Temporal betweenness in space-time is defined solely in terms of light signals, using a signalling relation that does not distinguish between the sender and the receiver of a light signal. Special relativity and general relativity are considered separately, because the latter can be treated only locally. We conclude that the (local) coherence of time can be described if we know only which pairs of space-time points are light-connected. Other consequences in the case of special relativity: (1) a categorical axiom system (...) exists in terms of nondirected light connection alone, with neither particle nor time order as a primitive concept, though we do not actually present the axioms; (2) any concept definable by coordinates is also definable in terms of nondirected light signals if and only if it is invariant under Lorentz transformations, translations, dilations, space reflections, and time reflections; and (3) any transformation of space-time (not necessarily continuous) which preserves nondirected light connection is a product of transformations just listed above. The bulk of the paper is devoted to proving that the definitions we give correspond to their intended interpretations in the usual space-time continua. (shrink)

For decades questionnaires have been used to measure the cognitive and psychological effects of prenatal genetic testing, but little is known about why some women undergo testing and others decline. Research indicates that many factors influence decision making, including values and beliefs. What is often denied rather than recognized is that the professional and personal values and beliefs held by the health care provider influence the patient’s decision. It is assumed that, if genetic services are delivered in a nondirective (...) manner, patients will not be affected by the provider’s personal and professional standpoint. The qualitative research data reported here challenge this assumption. Getting to know patients’ moral understanding and patterns of ethical reasoning by listening to their personal stories is recommended as a better way for nurses to help patients to make informed and autonomous decisions about prenatal genetic screening or diagnostic tests. (shrink)

: Common wisdom in genetic counseling, which is supported by Biesecker, holds that counselors should strive not to influence their clients' decision making. Such a presumption of nondirectiveness is challenged in this commentary.

The article aims at organizing multifaceted discourse on the concept of nondirectiveness in the practice of genetic counseling. The analysis of areas where nondirectiveness was invoked and discussed reveals the problematic confusion of different meanings of the term that often leads to false conclusions about the relations between the professional standards and the practice of genetic counseling. The article offers clear and comprehensive description of different approaches to nondirectiveness and various ideas associated with the term. Normative consequences of various meanings (...) attributed to nondirectiveness are explored. The article concludes by presenting important but unsolved problems regarding both theory (the meaning of nondirectiveness and its operational definition) and practice of genetic counseling (the scope and content of the norm of nondirective counseling). (shrink)

In organ transplantation, there is a lack of ethical discussion about the recipient’s right not to receive a transplant. Using the current situation of living organ transplantation and deceased organ transplantation in Japan as an example, we prospectively discussed to what extent the recipient’s right not to receive a transplant is ethically acceptable. In directed transplantation from a living donor, a recipient may refuse organ donation from a particular donor. It is preferable that a recipient’s request for organ donation from (...) a donor occurs as part of a transparent process. In nondirected transplantation from a deceased donor, refusal of transplantation from a particular type of donor appears potentially justifiable. There are both moral and pragmatic considerations. Certain refusals based solely on belief are morally unacceptable, and refusal to transplant a recipient based on the donor’s age jeopardizes the entire transplant system. When religious beliefs affect mental and physical health, individualized measures are required for transplant rejection. We also deductively developed a prospective argument based on the current status of donor–recipient communication in living organ transplantation in Japan and the 2010 amendment of the law allowing relatives to be given priority in organ transplantation from deceased donors. (shrink)

Nondirectiveness is widely regarded as an important principle of genetic counseling. However, numerous studies have indicated that the use of this principle and its content itself are subject to controversies. The present study aimed to verify how the nondirectiveness principle is defined by Polish geneticists, the extent to which it is considered the main principle in clinical practice, and the situations in which geneticists see the positive value of the directive action. Using quantitative and qualitative methods, the study compared the (...) abstract declarations of the directiveness validity and the scope of this principle with the declaration of action in situations close to reality (case scenarios). The results showed that the high rank assigned to the nondirectiveness principle does not translate into the conviction about the absolute obligation to use it in clinical practice. Polish geneticists are inclined to restrict the scope of patients’ choices when these are outside of their definition of medical standard. Strong medical paternalism manifests itself particularly in invasive prenatal diagnostics, where geneticists play the role of gatekeepers. In this study, we offer hypotheses about the sources of these attitudes by analyzing the current cultural and legal context of Poland. (shrink)

