Slips of the tongue, unwitting favoritism and stereotyped assumptions are just some examples of microaggression. Nearly all of us commit microaggressions at some point, even if we don’t intend to. Yet over time a pattern of microaggression can cause considerable harm by reminding members of marginalized groups of their precarious position. The Ethics of Microaggression is a much needed and clearly written exploration of this pervasive yet complex problem. What is microaggression and how do we know when it is occurring? (...) Can we be held responsible for microaggressions and if so, how? How has social media affected the problem? What role can philosophy play in understanding microaggression? Regina Rini explores these highly topical and controversial questions in an engaging and fair-minded way, arguing that an event is a microaggression precisely because it causes a marginalized person to experience an ambiguous encounter with oppression. She illustrates her argument with compelling examples from media, politics and psychology and explains the significance of essential concepts, such as media representation, reparative renaming, and safe spaces. The Ethics of Microaggression explains what microaggression is and offers strategies for combating it. Assuming no prior knowledge of the topic or philosophy, it demystifies a controversial and extremely important topic in clear language. It is ideal for anyone coming to the topic for the first time and for students in philosophy, gender studies, race theory, disability theory and social and political philosophy. (shrink)

Build the skills you need to understand and resolve ethical problems! Ethical Dimensions in the Health Professions, 7th Edition provides a solid foundation in ethical theory and concepts, applying these principles to the ethical issues surrounding health care today. It uses a unique, six-step decision-making process as a framework for thinking critically and thoughtfully, with case studies of patients to illustrate ethical topics such as conflict of interest, patient confidentiality, and upholding best practices. Written by Regina F. Doherty, an (...) educator and occupational therapist, this book will help you make caring and effective ethical choices that improve patient care and outcomes. UNIQUE! Ethical decision-making process provides an organizing framework to use in making the best decisions when faced with ethical problems. Patient stories depict real-life situations and demonstrate the ethical decision-making process. Reflection boxes depict important concepts and stimulate critical thinking. Summary boxes highlight the most important information in each section. Coverage of interprofessional team decision-making reflects this important, expanding movement in healthcare nationally and internationally. Questions for thought and discussion encourage students to apply the ethical decision-making process to different situations. NEW! Updated content throughout the book reflects the changes in the growing interprofessional movement. NEW! Expanded content on clinician well-being includes tools for supporting moral resilience and preventing burnout in health professionals. NEW! Updated content addresses the topics of social justice, health disparities, intersectionality, and health outcomes. NEW! Updated national standards and regulations are provided for electronic health communications, data protections, and clinical research. NEW! Coverage of scientific literature is expanded with studies on the effects of compassion on patient outcomes, patient safety, and provider and organizational well-being. NEW! Coverage of ethical issues impacting healthcare and society includes topics such as medical scarcity due to healthcare supply chain shortages and extreme weather events due to climate change. (shrink)

Palliative Care Nursing: Caring for Suffering Patients explores the concept of suffering as it relates to nursing practice. This text helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. In addition, it examines spiritual and ethical perspectives on suffering and discusses how witnessing suffering impacts nurses' ability to assume the professional role. Further, the authors discuss ways nurses as witnesses to suffering can optimize (...) their own coping skills and facilitate personal growth. Rich in case studies, pictures, and reflections on nursing practice and life experiences, Palliative Care Nursing: Caring for Suffering Patients delves into key topics such as how to identify when a patient is suffering, whether they are coping, sources of coping facades, what to do to ease suffering, and how to convey the extent of suffering to members of the health care team.Palliative Care Nursing: Caring for Suffering Patients helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. (shrink)

Palliative care is a recent branch of health care. The doctors, nurses, and other professionals involved in it took their inspiration from the medieval idea of the hospice, but have now extended their expertise to every area of health care: surgeries, nursing homes, acute wards, and the community. This has happened during a period when patients wish to take more control over their own lives and deaths, resources have become scarce, and technology has created controversial life-prolonging treatments. Palliative care is (...) therefore faced with more ethical problems that other areas of health care. This book, by a clinician, teacher, and writer on health care ethics, has been written to provide all those who care for the terminally ill--doctors, nurses, social workers, clergymen, physiotherapists--with the concepts and principles which will assist them with difficult decisions. It challenges many received doctrines of palliative care, but its well-illustrated central theme is that technical expertise must be controlled by humane, non-technical judgments. (shrink)

