Perceived control in contingency learning is linked to psychological wellbeing with low levels of perceived control thought to be a cause or consequence of depression and high levels of control considered to be the hallmark of mental healthiness. However, it is not clear whether this is a universal phenomenon or whether the value that people ascribe to control influences these relationships. Here we hypothesize that values affect learning about control contingencies and influence the relationship between perceived control and symptoms of (...) mood disorders. We tested these hypotheses with European university samples who were categorized as endorsing (or not) values relevant to control - individualist and collectivist values. Three online experimental contingency learning studies (N1 = 127, N2 = 324, N3 = 272) were carried out. Evidence suggested that individualist values influenced basic learning processes via an effect on learning about the context in which events took place. Participants who endorsed individualist values made control judgments that were more in line with an elemental associative learning model, whilst those who were ambivalent about individualist values made judgments that were more consistent with a configural process. High levels of perceived control and individualist values were directly associated with increased euphoric symptoms of bipolar disorder, and such values completely mediated the relation between perceived control and symptoms. The effect of low perceived control on depression was moderated by collectivist values. Anxiety created by dissonance between values and task may be a catalyst for developing mood symptoms. Conclusions are that values play a significant intermediary role in the relation between perceived control and symptoms of mood disturbance. (shrink)

The idea of a profound urban–rural divide has shaped analysis of the 2016 U.S. presidential election results. Here, through examples from agri-food systems, we consider the limitations of the urban–rural divide framework in light of the assumptions and intentions that underpin it. We explore the ideas and imaginaries that shape urban and rural categories, consider how material realities are and are not translated into U.S. rural development, farm, and nutrition policies, and examine the blending of rural and urban identities through (...) processes of rural deagrarianization and urban reagrarianization. We do not argue that an urban–rural divide does not exist, as studies and public opinion polls illustrate both measured and perceived differences in many aspects of the lived experiences that shape our individual and collective actions. Ultimately, we suggest that the urban–rural divide concept obscures the diversity and dynamism of experiences each category encompasses. Additionally, it ignores the connections and commonalities that demand integrative solutions to challenges in agri-food systems, and draw attention to the power relations that shape resource access and use within and across urban and rural spaces. (shrink)

CRISPR, a recently developed gene-editing tool, has become synonymous with rapid biological advancement. While gene editing had been performed in life sciences research for decades, genetic engineering with CRISPR is much more straightforward, faster, and less expensive—and thus, the technology has been rapidly democratized. CRISPR was built on a natural mechanism, the method by which bacteria resist infections from viruses called bacteriophage. Once infected, bacteria may recognize specific genetic sequences of the invading bacteriophage virus and chop its genetic material into (...) pieces. This bacterial immune response, discovered through basic research, has been exploited by scientists to develop a gene-editing tool... (shrink)

This thought-provoking book examines the science behind human attractiveness—the ratios, proportions, and other factors that to a large extent dictate what we find "beautiful." It's said that "beauty is in the eye of the beholder," but recent scientific research suggests that human attractiveness is much more objective than we once thought, deeply rooted in our biology and evolutionary history. For instance, facial symmetry is considered extremely attractive because it indicates good health and nutrition during the formative developmental years. This book (...) explores these insights. Part I of The Biology of Beauty: The Science behind Human Attractiveness takes a closer look at what traits we find the most alluring and why. It discusses why attractiveness is important from an evolutionary standpoint and the advantages (and disadvantages) of being attractive. In addition to exploring these beauty "universals," it examines how beauty ideals can be shaped by factors such as culture, religion, and the media. Part II provides an in-depth analysis of individual features that contribute to attractiveness, offering scientific explanations for our preferences. The book also includes a collection of insightful sidebars that highlight beauty ideals in different parts of the world and at other times in history. (shrink)

While a number of valid molecular targets have been discovered for tumours over the past decade, finding an effective way of delivering therapeutic genes specifically to tumours has proved more problematic. A variety of viral and non‐viral delivery vehicles have been developed and applied in anti‐cancer gene therapies. However, these suffer from either inefficient and/or short‐lived gene transfer to target cells, instability in the bloodstream and inadequate tumour targeting. Recently, various types of non‐pathogenic obligate anaerobic and facultative anaerobic bacteria have (...) been shown to infiltrate and selectively replicate within solid tumours when delivered systemically. This has prompted the development of cancer gene therapy protocols that use such bacteria as gene delivery vehicles. Here, we review the evidence for the success of these in pre‐clinical models and clinical trials, as single modality treatments and in combination with conventional cancer therapies. BioEssays 28:84–94, 2006. © 2005 Wiley Periodicals, Inc. (shrink)