We have recently found that nondirective meditation facilitates stress reduction. This supplementary study investigated whether defensive functioning would moderate these beneficial effects. We explored the occurrence of defense mechanisms and the impact of defensive functioning on the outcome of companies’ stress management programs regarding worries nervousness, mental distress, sleep problems, and muscle pain. The sample was a population of active, working professionals recruited from Norwegian companies. The intervention group obtained significant benefits on all outcome measures, but there were no (...) effects in the control group. We analyzed defensive functioning with the self-report questionnaire, Life Style Index, at four time points. The healthy adults who participated had a low level of defense scores at the outset. There was a significant reduction in the level of defenses in both groups over the study period, 6 months. Defensive functioning significantly moderated the change of the outcome measures from baseline to follow-up in the intervention group, but not in the control group. (shrink)

The emergence of the genetic counseling profession has allowed laypeople to understand and benefit from biological advances, and to make critical decisions about their application. The discipline of genetic counseling has been criticized from its very beginning, in particular because of its early association with the eugenics movement. This paper presents a critical and reflective overview of how genetic counseling is implicitly embedded in the history of eugenics but also counteracts past eugenic practices and ideas. After World War II, attempts (...) were made to distance genetic counseling from eugenics. The first definition of genetic counseling did not position this field as a medical encounter but "as a kind of genetic social work aimed primarily to provide people with an understanding of their family's genetics problems." This approach was a reaction to the genetic and social evolutionary ideas that informed eugenic theories during the first half of the 20th century. Professionals engaged in genetic counseling during the 1940s and1950s rejected eugenic practices, but there was still support for eugenics’ goals of improving heredity and eliminating disease. From the 1960s, genetic counseling underwent professionalization alongside feminization and a definition of core values. Among these values were nondirectiveness counseling and the autonomy of the counselee. The dark shadow of Nazi ideology and other eugenic practices, attempts to employ the historical responsibility of geneticists, and the dynamic medical, social, political, and educational changes of the 1960s and 1970s helped to frame approaches and delineate the goals and limits of the new profession of “genetic counseling.”. (shrink)

Nondirective genetic counseling developed as a means of promoting informed and independent decision-making. To the extent that it minimizes risks of coercion, this counseling approach effectively respects client autonomy. However, it also permits clients to make partially informed, poorly reasoned or ethically questionable choices, and denies counselors a means of demonstrating accountability for the use of their services. These practical and ethical tensions result from an excessive focus on noncoercion while neglecting the contribution of adequate information and deliberative competence (...) to autonomous decision-making. A counseling approach that emphasizes the role of deliberation may more reliably produce thoroughly reasoned decisions. In such an approach, characterized by dialogue, counselors are responsible for ensuring that decisions are fully informed and carefully deliberated. Counseling remains nonprescriptive, but in the course of discussion counselors may introduce unsolicited information and/or challenge what they believe are questionable choices. By this means clients can be better assured that the decisions they make are fully considered, while counselors demonstrate a limited degree of professional accountability. (shrink)

Chronic widespread pain is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational nondirective resonance breathing, as a means of reducing pain and suffering in patients with chronic widespread pain. Motivational nondirective resonance breathing provides patients with a noninvasive means (...) of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life. (shrink)

Although deeply committed to the model of nondirective counseling, most genetic counselors enter the profession with certain assumptions about health and disability—for example, that it is preferable to be a hearing person than a deaf person. Thus, most genetic counselors are deeply troubled when parents with certain disabilities ask for assistance in having a child who shares their disability. This ethical challenge benefits little from viewing it as a conflict between beneficence and autonomy. The challenge is better recast as (...) a conflict between parental autonomy and the child's future autonomy. (shrink)