Deepfake technology uses machine learning to fabricate video and audio recordings that represent people doing and saying things they've never done. In coming years, malicious actors will likely use this technology in attempts to manipulate public discourse. This paper prepares for that danger by explicating the unappreciated way in which recordings have so far provided an epistemic backstop to our testimonial practices. Our reasonable trust in the testimony of others depends, to a surprising extent, on the regulative effects of the (...) ever-present possibility of recordings of the events they testify about. As deepfakes erode the epistemic value of recordings, we may then face an even more consequential challenge to the reliability of our testimonial practices themselves. (shrink)

Many of our cognitive capacities are the result of enculturation. Enculturation is the temporally extended transformative acquisition of cognitive practices in the cognitive niche. Cognitive practices are embodied and normatively constrained ways to interact with epistemic resources in the cognitive niche in order to complete a cognitive task. The emerging predictive processing perspective offers new functional principles and conceptual tools to account for the cerebral and extra-cerebral bodily components that give rise to cognitive practices. According to this emerging perspective, many (...) cases of perception, action, and cognition are realized by the on-going minimization of prediction error. Predictive processing provides us with a mechanistic perspective that helps investigate the functional details of the acquisition of cognitive practices. The argument of this paper is that research on enculturation and recent work on predictive processing are complementary. The main reason is that predictive processing operates at a sub-personal level and on a physiological time scale of explanation only. A complete account of enculturated cognition needs to take additional levels and temporal scales of explanation into account. This complementarity assumption leads to a new framework—enculturated predictive processing—that operates on multiple levels and temporal scales for the explanation of the enculturated predictive acquisition of cognitive practices. Enculturated predictive processing is committed to explanatory pluralism. That is, it subscribes to the idea that we need multiple perspectives and explanatory strategies to account for the complexity of enculturation. The upshot is that predictive processing needs to be complemented by additional considerations and conceptual tools to realize its full explanatory potential. (shrink)

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it (...) does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

This paper presents a regress challenge to the selective psychological debunking of moral judgments. A selective psychological debunking argument conjoins an empirical claim about the psychological origins of certain moral judgments to a theoretical claim that these psychological origins cannot track moral truth, leading to the conclusion that the moral judgments are unreliable. I argue that psychological debunking arguments are vulnerable to a regress challenge, because the theoretical claim that ‘such-and-such psychological process is not moral-truth-tracking’ relies upon moral judgments. We (...) must then ask about the psychological origins of these judgments, and then make a further evaluative judgment about these psychological origins… and so on. This chain of empirical and evaluative claims may continue indefinitely and, I will argue, proponents of the debunking argument are in a dialectical position where they may not simply call a halt to the process. Hence, their argument cannot terminate, and its debunking conclusion cannot be upheld. (shrink)

It is a philosophical truism that we must think of others as moral agents, not merely as causal or statistical objects. But why? I argue that this follows from the best resolution of an antinomy between our experience of morality as necessarily binding on the will and our knowledge that all moral beliefs originate in contingent histories. We can address this antinomy only by understanding moral deliberation via interpersonal relationships, which simultaneously vindicate and constrains morality’s bind on the will. This (...) means that moral agency is fundamentally social. I model an attitude toward our causal nature on sociologist Erving Goffman’s concept of ‘civil inattention’; our social practice of agency requires that we give minimal attention to the contingent origins of moral judgments in ourselves and others. Understood this way, seeing ourselves as moral agents requires avoiding appeal to causal aetiology to settle substantive moral disagreement. (shrink)

Recent work on enculturation suggests that our cognitive capacities are significantly transformed in the course of the scaffolded acquisition of cognitive practices such as reading and writing. Phylogenetically, enculturation is the result of the co-evolution of human organisms and their socio-culturally structured cognitive niche. It is rendered possible by evolved cerebral and extra-cerebral bodily learning mechanisms that make human organisms apt to acquire culturally inherited cognitive practices. In addition, cultural learning allows for the intergenerational transmission of relevant knowledge and skills. (...) Ontogenetically, enculturation is associated with neural plasticity and the development of new motor routines and action schemas. It relies on scaffolded learning that structures novice-teacher interactions. The acquisition of reading and writing are paradigm examples of enculturation. Based on an empirically informed analysis of the components of enculturation, I will apply the emerging account of enculturated cognition to narrative practices. To date, research on the impact of narratives on the constitution of the self and our understanding of folk psychology has not paid much attention to the question how narratives are influenced by cumulative cultural evolution and our capacity to acquire reading and writing during ontogeny. I will argue that textual narratives, above and beyond oral narratives, provide genuinely new ways of narration. Therefore, the enculturated interaction with textual narratives has the potential to contribute to a better understanding of ourselves and other cognitive agents. (shrink)

Learning the psychological origins of our moral judgments can lead us to lose confidence in them. In this paper I explain why. I consider two explanations drawn from existing literature—regarding epistemic unreliability and automaticity—and argue that neither is fully adequate. I then propose a new explanation, according to which psychological research reveals the extent to which we are disturbingly disunified as moral agents.

