The management of commons is now at the centre of researchers’ attention in many branches of science, particularly those related to the human or social sciences. This paper seeks to demonstrate how civil society participation in common goods or resources is not only possible but is also desirable for society because of the medium and long-term benefits it offers involved and/or affected parties. To this end, we examine the falsity of the discourse underlying the supposed incompetence of civil society (...) to cooperate interpersonally in the pursuit of common objectives, and also analyse a specific example of the necessary and possible participation of civil society in managing common goods through biobanks.La gestión del bien común se ha convertido actualmente en centro de atención para diferentes ramas de la ciencia, especialmente aquellas vinculadas con lo humano y lo social. El presente estudio busca mostrar cómo la participación de la sociedad civil en la gestión de este tipo de bienes o recursos no sólo es posible, sino deseable para la sociedad por los beneficios que reporta a las partes implicadas y/o afectadas a medio y largo plazo. Para ello, se atenderá la falsedad del discurso sobre el cual se asienta la supuesta incompetencia de la sociedad civil para poder cooperar interpersonalmente en busca de objetivos comunes, así como se analizará un ejemplo concreto de la necesaria y posible participación de la sociedad civil en la gestión del bien común a través de los centros de recursos biológicos (brcs). (shrink)

The article examines the role of discourse in organisational sensemaking. By building links between the theorising undertaken within organisational studies and the empirical analysis of multimodal social interaction, it argues for a relational view of sensemaking and investigates how sense is made in and through social interaction in real organisational situations where language use intertwines with embodied actions and the manipulation of artefacts. In particular, the article studies the use of discourse technologies of textual artefacts in sensemaking processes. The data (...) come from training workshops of a Finnish workplace organisation, conducted in order for the employees to delineate the history and future of their organisation with the help of writable papers. The results show how the papers exert agency in the situation by facilitating three specific discursive practices and by enabling and restricting the actions employed in constructing a shared understanding of the organisational reality. (shrink)

This research aims to examine access to medical treatment during the COVID-19 pandemic for people living with disabilities. During the COVID-19 pandemic, the practical and ethical problems of allocating limited medical resources such as intensive care unit beds and ventilators became critical. Although different countries have proposed different guidelines to manage this emergency, these proposed criteria do not sufficiently consider people living with disabilities. People living with disabilities are therefore at a higher risk of exclusion from medical treatments as physicians (...) tend to assume they have poor quality of life, whereas access to medical treatment should be based on several parameters, including clinical data and prognosis. However, the COVID-19 pandemic shifts the medical paradigm from person-centred medicine to community-centred medicine, challenging the main ethical theories. We reviewed the main guidelines and recommendations for resources allocation and examined their position toward persons with disabilities. Based on our findings, we propose criteria for not discriminating against people with disabilities in allocating resources. The shift from person-centred to community-centred medicine offers opportunities but also risks sacrificing the most vulnerable people. The principle of reasonable accommodation must always be considered to guarantee the rights of persons with disabilities. (shrink)

The Australian government's response to the Millennium Drought (1997–2010) has been met with praise and contestation. While proponents saw the response as timely and crucial, critics claimed it was characterized by government overreach and mismanagement. Five months of field research in farm communities in the Murray Darling Basin (MDB) identified two dominant discourses: administrative rationalism and a local community-based discourse I have termed community-centrism. Administrative rationalism reflects the value of scientific inquiry in service to the state and is the dominant (...) research-based problem-solving model used by water and natural resource agencies (Dryzek in The politics of the earth: environmental discourses, Oxford University Press, 2013; Colloff and Pittock in Aust J Water Resour, 23(2):88–98, 2019). Community-centrism was identified through discussions with farmers and represents a bottom-up approach to environmental planning and management that seeks to incorporate local knowledge, planning, and direct participation. This investigation reveals how discourses define problems and policy choices. While market-based government interventions were likely necessary to address the crisis in the MDB, community-centred responses could have enhanced the government’s capacity to respond to problems. This paper argues that the long-term sustainability of water management in the Basin will require a reorientation on the part of farmers, academics, and governments to develop a community-centred approach to water policies impacting agriculture. (shrink)

The Brundtland Report popularized the concept of sustainable development as meeting “the needs of the present without compromising the ability for future generations to meet their own needs.” Twenty years later a United Nations report argued that current development strategies are inadequate for achieving sustainable development beyond 2015. Any approach to sustainability requires the negotiation and reconfiguration of resources, the consideration of the different stakeholder perceptions to uncertainty and its communication and the continuous recognition of potential threats. This paper aims (...) to enhance current frameworks on sustainability and contribute to management decision making by drawing upon the teachings of the Sikh Gurus. The paper begins with a summary of the main challenges in implementing the sustainability agenda; it then discusses a number of common sustainability frameworks and draws out a set of common limitations. The teachings of the Sikh Gurus are then introduced to provide unique insights into how their understanding of the universe might contribute to some general lessons that can support current sustainability frameworks and related decision making. Next, the paper considers System Archetypes, and in particular the “Limits to Growth”, as mechanisms for gaining insight into the patterns of behaviours that underpin the potential for less unsustainable futures. The paper combines the sustainability frameworks and Sikh teachings to suggest an integrated whole systems approach, across time and space that can throw a new light on the nexus of sustainable development. (shrink)