Since the 1970s, prenatal testing has been integrated into many health care systems on the basis of two competing and largely irreconcilable rationales. The reproductive autonomy rationale focuses on nondirective counseling and consent as ways to ensure that women's decisions about testing and subsequent care are informed and free of undue pressures. It also represents an easily understandable and ethically convincing basis for widespread access to prenatal testing, since the value of autonomy is well established in Western bioethics and (...) widely recognized by funders of health care. In contrast, the public health rationale approaches prenatal testing as designed to reduce the incidence of certain conditions in the population to reduce the burden of disease. This rationale emphasizes the societal consequences of reproduction and the aggregate impact of women's individual reproductive decisions on the overall health of future populations. In this essay, I argue that, despite what could be seen as a persistent failure to meet the ideals of reproductive autonomy, resisting the public health rationale as a basis for prenatal screening is ethically and pragmatically crucial. I recommend policy mechanisms that can enhance reproductive autonomy at a societal level to support choice at the individual level. (shrink)

Michael Hand has defended the “epistemic criterion” for “directive and nondirective teaching” in his 2008 Educational Theory article, “What Should We Teach as Controversial? A Defense of the Epistemic Criterion,” as well as subsequent pieces. Here, John Tillson defends use of the epistemic criterion in the case of what he calls “momentous propositions,” but he rejects two of Hand's key arguments in support of the criterion. This rethinking comes in light of important contributions to the debate made by Bryan (...) Warnick and D. Spencer Smith and by Maughn Rollins Gregory, also published in this journal. Tillson begins the article with an elucidation of the directive/nondirective distinction, and then discusses some limitations of defining the distinction in terms of intention. Next, he draws attention to the problems with the “soft-directive teaching” method that Warnick and Smith advocate. Finally, Tillson provides an additional argument in favor of the epistemic criterion, an argument also grounded in work by Hand, which places emphasis on imparting knowledge alongside cultivating rationality among our educational aims. (shrink)

Children must be taught morality. They must be taught to recognise the authority of moral standards and to understand what makes them authoritative. But there’s a problem: the content and justification of morality are matters of reasonable disagreement among reasonable people. This makes it hard to see how educators can secure children’s commitment to moral standards without indoctrinating them. -/- In A Theory of Moral Education, Michael Hand tackles this problem head on. He sets out to show that moral education (...) can and should be fully rational. It is true that many moral standards and justificatory theories are controversial, and educators have an obligation to teach these nondirectively, with the aim of enabling children to form their own considered views. But reasonable moral disagreement does not go all the way down: some basic moral standards are robustly justified, and these should be taught directively, with the aim of bringing children to recognise and understand their authority. -/- This is an original and important contribution to the philosophy of moral education, which lays a new theoretical foundation for the urgent practical task of teaching right from wrong. (shrink)

A controversy rages over the question of how should controversial topics be taught. Recent work has advanced the “epistemic criterion” as the resolution to this controversy. According to the epistemic criterion, a matter should be taught as controversial when contrary views can be entertained on the matter without the views being contrary to reason. When an issue is noncontroversial, according to the epistemic criterion, the correct position can be taught “directively,” with the teacher endorsing that position. When there is a (...) legitimate controversy, the view should be taught “nondirectively,” with the teacher remaining neutral. In response, Bryan Warnick and Spencer Smith argue that the proponents of the epistemic criterion fail to recognize the multidimensional nature of what it means to learn to be rational. Recognizing this complexity undermines the link between the epistemic status of the controversy and directiveness of one's teaching, suggesting more flexibility in how teachers approach controversial issues. It also implies the need for a new category of teaching, which Warnick and Smith call “soft-directive” teaching. (shrink)

Article history: This article sketches the Parallel Architecture, an approach to the structure of grammar that Accepted 29 August 2006 contrasts with mainstream generative grammar (MGG) in that (a) it treats phonology, Available online 13 October 2006 syntax, and semantics as independent generative components whose structures are linked by interface rules; (b) it uses a parallel constraint-based formalism that is nondirectional; (c) Keywords: it treats words and rules alike as pieces of linguistic structure stored in long-term memory.

