Much of the literature on clinical ethical conflict has been specific to a specialty area or a particular patient group, as well as to a single profession. This study identifies themes of hospital nurses’ and physicians’ clinical ethical conflicts that cut across the spectrum of clinical specialty areas, and compares the themes identified by nurses with those identified by physicians. We interviewed 34 clinical nurses, 10 nurse managers and 31 physicians working at four different Canadian hospitals as part of a (...) larger study on clinical ethics committees and nurses’ and physicians’ use of these committees. We describe nine themes of clinical ethical conflict that were common to both hospital nurses and physicians, and three themes that were specific to physicians. Following this, we suggest reasons for differences in nurses’ and physicians’ ethical conflicts and discuss implications for practice and research. (shrink)
A multiple-case study of four hospital ethics committees in Canada was conducted and data collected included interviews with key informants, observation of committee meetings and ethics-related hospital documents, such as policies and committee minutes. We compared the hospital committees in terms of their structure, functioning and perceptions of key informants and found variation in the dimensions of empowerment, organizational culture of ethics, breadth of ethics mandate, achievements, dynamism, and expertise.
Writing involves risks—the risk that one will be misunderstood, the risk of being persecuted, the risks of being made a champion for causes in which one does not believe, this risk of inadvertently supporting a reader’s prejudices, to name a few. In trying to give expression to what is true, the writer must “clear a passage within the agitated world of passions,” an undertaking that always to some extent fails: writers are never the master of their own speech. In _Writing: (...) The Political Test, _France’s leading political philosopher, Claude Lefort, illuminates the process by which writers negotiate difficult path to free themselves from the ideological and contextual traps that would doom their attempts to articulate a new vision. Lefort examines writers whose works provide special insights into this problem of risk, both literary artists and political philosophers. Among them are Salman Rushdie, Sade, Tocqueville,m Machiavelli, Leo Strauss, Orwell, Kant, Robespierre, Guizot, and Pierre Clastres. In Tocqueville, for example, Lefort finds that the author’s improvisatory and open-ended expression represents the character of the democratic experience. Orwell’s work on totalitarianism shows up the totalitarian subject’s complicity in this political regime. And Rushdie is remarkable for his solid attack on relativism. With the character and fate of the political forms of modernity, democracy, and totalitarianism a central theme, Lefort concludes with some reflections on the collapse of the Soviet Union. This intriguing and accessible exploration of literature’s political aspects and political philosophy’s literary ones will be welcomed by those who have been stymied by current efforts to bridge these two fields. Taken together, the essays in this volume also stand as an intellectual autobiography of Lefort, making it an excellent introduction to his work for less experience students of political theory or philosophy. (shrink)
Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question ‘What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?’ Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. (...) We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed. (shrink)
To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and (...) opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC have become more regularised and formalised over time. CEC continue to be predominately advisory in their nature, and by 2008 there was a shift in the priority of the activities of CEC to meeting ethics education needs and providing counselling and support with less emphasis on advising about policy and procedures. More research is needed on how best to define what the scope of activities of CEC should be in order to meet the needs of hospitals in Canada and elsewhere. More research also is needed on the actual outcomes to patients, families, health professionals and organisations from the work of these committees in order to support the considerable time committee members devote to this endeavour. (shrink)
Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question ‘What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?’ We interviewed 34 registered nurses, 10 nurse managers, (...) and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians. (shrink)
That the pattern into which Lentricchia seeks to assimilate Stevens is politically charged becomes clearest when we turn to the following oddly incomprehensible statement: “In the literary culture that Stevens would create, the ‘phallic’ would not have been the curse word of some recent feminist criticism but the name of a limited, because male, respect for literature” . At the point where he makes this assertion, Lentricchia has been persuasively demonstrating that Stevens was “encouraged … to fantasize the potential social (...) authority of the literary as phallic authority” . But suddenly the critic’s measured discourse is disrupted by obviously personal feelings about the “curse word of some recent feminist criticism” and by a dazzlingly illogical definition of “respect for literature.” Such a disruption suggests that, in making his apparently objective argument about Stevens, Lentricchia has some other not so hidden agenda—and, of course, his peculiar decision to link his discussion of Stevens with an attack on The Madwoman in the Attic further supports this conclusion. What most strikingly reinforces the point, however, is the hysterical—or perhaps, with some recent feminist linguists, we should say “testerical”—rhetoric in which he couches his assault on our work.14 14. The term “testeria,” for male “hysteria,” is proposed by Juli Loesch in “Testeria and Penisolence—A Scourge to Humankind,” Aphra: The Feminist Literary Magazine, 4, 1 : 43-45; quoted in Casey Miller and Kate Swift, Words and Women: New Language in New Times , pp. 60-61. Sandra M. Gilbert, professor of English at Princeton University, and Susan Gubar, professor of English at Indiana University, are coauthors of No Man’s Land: The Place of the Woman Writer in the Twentieth Century, Volume I: The War of the Words , the first installment of a three-part sequel to their Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . They have also coedited The Norton Anthology of Literature by Women: The Tradition in English. (shrink)