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is (...) the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required. (shrink)

This article examines the potential for moral agency in human resource management practice. It draws on an ethnographic study of human resource managers in a global organization to provide a theorized account of situated moral agency. This account suggests that within contemporary organizations, institutional structures—particularly the structures of Anglo-American market capitalism— threaten and constrain the capacity of HR managers to exercise moral agency and hence engage in ethical behaviour. The contextualized explanation of HR management action directly addresses the (...) question of whether HRM is inherently unethical. The discussion draws on MacIntyre’s conceptualization of moral agency within contemporary social structures. In practice, HR managers embody roles that may not be wholly compartmentalized. Alternative institutional structures can provide HR managers with a vocabulary of motives for people-centred HRM and widen the scope for the exercising of moral agency, when enacted within reflective relational spaces that provide milieus for critical questioning of logics and values. This article aims to contribute to and extend debate on whether HRM can ever be ethical, and provide a means of reconnecting business ethics with longstanding concerns in critical management studies. (shrink)

At a time of increasing interest and advocacy in integrated and policy-oriented research, this paper offers an empirically-based view of the intellectual and practical challenges of undertaking such research. It analyses the experience of a long-standing university research and postgraduate training centre from 1973-2004: the Centre for Resource and Environmental Studies at The Australian National University. The paper discusses staff development issues, cross-disciplinary understanding, organisational requirements for collaborative research, postgraduate and early career considerations, a range of integrative (...) frameworks, and the tensions that arise for interdisciplinary research in the political and economic operating environments of modern universities. (shrink)

For nearly as long as the topic of sustainable business has been taught and researched in business schools, proponents have warned about barriers to genuine integration in business school practices. This article examines how academic sustainability centres try to overcome barriers to integration by achieving technical, cultural and political fit with their environment :67–92; Ansari et al., Academy of Management Review 35:67–92, 2010). Based on survey and interview data, we theorise that technical, cultural and political fit are intricately related, and (...) that these interrelations involve legitimacy, resources and collaboration effects. Our findings about sustainability centres offer novel insights on integrating sustainable business education given the interrelated nature of different types of fit and misfit. We further contribute to the literature on fit by highlighting that incompatibility between strategies to achieve different types of fit may act as a source of dynamism. (shrink)

This essay explores how indigenous knowledge about plant and animal remedies was gathered, classified, tested, and circulated across wide networks of exchange for natural knowledge between Europe and the Americas. There has been much recent interest in the “bioprospecting” of local natural resources—medical and otherwise—by Europeans in the early modern world and the strategies employed by European travellers, missionaries, or naturalists have been well documented. By contrast, less is known about the role played by indigenous and Creole intermediaries in this (...) process. And yet, the transmission of knowledge between indigenous communities and the European cabinet was neither transparent nor natural, and often involved epistemological, linguistic, and religious obstacles. Drawing on printed and manuscript collections of indigenous remedies, written in colonial Mexico between the sixteenth and the eighteenth centuries, I focus on how local intermediaries, like creoles scholars, sought to overcome such obstacles by observing indigenous uses of remedies, by studying indigenous languages and by producing natural histories and pharmacopoeias in indigenous languages. Ultimately, behind the Creole participation in the transmission of indigenous remedies, one can point to political and cultural interests and to inclusive definitions of knowledge, which cut across oppositions between science and superstition, cabinet and field, centre and periphery. (shrink)