The present paper deals with the semantics of locative expressions. Our approach is essentially model-theoretic, using basic geometrical properties of the space-time continuum. We shall demonstrate that locatives consist of two layers: the first layer defines a location and the second a type of movement with respect to that location. The elements defining these layers, called localisersand modalisers, tend to form a unit, which is typically either an adposition or a case marker. It will be seen that this layering is (...) not only semantically but in many languages also morphologically manifest. There are numerous languages in which the morphology is sufficiently transparent with respect to the layering. The consequences of this theory are manifold. For example, we shall show that it explains the contrast between English and Finnish concerning directionals, which is discussed in Fong (1997). In addition, we shall be concerned with the question of orientation of locatives, as discussed in Nam (1995). We propose that nondirectional locatives are oriented to the event, while directional locatives are oriented to certain arguments, called movers. (shrink)

Until recently, genetics counselors and medical geneticists considered themselves lucky if they could provide parents with predictive information about a small number of severe genetic disorders. Testing and counseling were indicated primarily for conditions of thithis s sort. Out of respect for the autonomy of parental reproductive decision making, the prevailing ethic of genetic counseling stressed nondirectiveness and value neutrality As summarized by Arthur Caplan, the hallmarks of this stance includea willingness to provide testing and counseling to all who voluntarily (...) seek it, the presentation of information concerning findings in a manner that is balanced and comprehensible to patients or clients, the fair and balanced presentation of all options for action if a problem is discovered, a willingness to answer all questions asked by those seeking services, and an obligation to protect privacy and confidentiality at all times regardless of societal needs or benefits. (shrink)

Until recently, genetics counselors and medical geneticists considered themselves lucky if they could provide parents with predictive information about a small number of severe genetic disorders. Testing and counseling were indicated primarily for conditions of thithis s sort. Out of respect for the autonomy of parental reproductive decision making, the prevailing ethic of genetic counseling stressed nondirectiveness and value neutrality As summarized by Arthur Caplan, the hallmarks of this stance includea willingness to provide testing and counseling to all who voluntarily (...) seek it, the presentation of information concerning findings in a manner that is balanced and comprehensible to patients or clients, the fair and balanced presentation of all options for action if a problem is discovered, a willingness to answer all questions asked by those seeking services, and an obligation to protect privacy and confidentiality at all times regardless of societal needs or benefits. (shrink)

Lainie Ross, in her article in this issue, criticizes on ethical grounds a number of factors in the University of Minnesota program that allows unrelated strangers to donate kidneys for transplant. I have to admit that when the transplant center at the University proposed allowing the practice of what came to be called nondirected donation, I was skeptical about a number of the same issues that trouble Dr. Ross. But as my colleagues and I examined and discussed the ethics of (...) such a plan, along with the risks to prospective donors, their possible motivations, and the logistics of performing the surgeries under conditions of anonymity between donor and recipient, among other factors, we came to believe that such donations can be ethically acceptable. As a product of frequent meetings over the course of a year in advance of the first nondirected donation, we set out to craft a process that would first and foremost meet the test of an ethical approach to organ donation and transplant, the description of which was published in the New England Journal of Medicine in August 2000. (shrink)

We prove that any positive elementary (least fixed point) induction expressing the negation of transitive closure on finite nondirected graphs requires at least two recursion variables.