After a review of terminology, I identify—in addition to Margaret Battin’s list of five primary arguments for and against aid-in-dying—the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan’s generalized empirical method. Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude that aid-in-dying must be justified on (...) its own merits and not on the basis of these well-established palliative care practices; and that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this part of their operative value structure. (shrink)

Palliation is a relatively new concept that is used in connection with the integral care provided to those who are unable to recover from their illness. The specific meaning of the concept has not been clearly defined. This article explores the possibilities offered by a responsive approach to evaluation that can facilitate a reflexive dialogue on this ambiguous concept. In doing so it draws on a case study of a palliative care project in a Dutch health care authority. The article (...) begins with an overview of the characteristics of a responsive approach to evaluation and addresses interpretative, representational and practical dilemmas. It goes on to present a series of dialogues between health professionals, informal caregivers, patients and evaluators. These dialogues take the form of juxtaposed stories, transcribed conversations and interpretations. Finally, the learning experiences are summarised and the appropriateness of the responsive approach to evaluate palliative care is discussed. (shrink)

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

As palliative care develops across many of the countries of Europe, we find that it continues to raise important ethical challenges. Palliative care practice requires ethical sensitivity and understanding. At the same time the very existence of palliative care calls for ethical explanation. Ethics and palliative care meet over some vital issues: 'the good death', sedation at the end of life, requests for euthanasia, futile treatment, and the role of research. Yet palliative care appears uncertain about its goals and there (...) is evidence that its ethical underpinnings are changing. Likewise, the moral problems of palliative care are only partly served by the four 'principles' of modern bioethics. This innovative book, with contributions by clinicians, ethicists, philosophers and social scientists, provides the first ever picture of palliative care ethics in the European context. It will be of interest to those involved in the delivery and management of palliative care services, as well as to students and researchers. (shrink)

Since at least 2016, many have worried that social media enables authoritarians to meddle in democratic politics. The concern is that trolls and bots amplify deceptive content. In this chapter I argue that these tactics have a more insidious anti-democratic purpose. Lies implanted in democratic discourse by authoritarians are often intended to be caught. Their primary goal is not to successfully deceive, but rather to undermine the democratic value of testimony. In well-functioning democracies, our mutual reliance on testimony also generates (...) a distinctively democratic value: decentralized testimonial networks evade control by the state or powerful actors. The deliberate exposure of deception in democratic testimonial networks undermines this value by implicating citizens in their own epistemic corruption, weakening the resilience of democratic society against authoritarian pressure. In this chapter I illustrate that danger through a close reading of recent Russian social media interference operations, showing both their epistemic underpinnings and their ongoing political threat. (shrink)

Background Traditionally, palliative care has focused on patients suffering from life-threatening somatic diseases such as cancer or progressive neurological disorders. In contrast, despite the often chronic, severely disabling, and potentially life-threatening nature of psychiatric disorders, there are neither palliative care units nor clinical guidelines on palliative measures for patients in psychiatry. Main text This paper contributes to the growing literature on a palliative approach in psychiatry and is based on the assumption that a change of perspective from a curative to (...) a palliative approach could help promote patient-centeredness and increase quality of life for severely ill patients in psychiatry as well as in somatic medicine. To exemplify this, we offer three different clinical scenarios: severe and enduring anorexia nervosa, treatment-refractory schizophrenia, and chronic suicidality and persistent self-injury in borderline personality disorder. Conclusion We emphasize that many typical interventions for treatment-refractory psychiatric disorders may indeed be of a palliative nature. Furthermore, introducing traditional features of palliative care, e.g. so-called goals of care conversations, could aid even further in ensuring that caregivers, patients, and families agree on which treatment goals are to be prioritized in order to optimize quality of life in spite of severe, persistent mental disorder. (shrink)

Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, (...) palliative care fares badly under a policy of QALY-maximisation, since procedures which prevent premature death (provided the life is of reasonable quality) or improve quality of life for those with longer life expectancy will produce more QALYs. This paper examines various responses to this problem and argues that in order to justify increased resources for palliative care its advocates must reject the ‘atomistic’ view of the value of life implicit in the QALY approach in favour of a ‘holistic’ or ‘narrative’ account. This, however, has implications which advocates of palliative care may be reluctant to embrace. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

How can we tell whether an incident counts as a microaggression? How do we draw the boundary between microaggressions and weightier forms of oppression, such as hate crimes? I address these questions by exploring the ontology and epistemology of microaggression, in particular the constitutive relationship between microaggression and systemic social oppression. I argue that we ought to define microaggression in terms of the ambiguous experience that its victims undergo, focusing attention on their perspectives while providing criteria for distinguishing microaggression.