Context: A central motivation behind various embodied, extended, and enactive (4E) approaches to cognition is to ground our understanding of minds and cognition within the biological structures that give rise to life. Because of this, their advocates often claim a natural kinship with dynamical and developmental systems theories. However, these accounts also explicitly or implicitly privilege individual organisms in ways that contrast with many of the insights of systems and developmental systems approaches to biology. Problem: The prioritization of individual organisms (...) within 4E approaches to cognition contrasts with the default entangled structure of biological systems associated with cognitive agency. We provide means for 4E cognitive science to move beyond an individual-centred view of cognitive agency. Method: We first identify and problematize individual-centredness within various predominant 4E approaches by comparison with biological research and developmental systems theory. Subsequently, we offer conceptual resources from the field of ecological research for understanding cognitive agency beyond the predominant focus on individual organisms. Results: Cognitive agency may be understood without privileging individual organisms by reading nonequilibrium maintenance in terms of a dynamic differentiation instead of individual organismic autonomy. This form of organizational structure corresponds to the notion of sympoiesis from ecological research. Implications: Approaching cognitive agency without privileging individual organisms should be invaluable to advocates of 4E cognition seeking to ground notions of cognition and mind within contemporary biological research. Constructivist content: We seek to expand upon existing constructivist perspectives on the organizing principles of cognitive agency, such as sensorimotor embodiment and autopoiesis, arguing that meta-organismic cognitive agents (including humans) embody distributed relations beyond the privileging of individual organisms. Key words: 4E cognition, autopoiesis, cognitive agency, developmental systems theory, enactivism, extended mind thesis, holobionts, sympoeisis. (shrink)

The fair distribution of health resources is critical to health justice. But distributing healthcare equitably requires careful attention to the existing distribution of other resources, and the economic system which produces these inequalities. Health is strongly determined by socioeconomic factors, such as the effects of racism on the health of communities of colour, as well as the broader market-oriented healthcare and pharmaceutical systems that put the pursuit of profit above the alleviation of suffering. Two papers in this issue confront health (...) injustices at different scales, and make far-reaching recommendations for more just healthcare allocation policies. Orphan drugs are those that pharmaceutical companies are unwilling to develop unless they are offered financial incentives to do so. When a target patient group is very small, or very poor, producing drugs is unprofitable. If patients are to benefit from these drugs in a marketised pharmaceutical regime, governments must step in to provide incentives for research and development. Yet government spending ought to prioritise value for money, and is generally guided by a utilitarian framework. In the case of neglected tropical diseases, there is no moral conflict: large numbers of people would benefit greatly from these treatments. However, there are practical limitations: the governments of affected populations are often unable to fund incentives for research and development, and solidarity from elsewhere is limited.1 2 In the case of rare diseases, Global North governments usually can afford to incentivise the development of treatments to serve their populations, but given the small numbers of beneficiaries, doing so seems a questionable use of resources. Many Global North governments make an exception to the general utilitarian heuristic to accommodate the moral intuition that the claims of a person with a rare …. (shrink)

The “centre-periphery” relationship historically structured scientific exchanges between metropolis and province, between the fount of empire and its outposts. But the exchange, if regarded merely as a one-way flow of scientific information, ignores both the politics of knowledge and the nature of its appropriation. Arguably, imperial structures do not entirely determine scientific practices and the exchange of knowledge. Several factors neutralise the over-determining influence of politics—and possibly also the normative values of science—on scientific practice.In examining these four examples of (...) Indian scientists in encounters with their peers at the centre, exceptional scientists are seen in a social context where the epistemology of science supposedly describes its practice. Imperialism imposes practices and patronage, which moderate the exchange of scientific knowledge. But, at Level Two, the politics of knowledge and the patterns of patronage within it mediate exchanges between the centre and the periphery.The first step in reconfiguring exchanges between centre and periphery —in this case, between Europe and India during the period 1850 to 1930— is to recognise the relation between the acquisition of resources and the maintenance of legitimacy and identity.67 Political life is not confined to the core of political institutions.68 Second, in examining science as practised in the colonies, it is necessary to see stages of scientific institutions, whose development structures the exchange.From the encounter of Ramchandra and De Morgan, it is evident that the centre-periphery framework should be separated from the models of transmission embedded within it. The notion of “translation” helps to suggest that scientists bring personal motives and meanings to each encounter. Ramchandra, for example, sought a novel method of teaching Indians calculus, while De Morgan's interest lay in finding a place for algebra in a liberal education.The hierarchy inherent in the centre-periphery framework compels the conclusion that, at Level Two, the autodidact outside the institutions of science must have his work presented to scientists at the centre by authoritative figures from the centre. This is not mainly a question of imperialism, but rather of patronage. The peripheral scientist could not be granted direct entry into the collegial circle until his efforts at the periphery could be translated into the language and concerns of the central community. Ramanujan's enigmatic formulas were translated into the language of analysis by Hardy, which enabled the creation of a field to which Hardy was committed. Scientists from the periphery who were already part of the circle by virtue of their training, were not necessarily subject to the same degree of attestation as other scientists from the periphery. P.C. Ray, with his DSc from Edinburgh, and his position at Calcutta University, had less difficulty in winning the trust of colleagues at the centre, even when he returned to India. On the contrary, remaining at the periphery, he moved from a context of patronage to a sphere of competition. In addition, Ray's collegiality, even at Level Two, was more comprehensive, and connected him with Level One.Eventually, the professional Indian science graduate found collegiality within the international community of scientists. Saha's self-imposed progressive nationalism constrained his identification with the centre and made him a potential competitor instead. Once having achieved eminence in the world of science, C.V. Raman and Saha shifted their work to journals of physics published in India in order to further the cause of physics research in their own country.69To go beyond the limitations of the centre-periphery model, it is necessary not merely to examine exchanges between scientists functioning in a “shared epistemological universe”,70 but also to recognise the part played by institutions, the experience of colonialism, and the forms of patronage characterising both colonialism and science. Put another way, although there is relative epistemological autonomy within the disciplinary research communities of science, the interplay between knowledge and power structures this exchange.The scientific links between colonial India and Britain at the turn of the century were mediated by structures which prefigured change. Does structure determine all? If it does, we are left with an Orientalist reconstruction of the docile native, and a passive cultural medium into which science percolates. But this neglects the role of scientists in creating new structures within which they worked. A middle position—one more sensitive to the exigencies of colonial scientific life—would be one where the participants are seen not as the dupes of “structure nor the potentates of action”, but as occupying a ground between the two.71. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of health (...) care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of health (...) care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