In the United States, people may donate organs and tissues to a family member, friend, or anyone whose specific need becomes known to them. For example, in late 2003 dozens of people came forward to donate a kidney to a professional basketball player known to them only through his sports performances. People may also donate a kidney to no one in particular through a process known as nondirected donation. In nondirected donation, people donate a kidney to the organ allocation system (...) rather than to anyone known to them personally. There are limits, though, to generosity. People are usually not allowed to donate to groups of people, no matter the contours of the group, whether white, black, Catholic or Presbyterian, third-time liver recipient, and so on. As the agency that oversees national transplantation policy, the United Network for Organs Sharing does not allow this sort of restricted donation, though it appears that some regional Organ Procurement Organizations occasionally bend the rules when donors insist that their organs go to children or to first-time recipients. Those ad hoc arrangements are, however, the exception to the rule. (shrink)

While we consider directive teaching to be detrimental to the Community of Inquiry, we nonetheless find ourselves in qualified agreement with Hand as he challenges certain norms of practice that support the common presumption in favour of nondirective teaching in the moral CoI. We agree with Hand that it is possible for teachers to impart their own moral beliefs without indoctrinating students, yet we argue that the risk of indoctrination remains present in the many realistic scenarios in which teachers (...) misjudge controversial standards as uncontroversial or in which teachers’ arguments bypass students’ reason. We agree with Hand that substantively closed questions can generate satisfying inquiries, with the caveat that in the absence of open inquiry there is a chronic risk of eroding the ethos of trust in a CoI. Similarly, we find qualified agreement with Hand regarding teachers’ philosophical self-effacement. We accept that teachers may judiciously suspend neutrality in order to ensure that sound arguments and objections are aired and understood, yet we caution teachers against endorsing any particular justification or rebuttal. We further raise three distinct concerns about Hand’s theory. Firstly, we argue that Hand’s theory is insensitive to the varieties of moral controversy that emerge within the CoI. We maintain that a nondirective approach is required for a proper exploration of controversy over conflicting justifications for shared moral standards grounded in diverse normative ethical theories, where the conative power of particular justifications may differ among individuals; controversy over the meaning, scope and significance of moral concepts; and controversy over the application of moral standards and concepts to actual cases. Secondly, we argue that in light of teachers’ susceptibility to motivated reasoning and myside bias, Hand’s theory places undue demands on teachers to exercise objective judgement. Where teachers unwittingly transmit biases to students, we are not assured that Hand’s proposal can safeguard against indoctrination. Thirdly, we do not share Hand’s conception of moral inquiry as concerned exclusively with argument over the content and justification of moral standards. The narrowness of this conception, together with available evidence that moral argument alone has little effect on moral behaviour, leads us to question Hand’s claim that a fundamental reason for engaging students in moral inquiry is to reinforce their moral formation. We suggest that the scope of the moral CoI should not be limited to argument over the content and justification of moral standards, but should also include the cultivation of virtues and dispositions that prepare students for complex moral decision-making, as well as the investigation of Aristotelian questions concerning what is worthwhile in human life. Given our broader conception of the CoI as both moral and ethical, and our emphasis on students having both the freedom and the responsibility to judge reasonableness for themselves, we conclude that nondirective teaching remains a beneficial regulatory principle for CoI practice. (shrink)

In the following interview, philosophers Leonard Fleck and Arthur Ward discuss the latter’s recent experience of being a nondirected kidney donor. The interview took place in the Center for Bioethics and Social Justice at Michigan State University.

Recent articles on teaching controversial topics in schools have employed Michael Hand's distinction between “directive teaching,” in which teachers attempt to persuade students of correct positions on topics that are not rationally controversial, and “nondirective teaching,” in which teachers avoid persuading students on topics that are rationally controversial. However, the four methods of directive teaching discussed in the literature — explicit directive teaching, “steering,” “soft-directive teaching,” and “school ethos endorsement” — make rational persuasion problematic, if not self-defeating. In this (...) essay, Maughn Rollins Gregory argues that “procedurally directive teaching” offers an alternative to such approaches because it derives from the intention to guide inquiry rather than to persuade. He demonstrates that the conceptual frameworks of perfectionism and antiperfectionism, which have been proposed for directive teaching on same-sex marriage, can instead be used to generate open questions for student inquiry, as can a third, civil rights framework. Given these considerations, Gregory maintains that pedagogical guidance on this topic should be procedurally directive rather than substantively directive. Further, the fact that legal, political, and ethics scholars disagree about which framework is more appropriate to the issue of same-sex marriage indicates that such arguments cannot be dispositive of the pedagogical issue of how to frame classroom discussions about it. Rather, students should inquire into this meta-level framing dispute for themselves. (shrink)