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, (...) to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. (...) Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice. (shrink)

Billions of animals live and die under deplorable conditions in factory farms. Despite significant efforts to reduce human consumption of animal products and to encourage more humane farming practices, the number of factory-farmed animals is nevertheless on an upward trajectory. In this paper, we suggest that the high levels of suffering combined with short life-expectancies make the situation of many factory-farmed animals relevantly similar to that of palliative patients. Building on this, we discuss the radical option of seeking to reduce (...) the suffering of factory-farmed animals through the use of drugs that alleviate pain and distress, administered under a regimen where experiential wellbeing is prioritized over the aim of avoiding drug-dependence. (shrink)

We ought to treat others’ moral views with respect, even when we disagree. But what does that mean? This paper articulates a moral obligation to make ourselves open to sincere moral persuasion by others. Doing so allows us to participate in valuable relationships of reciprocal respect for agency. Yet this proposal can sound tritely agreeable. To explore its full implications, the paper applies the general obligation to one of the most challenging topics of moral disagreement: the morality of abortion. I (...) consider and reject arguments that abortion decisions have special features exempting them from the obligation to be open to moral persuasion. Further, I argue that viewing fetal ultrasound images can accomplish morally persuasion. Accordingly, in at least some cases a woman seeking abortion has an obligation to view fetal ultrasound images as a means of being open to moral persuasion. However, this conclusion does not support recent laws compelling women seeking abortion to view ultrasound images; such laws are in fact incompatible with the respect for agency that underwrites the obligation to be open to persuasion. (shrink)

This short piece draws on political philosophy to show how social media interference operations can be used by hostile states to weaken the apparent legitimacy of democratic governments. Democratic societies are particularly vulnerable to this form of attack because democratic governments depend for their legitimacy on citizens' trust in one another. But when citizen see one another as complicit in the distribution of deceptive content, they lose confidence in the epistemic preconditions for democracy. The piece concludes with policy recommendations for (...) how democratic governments should protect themselves. (shrink)

In this article I maintain the importance of the Aristotelian concept of prudence or phronesis applied to business ethics, distinguishing its meaning from Solomon and Hartman’s approaches to Aristotelian business ethics. Whereas Solomon stresses the value of perception of particulars and Hartman criticizes the incapacity of Aristotelian phronesis to dwell with the interests of others, I advocate that Aristotelian virtue ethics is important because the concept of phronesis does three things: (a) stresses the rational calculation and general principles or rules (...) in virtue ethics, in general, and business ethics, in particular; (b) provides a communal-based ethics principle; and c) offers us a clear comprehension about what calculation or reasoning is in ethics. (shrink)

The drive for cost-effective use of medical interventions has advantages, but can also be challenging in the context of end-of-life palliative treatments. A quality-adjusted life-year (QALY) provides a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. However, since it is in the nature of end-of-life palliative care that the benefits it brings to its patients are of short duration, it fares poorly (...) under a policy of QALY-maximization. Nevertheless, we argue that the goals of palliative care and QALY are not incompatible, and optimal integration of palliative care into the calculation of QALY may reveal a mechanism to modify considerations of how optimal quality of life can be achieved, even in the face of terminal illness. The use of QALYs in resource allocation means that palliative care will always compete with alternative uses of the same money. More research should be conducted to evaluate choices between palliative care and more aggressive therapies for the terminally ill. However, current limited data show that investing in palliative care makes more sense not only ethically, but also financially. (shrink)

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided (...) less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. (shrink)

Over the last years, the debate over global justice has moved beyond the divide between statist and cosmopolitan, as well as ideal and non-ideal approaches. Rather, a turn to empirical realities has taken place, claiming that normative political philosophy and theory need to address empirical facts about global poverty and wealth. The talk argues that some aspects of the earlier “Critical Theory” and its notions of negativity, praxis, and communicative power allow for a non-empiristic link between normative theory and a (...) well-informed social science analysis that is based on experienced injustice. The analysis of border politics and housing politics will serve as an example for a critical theory of global injustice that addresses regressive as well as emancipative developments in society. (shrink)