“Virtue jurisprudence” is a normative and explanatory theory of law that utilises the resources of virtue ethics to answer the central questions of legal theory. The main focus of this essay is the development of a virtue–centred theory of judging. The exposition of the theory begins with exploration of defects in judicial character, such as corruption and incompetence. Next, an account of judicial virtue is introduced. This includes judicial wisdom, a form of phronesis, or sound practical judgement. A virtue–centred account (...) of justice is defended against the argument that theories of fairness are prior to theories of justice. The centrality of virtue as a character trait can be drawn out by analysing the virtue of justice into constituent elements. These include judicial impartiality (even–handed sympathy for those affected by adjudication) and judicial integrity (respect for the law and concern for its coherence). The essay argues that a virtue–centred theory accounts for the role that virtuous practical judgement plays in the application of rules to particular fact situations. Moreover, it contends that a virtue–centred theory of judging can best account for the phenomenon of lawful judicial disagreement. Finally, a virtue–centred approach best accounts for the practice of equity, departure from the rules based on the judge’s appreciation of the particular characteristics of individual fact situations. [ABSTRACT FROM AUTHOR]. (shrink)

Clinical Ethics, Ahead of Print. It could hardly be denied that healthcare should be patient-centred. However, some of the practices commonly described as patient-centred care may have ethically problematic consequences. This article identifies and discusses twelve ethical conflicts that may arise in the application of person-centred care. The conflicts concern e.g. privacy, autonomous decision-making, safeguarding medical quality, and maintaining professional egalitarianism as well as equality in care. Awareness of these potential conflicts can be helpful in finding the best way to (...) ensure that healthcare has its focus on the needs and interests of the patients. Patient-centred care may have to take different forms, depending of the nature of the disease, the patient’s life situation, and the economic, organizational and technological resources available to the healthcare unit. (shrink)

In 1882, the South Australian Baptist Missionary Society sent off its first missionaries to Faridpur in East Bengal. Miss Marie Gilbert and Miss Ellen Arnold were the first of a stream of missionary women who left the young South Australian colony to work in India. Scores of women from other Christian denominations and from other Australian colonies also went to India and indeed to other mission fields in the nineteenth and twentieth centuries. As with other western women missionaries, (...) these women intended to save souls and to bring India's daughters to Christ, often by means of medical work. But unlike their British sisters, these women came from the edge of empire to intervene in another, but different, colonial site. These missionary ventures coincided with efforts of the Australian settlers to elaborate for themselves an identity separate from and against that of the metropolitan centre. Within these debates, contestations over the meaning of ‘the colonial girl’ and ‘the Australian girl’ played a key role. The article explores why the women were drawn to India rather than to working with Aboriginal people in Australia. It begins to investigate how in seeking to reconstruct Indian womanhood they elaborated for themselves a separate colonial, Australian identity and how much in their missionary endeavours they affirmed an identity as white, Christian and ultimately British. (shrink)

People should be at the centre of attention within knowledge-based economics. The leaders of each enterprise ought to focus on providing the best conditions for their employees’ professional and individual development and treat them with respect in terms of their dignity and needs. In contemporary literature two notions in perceiving people in organisations are noticeable. The first one treats employees as ‘resources’ which have to be properly used or as ‘capital’ that should bring a decent return on investment. The (...) second notion derives a lot from Christian philosophy and sees the human as a person who treats work as a way to realize his calling and thus is able to take responsibility for the decisions made and actions taken. Acting in a constantly changing environment, people have to be flexible and able to take advantage of emerging opportunities and avoid threats. Within this process it is not a matter of being a human ‘being’ but rather becoming, which means that they are incessantly developing their potential. Although it is hard to predict human behaviour, the main task for managers is to lead in a way that will help employees use their full potential for both their own and the company’s benefit. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