Respect for patient autonomy has served as the dominant ethical principle of genetic counselling, but as we move into a genomic era, it is time to actively re-examine the role that this principle plays in genetic counselling practice. In this paper, we argue that the field of genetic counselling should move away from its emphasis on patient autonomy and toward the incorporation of a more balanced set of principles that allows counsellors to offer clear guidance about how best to obtain (...) or use genetic information. We begin with a brief history of how respect for patient autonomy gained such emphasis in the field and how it has taken on various manifestations over time, including the problematic concept of nondirectiveness. After acknowledging the field's preliminary move away from nondirectiveness, we turn to a series of arguments about why the continued dominance of patient autonomy has become untenable given the arrival of the genomic era. To conclude, we describe how a more complete set of bioethical principles can be adapted and used by genetic counsellors to strengthen their practice without undermining patient autonomy. (shrink)

It is widely thought that genetic counselors should work with parents “nondirectively”: they should keep parents informed and support their decisions. But this view misconceives human decisionmaking by failing to recognize that value choices are constructed within and constrained by a community. Acknowledging that decisions involve interaction with and responsibility toward others leads to a “dialogical” model of counseling, in which genetic counselors may question and guide parents’ decisions.

In August 2000, Arthur Matas and his colleagues de scribed a protocol in which their institution began to accept as potential donors, individuals who came to the University of Minnesota hospital offering to donate a kidney to any patient on the waiting list. Matas and his colleagues refer to these donors as nondirected donors by which is meant that the donors are altruistic and that they give their organs to an unspecified pool of recipients with whom they have no emotional (...) relationship. This paper represents an ethical and policy critique of the nondirected donation protocol that was implemented at the University of Minnesota in August 1999. Specifically, I address the ethical questions: Whether altruistic living solid organ donations by strangers should be permitted? And if so, What are appropriate ethical guidelines for such donations? (shrink)

This essay examines the possible systematic bias against the disabled in the structure and practice of genetic counseling. Finding that the profession's “nondirective” imperative remains problematic, the authors recommend that methodology developed by feminist standpoint epistemology be used to incorporate the perspective of disabled individuals in genetic counselors' education and practice, thereby reforming society's view of the disabled and preventing possible negative effects of genetic counseling on the self-concept and material circumstance of disabled individuals.

In August 2000, Arthur Matas and his colleagues de scribed a protocol in which their institution began to accept as potential donors, individuals who came to the University of Minnesota hospital offering to donate a kidney to any patient on the waiting list. Matas and his colleagues refer to these donors as nondirected donors by which is meant that the donors are altruistic and that they give their organs to an unspecified pool of recipients with whom they have no emotional (...) relationship. This paper represents an ethical and policy critique of the nondirected donation protocol that was implemented at the University of Minnesota in August 1999. Specifically, I address the ethical questions: Whether altruistic living solid organ donations by strangers should be permitted? And if so, What are appropriate ethical guidelines for such donations? (shrink)

: This essay examines the possible systematic bias against the disabled in the structure and practice of genetic counseling. Finding that the profession's "nondirective" imperative remains problematic, the authors recommend that methodology developed by feminist standpoint epistemology be used to incorporate the perspective of disabled individuals in genetic counselors' education and practice, thereby reforming society's view of the disabled and preventing possible negative effects of genetic counseling on the self-concept and material circumstance of disabled individuals.