Cognitive innovation has shaped and transformed our cognitive capacities throughout history. Until recently, cognitive innovation has not received much attention by empirical and conceptual research in the cognitive sciences. This paper is a first attempt to help close this gap. It will be argued that cognitive innovation is best understood in connection with cumulative cultural evolution and enculturation. Cumulative cultural evolution plays a vital role for the inter-generational transmission of the products of cognitive innovation. Furthermore, there are at least two (...) important functions of enculturation for cognitive innovation. First, enculturation is responsible for the ontogenetic acquisition of cognitive practices governing the interaction with innovative products. Second, successful processes of enculturation provide opportunities for subsequent innovative processes. The trans-generational trajectory of calculation from mathematical symbol systems to the first digital computers will serve as a paradigm example of the delicate interplay of cognitive innovation, cumulative cultural evolution, and enculturation. (shrink)

Background: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural palliative care is, however, largely lacking.This paper aims at describing elements of both the physical workplace and the cultural-social context of the palliative care practice, which are imperative for the use of teleconsultation technologies. Methods: A semi-structured expert meeting and qualitative, open interviews were deployed to explore (...) professionals’ assumptions and wishes, which are considered to contain latent presumptions about the practice’s physical workplace and latent elements of the cultural-social context, regarding (1) the mediating potential of audio-visual teleconsultation, (2) how the audio-visual teleconsultations will affect medical practice, and (3) the design and usage of the teleconsultation technology. We used a qualitative analysis to investigate how palliative care professionals interpret the teleconsultation package in preparation. The analysis entailed open and axial coding techniques developed in a grounded theory approach. Results: Respondents assume: 1. teleconsultation will hinder physical proximity, thereby compromising anamnesis and diagnosis of new or acutely ill patients as well as “real contact” with the person behind the patient; 2. teleconsultation will help patients becoming more of a pivotal figure in their own care trajectory; 3. they can use teleconsultation to keep a finger on the pulse; 4. teleconsultations have a healing effect of their own due to offered time and digital attention; 5. teleconsultation to open up an additional “gray” network outside the hierarchical structures of the established chain of transmural palliative care. This network could cause bypassing of caregivers and uncertainty about responsibilities; 6. teleconsultations lead to an extended flow of information which helps palliative care professionals to check the stories of patients and medical specialists. Conclusions: Professionals assume teleconsultation co-defines a new patient–professional relationship by extending hospital-based caregivers’ perceptions of as well as attention for their patients. At the cost, however, of clinical and personal connectedness. Secondly, a hermeneutics is needed to carefully interpret teleconsultation images. Thirdly, teleconsultations transform caregiving cultures as formerly separated care domains collide, demanding a redefinition of roles and responsibilities. (shrink)

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better (...) not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units. (shrink)

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

A deliberative model of politics has recently been criticized for not being very well equipped to conceptualize public spheres in world society. A first critique is that this model assumes a conception of public spheres that is too idealistic, because it presupposes counterfactual conditions of communication in public discourse that do not meet empirical real word conditions. Secondly, it assumes an antiquated notion of a shared “we” of political actors. Because of this it does not take into consideration the “digital (...) turn” and the ego-centering and depersonalizing effects of social media like Facebook, twitter, and blogs, which have led to a rapid decline of the public sphere. And a third critique states that the deliberative model ignores the fact that politics, and especially protests and revolutions, are not seminar-like debates but spontaneous, chaotic and sometimes violent expressions. So it is not just unreceptive for the “digital space” but also for gathering and protesting in real public places surrounded by military troops. I will argue that all of these critiques fall short. A deliberative model of politics allows us to address the tension between the ideal and the real, the “old media” and the so-called digitalization of public spheres as well as peaceful discourse and violent uprisings. Especially the concept of communicative power, a notion also used by Hannah Arendt, reveals the potential for future participation in digital spaces and public places. (shrink)

It is a philosophy of patient care, and is therefore open to critique and evaluation.Using the Oxford Textbook of Palliative Medicine Third Edition as their ...

Loving Justice, Living Shakespeare asks why love is regarded as the highest human value in some cultural sectorsDLreligion, literature and the artsDL and is not even on the map in othersDLphilosophy, law, and political thought. In the biblical vision, 'love the neighbor' is both the law and the just way to live. And yet, while religious thinkers cannot conceive of justice without love, for political philosophers, justice and love belong in completely different spheres, rational and public vs. emotional and private. (...) This book engages our dominant ideas of justice, including theories of contract, retribution and distribution, showing how they fall short if love is not included. Shakespeare emerges as its hero: part of his endurance is due to the many ways his plays stage how justice must be driven by loveDL no mere private passion, but a vital understanding of care for one another, care that a just world cannot do without. (shrink)