This is a response to Hwa Yung's paper on the shift of the centre of the gravity of the church from the West into the Majority World. It reflects on the reasons why the church grew in the West, particularly in Europe, in the past and suggests what can be learned from the strengths of the Western church, as well as its weaknesses and failures. Three periods of Western church history are covered: The Early Church from AD 30 to (...) AD 330, the sixteenth century European Reformation, and the modern missionary expansion in the nineteenth and twentieth centuries and the subsequent decline of the Western church. (shrink)

The notion that Western ways are superior can be used to justify subsidising advocacy to the poor in Africa who might otherwise reject those ways out of ignorance. This ignores differences in culture that can trip up Western logic in Africa. When generosity is the reason to subsidise Western interventions, outside agents can be paid back in honour in ways not appropriate for Christians to accept. Perceived global inequalities used to convince donors to part with their money are impositions when (...) those inequalities are not realised by recipients. When something inherently good, like the gospel, is routinely subsidised, some African people only value it when it comes with money. This disenfranchises poor evangelists. In order to overcome missionary ignorance, promotion of the prosperity gospel, and corruption associated with excessive foreign subsidies, this article advocates that vulnerable mission, namely, foreign intervention using local languages and resources, be permitted. (shrink)

Objectives During the COVID-19 pandemic, healthcare resources including staff were diverted from paediatric services to support COVID-positive adult patients. Hospital visiting restrictions and reductions in face-to-face paediatric care were also enforced. We investigated the impact of service changes during the first wave of the pandemic on children and young people (CYP), to inform recommendations for maintaining their care during future pandemics. Design A multi-centre service evaluation was performed through a survey of consultant paediatricians working within the North Thames Paediatric (...) Network, a group of paediatric services in London. We investigated six areas: redeployment, visiting restrictions, patient safety, vulnerable children, virtual care and ethical issues. Results Survey responses were received from 47 paediatricians across six National Health Service Trusts. Children's right to health was largely believed to be compromised by the prioritisation of adults during the pandemic (81%; n = 33). Sub-optimal paediatric care due to redeployment (61%; n = 28) and the impact of visiting restrictions on CYP's mental health (79%; n = 37) were reported. Decreased hospital attendances of CYP were associated with parental fear of COVID-19 infection-risks (96%; n = 45) and government ‘stay at home’ advice (89%; n = 42). Reductions in face-to-face care were noted to have disadvantaged those with complex needs, disabilities and safeguarding concerns. Conclusion Consultant paediatricians perceived that paediatric care was compromised during the first wave of the pandemic, resulting in harm to children. This harm must be minimised in subsequent pandemics. Recommendations for future practice which were developed from our findings are provided, including maintaining face-to-face care for vulnerable children. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Theravada Buddhism and The British Encounter: Religious, Missionary, and Colonial Experience in Nineteenth Century Sri LankaTerry C. MuckTheravada Buddhism and The British Encounter: Religious, Missionary, and Colonial Experience in Nineteenth Century Sri Lanka. By Elizabeth Harris. London: Routledge, 2006. 274 pp.Of all the facets of the multifaceted interactions among Buddhists and Christians, the one sure to generate the most heat is mission: Christians spreading the gospel, (...) Buddhists spreading the dhamma, Christians preaching and Buddhists preaching at the same time in the same places. This is the central topic of Elizabeth Harris’s Theravada Buddhism and the British Encounter: Religious, Missionary, and Colonial Experience in Nineteenth Century Sri Lanka. By throwing light on this crucial encounter, Harris greatly reduces the heat generated by these competing missions and makes greater understanding possible. At least, that would be one hoped-for outcome.Harris challenges the standard postcolonial critique (SPC) of what happened to Sri Lankan Theravada Buddhism and Sri Lankan Theravada Buddhists when Christian missionaries, riding on the coattails of the Portuguese, Dutch, and British colonialists, invaded the peaceful and pristine island of Ceylon, now Sri Lanka, in the seventeenth, eighteenth, nineteenth, and twentieth centuries. SPC posits Western colonial missionaries gaining power through their political proxies, shaping Western understandings of Theravada Buddhism to fit their Puritan and rationalistic preconceptions, and then attempting to destroy this made-in-the-West Buddhism, using aggressive and triumphalistic mission tactics that not only failed, but generated such a backlash that still, today, Buddhist-Christian relationships in Sri Lanka are poisoned almost beyond remedy.Harris challenges the SPC not by denying the obvious truths embedded in the various elements of this version of the sad story, but by convincingly showing us that the SPC is only one side of a very complex story. The SPC, Harris argues, needs to be complexified by realizing that not all British in nineteenth century Ceylon fit the stereotypical missionary model, that Sri Lankan Buddhists had agency in shaping what became known as Protestant Buddhism in the twentieth century Buddhist revival, and that the Buddhist mission effort that corresponded to the Christian mission effort led to a system of competing mission efforts that must be factored into any attempt to understand the influence of the nineteenth century on the twentieth—and the twenty-first.British ChristiansHarris uses three paradigms to show the diversity of British interlocutors with Sri Lankan Theravada Buddhism and Buddhists. The first paradigm is an early (1796–1830), middle (1830–1870), late (1870–1900) periodization that corresponds to parts 1, 2, and 3 of the book. By means of this paradigm Harris shows that development took place in British understandings of Buddhist precept and practice. The earliest observers made mistakes, even when they based their observations on texts and [End Page 188] practicing Buddhist informants. As with most such developments, the changes and depths of understanding were uneven, with later commentators sometimes repeating the howlers and biases of the earliest commentators, even as they in some areas went far beyond them in depth of understanding. Later was not always better, but it usually was.The second paradigm one might call vocational. The British did not all come to Ceylon for the same reason. Some came as political overseers for the colonial government. Some came as merchants, looking for a way to turn the island’s abundant natural resources into pounds in their bank accounts back home. Some came simply as “tourists” looking to find out more about what was in the nineteenth century a very exotic culture indeed to European eyes. Some came as missionaries to spread the Christian gospel story. And a trickle of scholars seeking data for research topics gradually turned into a fairly broad stream by the end of the century. Each of these five groups came asking slightly different questions. Because Buddhism was so ubiquitous among the people of Ceylon, Buddhism was always part of the answer to the different questions politicos, businesspeople, travelers, Christians, and professors asked, but the different questions produced different products: statements of public policy vis-à-vis Buddhism, Southeast Asian versions of Weber’s observations about religion and economics, diaries and travelogues, theologies of religion, and... (shrink)

Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community (...) staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community and faith-based organisations to holistic people-centred healthcare in South Africa. (shrink)

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervized weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass (...) index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervized weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid (...) organ transplant, thirty-nine (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Background: The research community has a mandate to discover effective treatments for neurodegenerative disorders. The ethics landscape surrounding this mandate is in a constant state of flux, and ongoing challenges place ever greater demands on investigators to be accountable to the public and to answer questions about the implications of their work for health care, society, and policy. Methods: We surveyed US-based investigators involved in neurodegenerative diseases research about how they value ethics-related issues, what motivates them to give consideration to (...) those issues, and the barriers to doing so. Using the NIH CRISP database we identified 1,034 researchers with relevant, active grants and invited them to complete an online questionnaire. We received 193 responses. We used exploratory factor analysis to transform individual survey questions into a smaller set of factors, and linear regression to understand the effect of key variables of interest on the factor scores. Results: Ethics-related issues clustered into two groups: research ethics and external influences. Heads of research groups viewed issues of research ethics to be more important than the other respondents. Concern about external influences was related to overall interest in ethics. Motivators clustered into five groups: ensuring public understanding, external forces, requirements, values, and press and public. Heads of research groups were more motivated to ensure public understanding of research than the other respondents. Barriers clustered into four groups: lack of resources, administrative burden, relevance to the research, and lack of interest. Perceived lack of ethics resources was a particular barrier for investigators working in drug discovery. Conclusions: The data suggest that senior level neuroscientists working in the field of neurodegeneration (ND), and drug discovery specifically, are motivated to consider ethics issues related to their work, but the perceived lack of ethics resources thwarts their efforts. With bioethics centres at more than 50% of the institutions at which these respondents reside, the neuroscience and bioethics communities appear to be disconnected. Dedicated ethical, legal and social implications (ELSI) programs, such as those fully integrated into genetics and regenerative medicine, provide models for achieving meaningful partnerships not yet adequately realized for scholars and trainees interested in drug discovery for ND. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ECHIC—The European Consortium for Humanities Institutes and Centres 2023 Annual ConferenceIlenia Vittoria CasmiriEcological Mindedness and Sustainable Wellbeing, ECHIC—The European Consortium for Humanities Institutes and Centres 2023 Annual Conference, May 25–27, 2023, University of Ferrara, ItalyThis year’s annual conference of the European Consortium for Humanities Institutes and Centres (ECHIC) invited international scholars with diverse backgrounds to explore visions of a desirable future world that is both environmentally sustainable and socially (...) just. In stressing the social and political relevance of the humanities in Europe today, the main goal of the Consortium, as it is articulated on the conference website, is the pursuit of the highest international standards of excellence with a spirit of innovation and exploration of new research areas:Since the World Commission on Environment and Development published Our Common Future (1987) [commonly known as the Brundtland Report], the notion of... sustainability has been expanded to incorporate environmental, cultural, legal, and economic features of a low-carbon future and to encompass the wellbeing of all living species, which involves material aspects such as the social acceptance of resource-efficient transitions and immaterial ones such as flourishing human capabilities. [End Page 625]The participants of the 2023 ECHIC conference on Ecological Mindedness and Sustainable Wellbeing presented original, multidisciplinary perspectives, and offered valuable opportunities to develop holistic approaches to the prismatic issue of environmental sustainability. Bringing together cultural diversity as well as local and global perspectives, keynoters and panelists addressed the vast array of challenges imposed by the perpetuation of anthropocentric worldviews. Their challenge to traditional demarcations between the humanities, the social