: The past decade has witnessed the emergence of novel methods to increase the number of living donors. Although such programs are not likely to yield high volumes of organs, some transplant centers have gone to great lengths to establish one or more of them. I discuss some of the ethical and policy issues raised by five such programs: (1) living-paired and cascade exchanges; (2) unbalanced living-paired exchanges; (3) list-paired exchanges; (4) nondirected donors; and (5) nondirected donors catalyzing cascade exchanges. (...) I argue that living-paired and cascade exchanges are ethically sound, but will lead to only a few additional transplants. Unbalanced exchanges and list-paired exchanges raise ethical issues that should limit their permissibility. Nondirected donations can be ethically sound with adherence to strict eligibility criteria and fair allocation procedures. Nondirected donors catalyzing cascade exchanges can be ethically sound provided that individuals with blood types O and B are not made worse off. (shrink)

Compared to other approaches, it is virtue ethics that puts greatest emphasis on moral education. This results from its focus on moral agent and his or her moral condition as the main object of ethical enquiry. The aim of this paper is to outline the moral education within the framework of virtue ethics. I intend to explain how such education embraces the cognitive, affective, and behavioral elements. In the first part of the article, I present the concept of ethical virtue (...) to contrast it with certain misunderstandings which might lead to unnecessary fear of introducing the category of virtue into moral education. In the second part, I respond to various objections raised against virtue ethics, the most important being the objection of indoctrination and undermining autonomy of the educated. Another objection to which I pay special attention is the objection that there is no one catalogue of virtues but many different catalogues praised by different cultures, which especially poses a problem in multicultural societies. I am also trying to show the advantages of virtue education over other, nondirective approaches to moral education. (shrink)

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims: to gain access to the bodily phenomenon of being placed in mechanical restraints; to give voice to the intimate experiential (...) understanding of this experience; and through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses and patients we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: context of care, meaning of quality of care, emotional reactions and nurse–patient relationship, meeting the needs and need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice. (shrink)

Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained. Qualitative interviews were conducted with six adult clients undergoing genetic counseling for predictive testing. (...) Engagement, dialogue and presence were revealed as relevant to genetic counselor-client relationships. A relational ethics approach in genetic counseling challenges the concept of nondirectiveness and may enhance the outcome of counseling for both counselor and client. (shrink)

Beginning with a discussion of why value neutrality on the part of the genetics counselor does not necessarily preserve autonomy of the counselee, the idea that social values unavoidably underlie the articulation of risks and benefits of genetic testing is made explicit. Despite the best efforts of a counselor to convey value neutral facts, risk assessment by the counselee and family is done according to normative analysis, experience with illness, and definitions of health. Each of these factors must be known (...) by the genetic counselor in order to relate those facts which she acknowledges as relevant to the decisions that will be made by those people seeking the genetic information. (shrink)

This paper presents a novel methodological approach of how to design, conduct and analyse robot-assisted play. This approach is inspired by nondirective play therapy. The experimenter participates in the experiments, but the child remains the main leader for play. Besides, beyond inspiration from non-directive play therapy, this approach enables the experimenter to regulate the interaction under specific conditions in order to guide the child or ask her questions about reasoning or affect related to the robot. This approach has been (...) tested in a long-term study with six children with autism in a school setting. An autonomous robot with zoomorphic, dog-like appearance was used in the studies. The children’s progress was analyzed according to three dimensions, namely, Play, Reasoning and Affect. Results from the case-study evaluations have shown the capability of the method to meet each child’s needs and abilities. Children who mainly played solitarily progressively experienced basic imitation games with the experimenter. Children who proactively played socially progressively experienced higher levels of play and constructed more reasoning related to the robot. They also expressed some interest in the robot, including, on occasion, affect. Keywords: Human–Robot Interaction, Robot-Mediated Therapy, Robot-Assisted Play, Non-Directive Play Therapy, Assistive Technology, Autism, Children. (shrink)