There is a striking difference, however, between the ways female and male modernists define and describe literal or figurative costumes. Balancing self against mask, true garment against false costume, Yeats articulates a perception of himself and his place in society that most other male modernists share, even those who experiment more radically with costume as metaphor. But female modernists like Woolf, together with their post-modernist heirs, imagine costumes of the mind with much greater irony and ambiguity, in part because women's (...) clothing is more closely connected with the pressures and oppressions of gender and in part because women have far more to gain from the identification of costume with self or gender. Because clothing powerfully defines sex roles, both overt and covert fantasies of transvestism are often associated with the intensified clothes consciousness expressed by these writers. But although such imagery is crucially important in works by Joyce, Lawrence, and Eliot on the one hand, and in works by Barnes, Woolf, and H. D. on the other, it functions very differently for male modernists from the way it operates for female modernists.Sandra M. Gilbert, professor of English at the University of California at Davis, is the author of Acts of Attention: The Poems of D.H. Lawrence and In the Fourth World; the coauthor, with Susan Gubar, of The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination, and its sequel, No Man's Land: The Woman Writer and the Twentieth-Century Literary Imagination. (shrink)
We’d like to do a little hypnosis on you. Imagine that you’re ensconced in your own family room, your study, or your queen-sized bed. Settling back, you pick up the remote, flick on the TV, and naturally you turn to PBS. This is what you hear:Host 1: Good evening. Welcome to Masterpiece Theatre. Because Alistair Cooke is away on assignment in Alaska, we’ve agreed to host the show tonight, and that’s both a pleasure and a privilege because our program this (...) evening marks the beginning of a fascinating new series, a first on television: Masterpiece Theatre will present you with a docudrama entitled “Masterpiece Theatre.”Host 2: Like “The First Churchills,” this show analyzes the situation of real-life people—tonight, people in the academy. Names have not been changed to protect either the innocent or the guilty, but all the situations are fictive and at times words that may never have been spoken are put into the mouths of people who did not speak them. Other lines, however, are direct quotations from various written sources, although none of the characters, as we depict them, should be confused with any “actual” persons, whether or not those persons would scribe to the idea of their own reality. Like “Upstairs/Downstairs,” this program will introduce you to a spectrum of characters from many walks of life. What’s different about tonight’s episode, though, is that all these characters have passionate opinions about the show itself. Why, the very idea of Masterpiece Theatre drives some of them to Guerrilla Theatre, others to Theatre of the Absurd. Yes, you’ve always already guessed it: we focus tonight on a drama involving what we used to call humanists—now for some a dirty word—and most of our characters are in deep trouble. Sandra M. Gilbert, professor of English at the University of California, Davis, and Susan Gubar, professor of English at Indiana University, are coauthors of No Man’s Land: The Place of the Woman Writer in the Twentieth Century, Volume 1: The War of the Words and Volume II: Sexchanges , the first installments of a three-part sequel to their Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . They have also coedited The Norton Anthology of Literature by Women: The Tradition in English. (shrink)
A definition of [George] Eliot as renunciatory culture-mother may seem an odd preface to a discussion of Silas Marner since, of all her novels, this richly constructed work is the one in which the empty pack of daughterhood appears fullest, the honey of femininity most unpunished. I want to argue, however, that this “legendary tale,” whose status as a schoolroom classic makes it almost as much a textbook as a novel, examines the relationship between woman’s fate and the structure of (...) society in order to explicate the meaning of the empty pack of daughterhood. More specifically, this story of an adoptive father, an orphan daughter, and a dead mother broods on events that are actually or symbolically situated on the margins or boundaries of society, where culture must enter into a dialectical struggle with nature, in order to show how the young female human animal is converted into the human daughter, wife, and mother. Finally, then, this fictionalized “daughteronomy” becomes a female myth of origin narrated by a severe literary mother uses the vehicle of a half-allegorical family romance to urge acquiescence in the law of the Father.If Silas Marner is not obviously a story about the empty pack of daughterhood, it is plainly, of course, a “legendary tale” about a wanderer with a heavy yet empty pack. In fact, it is through the image of the packman that the story, in Eliot’s own words, “came across my other plans by a sudden inspiration”—and, clearly, her vision of this burdened outsider is a re-vision of the Romantic wanderer who haunts the borders of society, seeking a local habitation and a name.11 I would argue further, though, that Eliot’s depiction of Silas Marner’s alienation begins to explain Ruby Redinger’s sense that the author of this “fluid and metaphoric” story “is” both Eppie, the redemptive daughter, and Silas, the redeemed father. For in examining the outcast weaver’s marginality, this novelist of the “hidden life” examines also her own female disinheritance and marginality.12 11. Eliot to Blackwood, 12 Jan. 1861, quoted in Ruby V. Redinger, George Eliot: The Emergent Self , p. 436. As Susan Garber has suggested to me, the resonant image of the “packman” may be associated with the figure of Bob Jakin in The Mill on the Floss , the itinerant pack-bearing peddler who brings Maggie Tulliver a number of books, the most crucial of which is Tomas à Kempis’ treatise on Christian renunciation .12. Rediner, George Eliot, p. 439; Eliot, “Finale,” Middlemarch, p. 896. Sandra M. Gilbert, now professor of English at the University of California, Davis, will join the Department of English at Princeton University in fall 1985. Her most recent works include a collection of poems, Emily’s Bread , and, coedited with Susan Gubar, The Norton Anthology of Literature by Women: The Tradition in English . In addition, she is at work on Mother Rites: Studies in Literature and Maternity, a project from which “Life’s Empty Pack” is drawn, and, with Susan Gubar, on No Man’s Land: The Place of the Woman Writer in the Twentieth Century, a sequel to their collaborative Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . “Costumes of the Mind: Transvestitism as Metaphor in Modern Literature” appeared in the Winter 1980 issue of Critical Inquiry. (shrink)
In 1935, the British scholar Eliza M. Butler published The Tyranny of Greece Over Germany, in which she explored the appeal of Greek art and poetry to modern German writers. She argued that Hellenism had exerted a baleful influence on German literature and culture, and that Germans were especially—even dangerously—susceptible to the power of ideas. In her view, the most dangerous Hellenic concept to German culture and society was the daimon, which had reached Germany via the work of Winckelmann. Butler's (...) thesis and methods may be problematic, as some reviewers of Tyranny pointed out, but her work is noteworthy as the product of a scholar who had lived in Germany and was a witness to history, familiar with German language, literature, and culture, writing on Germany during difficult times. As a British scholar who began studying German just before World War I and ended her career after World War II, Butler had an ambivalent relationship with Germany and Germans. But in addition to political factors, she was also influenced by her family, her educational and research experiences in Germany, and her preference for 18th- and 19th-century over 20th-century Germans. Moreover, her perception of Germans and Germanness was consistently posed against her perception of England and Englishness, and she defined the two cultural identities in terms of their relation to each other. Writing Tyranny as the National Socialists came to power in Germany, Butler judged Germans and their relationship to the daimon harshly. In 1956, Butler reconsidered the daimonic in a study of Byron and Goethe, and in this work it received a more sympathetic and nuanced analysis. A comparison of these two works is useful for understanding the evolution of Butler's thought in the 20-year interval between their publication. (shrink)
Idealism became the dominant philosphical school of thought in late nineteenth-century Britain. In this original and stimulating study, Sandra den Otter examines its roots in Greek and German thinking and locates it among the prevalent methodologies and theories of the period: empiricism and positivism, naturalism, evolution, and utilitarianism. In particular, she sets it in the context of the late nineteenth- and early twentieth-century debate about a science of society and the contemporary preoccupation with `community'.
In this original and stimulating study of Idealism, the dominant philosophical school of thought in late nineteenth-century Britain, Sandra den Otter interweaves philosophical and sociological concerns to make an important contribution to intellectual history.
Bioethics at the Movies explores the ways in which popular films engage basic bioethical concepts and concerns. Twenty philosophically grounded essays use cinematic tools such as character and plot development, scene-setting, and narrative-framing to demonstrate a range of principles and topics in contemporary medical ethics. The first section plumbs popular and bioethical thought on birth, abortion, genetic selection, and personhood through several films, including The Cider House Rules, Citizen Ruth, Gattaca, and I, Robot. In the second section, the contributors examine (...) medical practice and troubling questions about the quality and commodification of life by way of Dirty Pretty Things, Eternal Sunshine of the Spotless Mind, and other movies. The third section's essays use Million Dollar Baby, Critical Care, Big Fish, and Soylent Green to show how the medical profession and society at large view issues related to aging, death, and dying. A final section makes use of Extreme Measures and select Spanish and Japanese films to discuss two foundational matters in bioethics: the role of theories and principles in medicine and the importance of cultural context in devising care. Structured to mirror bioethics and cinema classes, this innovative work includes end-of-chapter questions for further consideration and contributions from scholars from the United States, Canada, the United Kingdom, Israel, Spain, and Australia. Contributors: Robert Arp, Ph.D., Michael C. Brannigan, Ph.D., Matthew Burstein, Ph.D., Antonio Casado da Rocha, Ph.D., Stephen Coleman, Ph.D., Jason T. Eberl, Ph.D., Paul J. Ford, Ph.D., Helen Frowe, M.A., Colin Gavaghan, Ph.D., Richard Hanley, Ph.D., Nancy Hansen, Ph.D., Al-Yasha Ilhaam, Ph.D., Troy Jollimore, Ph.D., Amy Kind, Ph.D., Zana Marie Lutfiyya, Ph.D., Terrance McConnell, Ph.D., Andy Miah, Ph.D., Nathan Norbis, Ph.D., Kenneth Richman, Ph.D., Karen D. Schwartz, LL.B., M.A., Sandra Shapshay, Ph.D., Daniel Sperling, LL.M., S.J.D., Becky Cox White, R.N., Ph.D., Clark Wolf, Ph.D. (shrink)