sciences, economy, law, architecture, engineering, and the life and medical sciences, generated synergies for exploring interconnections between life forms, resources, and heritage. While the theoretical frameworks varied considerably, they all advocated for the need to overcome ideological, cultural, and spatial barriers in favor of broader, more inclusive approaches to other disciplines, other cultures, other humans, other species. Overall, the conference not only exposed the cultural and economic roots of social inequality and of uneven distribution of resources, thanks to unsustainable modes of capitalist production and consumption, but also highlighted the media’s positive effect in eliciting pro-environmental behaviors.Toward More Sustainable FuturesThe prismatic nature of the concept of sustainability inspired keynote speakers Alexa Weik von Mossner (University of Klagenfurt), Adrian Ivakhiv (University of Vermont), Tim Waterman (University College London), and Antonio López (John Cabot University) to address climate apocalypse impacts on the human physical and psychological well-being from diverse personal and academic backgrounds.In the opening keynote lecture, “Growing Hope: Narratives of Food Justice and Sustainability,” Weik von Mossner explores the psychological implications of affect and emotion in the communication of environmental issues. Her diachronic account illustrates the rise and fall of the South Central Farm in Los Angeles, a sanctuary for locals by providing fresh produce, stimulating a sense of community, and representing a symbol of resilience against systemic inequalities. Weik Von Mossner elucidates the psychological benefits accruing from exposure to such a sustainably inhabited space. Her analysis of Scott Hamilton Kennedy’s documentary, The Garden (2008), affirms that climate change narratives across media may prompt food justice activism (Retzinger 2011, 337) by eliciting the emotional engagement of its audience. [End Page 626]However, observes von Mossner, the greater the popularity of the Farm, the greater the threat posed to its existence. Through documentaries, news articles, and online campaigns, the South Central Farm has received national and international attention. At the same time, media have shed light on the struggles faced by marginalized communities and provided a solid basis for discussions on social justice, environmental activism, and the value of communal spaces. She explains that activists used social media to voice their concerns about the potential eviction and the loss of a vital resource for the local community, leading to an outpouring of support from environmentalists and celebrities who had realized to what extent the predominantly low-income, minority community was affected by limited access to fresh food and green spaces.Adrian Ivakhiv, delivering his keynote “How to Face the Angel of History: A Call to Anthropocenic Conscience” the following day, suggests that a pervasive lack of an emotional... (shrink)

The requirement by the National Science Foundation (NSF) that research proposals include plans for “broader impact” activities to foster connections between Science, Technology, Engineering, and Math (STEM) research and service to society has been controversial since it was first introduced. A chief complaint is that the requirement diverts time and resources from the focus of research and toward activities for which researchers may not be well prepared. This paper describes the theoretical framework underlying a new strategy to pair NSF-funded nano (...) research centres with science museums in order to achieve greater success in the broader impact mission, and to transform the perceived burden of the requirement into an opportunity to provide enhanced value to the constituencies of the partnering organizations, as well as to the larger community. This partnership approach is presented as a model that also can be applied to NSF-funded research centres in other STEM fields, and to non-NSF-funded STEM research centres nevertheless looking to pursue broader impacts types of activities. The model also provides an opportunity to stretch the typical spectrum of broader impacts activities to include citizen engagement in science, technology and societal concerns. (shrink)

This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre‐registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice‐Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre‐registration nursing students is not (...) only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. (shrink)

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of ‘globalised’ in the bioethics literature: a focus on global issues; an attempt to develop a universal ethical theory that can transcend (...) cultural differences; an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place. (shrink)

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The acute care setting is (...) characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence. (shrink)