In this rejoinder to the foregoing responses to my article ‘Moral education in the community of inquiry’, I address what I take to be the four most fundamental objections to my proposed expansion of the community of inquiry (CoI) method. My proposal is that we make room in the CoI for directive teaching of moral standards we know to be justified or unjustified, in addition to nondirective teaching of moral standards whose justificatory status is unknown. The four objections I (...) consider are: (i) that the dominant conception of the CoI method already permits directive moral teaching; (ii) that permitting directive moral teaching in the CoI would edge out other valuable kinds of inquiry; (iii) that all moral standards are controversial; and (iv) that the task of distinguishing justified and unjustified moral standards from controversial ones is unreasonably demanding. I argue that none of these objections is successful. (shrink)

The aim of this paper is to define a λ-calculus typed in aMixed (commutative and non-commutative) Intuitionistic Linear Logic. The terms of such a calculus are the labelling of proofs of a linear intuitionistic mixed natural deduction NILL, which is based on the non-commutative linear multiplicative sequent calculus MNL [RuetAbrusci 99]. This linear λ-calculus involves three linear arrows: two directional arrows and a nondirectional one (the usual linear arrow). Moreover, the -terms are provided with seriesparallel orders on free variables. We (...) prove a normalization theorem which explicitly gives the behaviour of the order during the normalization procedure. (shrink)

The present volume intends an incursion into some key techniques of social work practice. Using arguments of social epistemology, the author introduces an overview of the case work and brings to attention important aspects of social work counselling. The reader is challenged to explore methodological aspects of counselling and is encouraged to practice the use of NLP techniques during the nondirective interview, which is able to lead to a change focused on the strengths of the client. Putting into relation (...) the main occupations used in assistance-work creates the complex context of inter and multidisciplinary approach of social work practice, recognizing the border aspect of the discipline. The whole approach proposed by the author is filtered by the ethical character of social intervention directed towards the promotion of individual rights and having as central concept the quality of life. This is not viewed as an abstract concept, but as a source of operational indicators relevant to individual existence. To validate social work as applied science, the author brings into focus epistemological arguments adapted to the requirements and demands of this field. (shrink)

Reproductive counseling includes counseling of prospective parents by obstetricians, clinical geneticists, and genetic counselors regarding, for example, the use of assisted reproductive technologies, prenatal testing, and preimplantation genetic diagnosis. Two different views on wisdom and the goal of reproductive counseling are analyzed. According to the first view, the goal of reproductive counseling is to help prospective parents reach a wise decision. A specific course of action is recommended by the counselor in contrast to other possible alternatives. According to the second (...) view, the goal of reproductive counseling is not to help prospective parents reach a wise decision but to help them reach their own decision wisely. It is the prospective parents who should make the decision, and it is their value commitments that should be decisive. It is argued that the second approach is to be preferred to the first. It combines respect for autonomy with a recognition of the need for assistance in decision-making. Both the first and second views relate the goal of reproductive counseling to wisdom. A problem is, however, what wisdom more precisely means — there are many different views. A casuistic view of wisdom is investigated. This view roughly defines wisdom as practical prudence in dealing with particular cases. What characterizes a casuistic decision-making method is elaborated in more detail. Applied to the second view, a casuistic view of wisdom implies that the counselor should encourage prospective parents to take into consideration the nature of the particular problem at hand, the context of the problem, their own individual identities, their personal value commitments, and various alternative perspectives, values and arguments. (shrink)

Moral inquiry - inquiry with children and young people into the justification for subscribing to moral standards - is central to moral education and philosophical in character. The community of inquiry (CoI) method is an established and attractive approach to teaching philosophy in schools. There is, however, a problem with using the CoI method to engage pupils in moral inquiry: some moral standards should be taught directively, with the aim of bringing it about that pupils understand and accept the justification (...) for subscribing to them; but directive moral teaching is widely thought to be impermissible in the CoI. In this article I identify, and push back against, three sources of resistance to directive teaching in the CoI literature: (i) the idea that imparting moral beliefs is indoctrinatory; (ii) the idea that questions discussed in the CoI must be open; and (iii) the idea that teachers in the CoI must be philosophically self-effacing. I argue for a more expansive understanding of the CoI method - one in which there is, after all, room for directive moral teaching. (shrink)