Liberalism, in any of its forms, places a strong emphasis on the individual---it prioritizes equal rights and liberties, and measures are taken to assure for all citizens the opportunity to make full use of their freedoms and entitlements. Many conceptions of human rights are objected to on the grounds that they are based on liberal premises, and insufficiently sensitive to the fact of reasonable cultural pluralism. ;Using as a foil recent work in this area by John Rawls, I argue in (...) chapter one for a justificatory basis of human rights that advances values---in particular values of minimal democracy including the right to political participation---that may have emerged historically alongside liberalism but that we ought not consider specifically liberal. My account diverges form Rawls' at this point: he does not believe that such values can be defended from premises that are not specifically liberal. ;Since a group is, after all, merely a collection of individuals, liberalism appears to be committed, unsatisfactorily, to a permissive right to secede in the sense that, other things being equal, groups always ought to be permitted to secede voluntarily. I show in my second chapter that liberalism is not committed to this permissive view. Though liberalism implies that no one has a duty to refrain from secession, it does not support the stronger thesis that states must permit groups to secede if they wish. My treatment of secession argues for a more general framework in which those liberties whose protection is of basic importance to liberalism are distinguished from those whose protection is not so guaranteed. ;Derek Parfit has put forth a general difficulty regarding our obligations to future generations to which I respond in chapter three. Parfit claims, plausibly, that we may suppose a major public policy decision to have sufficiently broad ramifications that in about two hundred years there would be nobody alive who would have been alive had some different policy been selected. But then the choice of such a policy would not make those people worse off, since they would not otherwise have been born. This would remain so even in the case of policies that cause the lives of future generations to be of a very low quality. Parfit's "Non-Identity Problem" challenges us to provide plausible moral reasons against such public policies. ;I argue that the only adequate response to this problem comes from a liberal focus on the rights of future generations, and the moral status that this confers on them. Taking such seriously, many public polices can be shown to be objectionable despite the fact that such policies may not harm the interests of those affected by them. (shrink)

Background:New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are.Objectives:To explore the ethical tensions perceived to occur in practice for new graduate health professionals.Research design:This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After (...) the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis.Ethical considerations:No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour.Findings:Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice.Discussion:This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated.Conclusion:Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions. (shrink)

Expectations of receiving personal health information as a fringe benefit of biospecimen donation—termed diagnostic misconception—are increasingly documented. We developed an instrument measuring conflation of observational biospecimen-based research and clinical care for use with Latino communities, who may be particularly affected by diagnostic misconception due to limited health care access.

Collaborative remembering is essential to enabling teams to build shared understanding of projects and their progress. This article presents an analysis of collaborative remembering sequences in a corpus of interactions collected in a workplace where a team of designers developed a video television commercial. On the basis of coding and analysing linguistic and bodily behaviors in 158 such sequences, extracted from over 45 hours of video recordings, recurrent patterns of collaborative remembering processes were identified, relating to the interplay of work (...) roles. This article shows that collaborative remembering in the design studio is structured by behavioural, interactive and social factors. (shrink)

Defense of reproductive choice is an important motivation in women's self-protection psychology for which the “staying alive theory” cannot fully account. Evidence indicates that some elements of women's self-protection psychology function to protect reproductive choice rather than survival, or may be equally well explained by either motivation. Integrating perspectives will result in greater explanatory breadth and precision in theory testing.

Professional workplaces that embody an “ideal worker” image that is implicitly white and male set-up persistent biases against the competence and suitability for authority of those who are not white men, forcing them to work harder to prove their competence and fit in. The added labor of coping with these burdens is largely invisible to dominant actors in the workplace who do not experience them. To facilitate change by making such burdens visible for all, we present data from a survey (...) of 1,349 architects, including white, Asian, Black, Latinx, and mixed race/other underrepresented men and women, about their specific behavioral experiences of prove-it-again bias, tightrope bias, problems of fit, exclusion, emotion work, and interruptions. Across all measures, white men architects report significantly lower levels of these burdens than do women of any race and almost all non-white men. Consistent with status expectations and stereotype prototypicality theories, we find intersectional patterns in the relative burdens experienced by women and men of different racial groups. Gender differences in bias experiences are greatest among white, less among Asian, and least among Black architects. Women of color report the highest levels of bias overall. (shrink)

In the United States, food banks served an estimated 46 million people in 2015. A combination of government policy reforms and political economic trends contributed to the rising numbers of individuals relying on private food assistance in the US, the United Kingdom and other high-income countries. Although researchers frequently map urban food environments, this project is one of the first to map private food assistance and potential need at the census-tract scale. We utilize Geographic Information Systems, demographic data, and food (...) assistance locations to develop a rapid assessment tool that could support food banks, pantries, soup kitchens, and government agencies that seek to answer the question of whether people with the greatest need have food distribution sites in close proximity. We define access based on distance and then calculate potential food insecurity using either poverty rates or a food insecurity index. We apply these methods in a case study analysis of Santa Clara County, California. Our findings suggest that food assistance distribution locations match the areas of potential need in more than 80% of urban census tracts. However, there are several potentially underserved locations and populations that could benefit from new food assistance operations. The poverty and index-based approaches show significant spatial overlap in mapped areas of high food insecurity and low access. The poverty only approach produces a higher estimate of food insecurity rates, is easier to calculate, and draws attention to the need to address poverty as a root cause of hunger. (shrink)