This article provides a cross-case analysis of four art and design research centres operating within UK universities. Findings from autobiographical and semi-structured interviews with researchers, research managers, and research leaders indicate that they encounter similar issues in trying to establish internal legitimacy within the university alongside the need to gain external support and recognition. In dealing with these challenges, art and design research centres tend to pass through four broadly identifiable phases: (i) Origination (utilising credentials and leadership capacity), (ii) Establishment (...) (securing resources and embedding dedicated systems and processes), (iii) Development (furthering profile, diversifying, and retaining autonomy), and (iv) Sustainability (enhancing research culture, networks, and influence). Many interesting parallels are evident with the way small businesses strive to establish themselves within competitive market environments. Lessons for research managers and directors are explored to consider such similarities in key areas of responsibility that cover leadership, managing people and processes, developing organisational capacity, and building external networks. The research suggests research centre directors must demonstrate many intrapreneurial qualities to overcome obstacles in the development of a successful research team and that university departments can make substantial organisational interventions to help them succeed. (shrink)

The state of the art of contemporary philosophy and psychiatry is reviewed. Section 1 describes the new field as an international open society of ideas. Section 2 introduces values-based practice. Although originally a philosophy-into-practice initiative, values-based practice is now developing more strongly in areas of bodily medicine such as surgery. An example from surgery illustrates how values-based practice has been implemented as a partner to evidence-based practice in supporting shared clinical decision-making as the basis of best practice in contemporary person-centered (...) clinical care. Section 3 explores the difficulties presented by implementing values-based practice in mental health as illustrated by a case example of anorexia. This shows that these difficulties derive from the particularly intense challenges of values pluralism presented by anorexia. The resources of phenomenology provide the basis for an effective response to these challenges. Section 4 generalizes the argument of Section 3 showing that an effective response to the wider range of challenges of values pluralism arising across the board in mental health is available from the resources of the international open society of ideas of contemporary philosophy and psychiatry. The article concludes with a promissory note on values and a cautionary note on science. (shrink)

This article suggests a shift in focus from stories as verbal accounts to narrative interpretation of the every day as a resource for achieving person‐centred health and social care. The aim is to explore Ricoeur's notion of narrative and action, as expressed in his arguments on a threefold mimesis process, using this as a grounding for the use of narration to achieve person‐centredness in health and social care practice. This focus emerged from discussions on this matter at the IPONS (...) conference in Gothenburg, 2021. Based on philosophical resources from Ricoeur's notions of narrative and action developed in his arguments on a threefold mimesis process, we propose a wider use of stories in health and social care practices. We suggest expanding from only focusing on verbal accounts to focusing on narrative as a human way to interpret and make sense of everyday life and circumstances and to communicate possible meanings. We discuss how such complementary focus can be a resource in getting patients involved and collaborating in their health and social care and thereby help develop person‐centred practices. (shrink)

Connolly, Noel Pope Francis in Evangelii Gaudium defines the church as a 'community of missionary disciples'. We have to be missionary to be called disciples. He dreams of 'a missionary option' that will transform everything. For Francis, mission is clearly essential to the church. He is continuing a movement that began with Ad Gentes, the missionary document of Vatican II. The fathers at the council insisted, 'The pilgrim Church is missionary by her very nature. For (...) it is from the mission of the Son and the mission of the Holy Spirit that she takes her origin, in accordance with the decree of God the Father'. This was reiterated by Paul VI in Evangelii Nuntiandi: 'Evangelizing is in fact the grace and vocation proper to the Church, her deepest identity. She exists in order to evangelize'; and by John Paul II in Redemptoris Missio: 'the Church is missionary by her very nature'. (shrink)

Countries, companies and farming communities are increasingly involved in issues of sharing and protecting plant genetic resources, (traditional) knowledge and technologies. Intellectual Property Rights and Access and Benefit-Sharing policies currently regulate the transfer and usage of much of this genetic material, information and related production, which is employed in multiple research projects involving public research institutes. Strikingly, not much is known about how these institutes deal with the transfer and usage regulations. And what, furthermore, are their responsibilities while serving a (...) civil society in which there is such a range of diverging interests in and opinions about such regulations? In order to shed more light on these questions, two public research institutes will here be studied, the International Potato Centre in Peru and Wageningen University & Research Centre in the Netherlands. These institutes are both heavily involved in research into genetic resources, knowledge and technologies related to the potato, and work together with a wide spectrum of stakeholders that have a direct interest in the sharing and/or protection of these resources. The two institutes are continuously weighing up the various stakeholder interests in their attempts to strike a balance between policies geared towards sharing and those aimed at protection. It will be argued that public research institutes must dare to share, and that they need to develop new ways of sharing and protecting in order to adhere to their mission and best serve the public interest. (shrink)

La obra presenta, apoyándose en textos originales, el pensamiento de escritoras hispanas como María Zambrano y Victoria Ocam.

The healing and preventive powers of people's health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this article, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine. Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at (...) a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter. By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are briefly presented as examples of empowerment through dialogue. (shrink)