Reflecting teams play a significant role in family therapy; they broaden perspectives on how family dynamics or problems can be understood. However, what happens when a reflector does not feel compassionate towards a particular family member? There is a risk of biased reflections: families can pick up negative signals, putting the therapeutic relationship at risk. In this paper, I explore how I was supported to explore my lack of compassion for Dad ‘John’. It was only after reaching out to (...) an experienced supervisor who undertook an ‘internalised other’ interview with me – where I played the role of Dad – did my compassion increase. From an ethics of care perspective, I suggest that social professionals need to explore ways to increase empathy and compassion for clients they dislike. If they do not, they are open to valid criticism that they are behaving unethically as professionals. Therefore, there is a need to address deficits in empathy and compassion to sustain ethical social work practices. (shrink)

Concepts that include the participation and empowerment of workers are becoming increasingly important nowadays. In many of these concepts, the formal responsibility is delegated to teams. Does this imply that the normative responsibility for the actions of teams is also delegated? In this article we will reflect on the difference between holding a person accountable and bearing responsibility. A framework is elaborated in order to analyse the accountability and responsibility of teams. In this framework, the emergence of a collective mind, (...) and the organisational factors that influence the extent to which teams have the possibility of acting in a responsible way play an important role. It shows that teams can bear responsibilities that could never be carried by a group of individuals. The framework is used to analyse two sample cases with self-managing teams in production facilities. The authors discuss the implications for the theory and practice of self-managing teams and the allocation of responsibility between individuals, teams and the organisation. (shrink)

Team reflexivity has gained increasing research attention as an effective response to the core challenge of constant learning, innovation, and adaptation in teams due to changing circumstances. Under the right conditions, empirical studies have found that team reflexivity can improve team performance, team learning, team innovation, team creativity, and team member well-being. Thus, research shows that team reflexivity is an effective means to improve teamwork and team outcomes. This book addresses the (...) problem that team reflexivity research is focused too narrowly on improving these empirical team outcomes while neglecting the importance of normative principles and values in good teamwork, such as the do no harm principle. Therefore, this book proposes that the team reflexivity concept needs broader reframing and deeper reflection to realize normative principles and values in teams as a precondition for good teamwork, e.g., do no harm. It further presents two team reflexivity tools and applies them in the cases of burnout prevention and speaking up freely in teams to illustrate the point of this book: Do no harm in teams requires team reflexivity, and vice versa, team reflexivity requires do no harm. (shrink)

Among the many approaches to leadership, servant leaders stand out for the emphasis they place on the importance of service to their followers, the organization, and the broader community. We develop and test a multilevel mediation model, in which the relationship between servant leadership and team performance is sequentially transmitted through individual-level organizational citizenship behavior (OCB) and team-based internal social capital. Multilevel structural equation modeling was applied to a sample of 343 teams, reflecting 835 respondents from various (...) departments at 171 hotels in Spain; both top-down (between team leaders and individual employees) and bottom-up relationships (individual employee behavior and team outcomes) were assessed. As anticipated, individual-level OCB and group-level internal social capital fully mediated the positive effect of servant leadership on team performance. Our findings illustrate that servant leadership in the team-based business enterprise context can foster virtuous individual-level OCB to help build task-focused community, in which leaders, followers, and teams can flourish for the common good. Thus, managers should know that serving their team members first and foremost is a positive for the flourishing of all involved. As such, policymakers should pursue communication and training initiatives to encourage the practice of servant leadership. (shrink)

To advance understanding of the mechanisms allowing for team coordination (TC) in complex motor actions, we conducted a qualitative study with eight elite hand-to-hand circus acrobats. Data collection consisted of field observations, an open-ended interview with the participants’ head coach, and focus group interviews with all acrobats. Data analysis yielded three higher order themes: TC, collective efficacy (CE), and TC-CE linkage. Teammates’ shared and complementary mental models, as well as implicit and explicit communication dynamics, emerged as formative sub-themes of (...) TC; self-efficacy and other’s-efficacy emerged as reflective sub-themes of CE. Our findings also suggest that TC is likely inter-related to CE in a systemic fashion. Practitioners should encourage the development of both shared and complementary models of thinking, while promoting verbal and non-verbal communication skills. Finally, increasing teammates’ confidence in themselves and in their teammates can help in the development of CE as well as the enhancement of TC. (shrink)

IntroductionEngaging undergraduates in the research process is one of the most rewarding aspects of being a professor because it more deeply connects us to our work and helps shape the professional futures of students by immersing them in the culture of research (including peer-to-peer mentoring and authoring publications; Russell, Hancock, & McCullough, 2007). But there is a real trick to working with undergraduates in a way that both shapes students’ futures and produces high-quality, publishable research because mentors must invest a (...) great deal of time developing undergraduates’ technical and writing abilities, and this effort is time not spent on the research itself. In this article, we describe a powerful, flexible approach that makes the production of publishable research possible. For context, we teach and conduct research at a small liberal arts college with a population of just over 2000 undergraduates. Research at primarily undergraduate institutions (PUIs) does not benefit a system of graduate students, post-docs, and paid research staff, so we have found it necessary to developed a structured, team-based approach to faculty-student research that provides excellent mentorship and produces publishable research (see Detweiler-Bedell & Detweiler-Bedell, 2013). Importantly, this team-based model can be put into practice with a broad array of students, including underrepresented and first-generation students. What we have learned in adopting this approach reflects... (shrink)

The purpose of this paper is to encourage reflection about the harm that could result if the positive aspects of team-organized health care are compromised during the health care reform process. While other models of health care delivery could replace teamwork and serve patients as well or better, the interdisciplinary health care team probably will not be abandoned. However, one or more disciplines whose members play important roles on various teams may be sacrificed in the hasty effort to (...) define essential health care. Moreover, a significant proportion of the types of IHCTs in existence could be rashly eliminated from health plans. These changes should not take place randomly or by default. (shrink)

The purpose of this paper is to encourage reflection about the harm that could result if the positive aspects of team-organized health care are compromised during the health care reform process. While other models of health care delivery could replace teamwork and serve patients as well or better, the interdisciplinary health care team probably will not be abandoned. However, one or more disciplines whose members play important roles on various teams may be sacrificed in the hasty effort to (...) define essential health care. Moreover, a significant proportion of the types of IHCTs in existence could be rashly eliminated from health plans. These changes should not take place randomly or by default. (shrink)

Interdisciplinary understanding requires integration of insights from different perspectives, yet it appears questionable whether disciplinary experts are well prepared for this. Indeed, psychological and cognitive scientific studies suggest that expertise can be disadvantageous because experts are often more biased than non-experts, for example, or fixed on certain approaches, and less flexible in novel situations or situations outside their domain of expertise. An explanation is that experts’ conscious and unconscious cognition and behavior depend upon their learning and acquisition of a set (...) of mental representations or knowledge structures. Compared to beginners in a field, experts have assembled a much larger set of representations that are also more complex, facilitating fast and adequate perception in responding to relevant situations. This article argues how metacognition should be employed in order to mitigate such disadvantages of expertise: By metacognitively monitoring and regulating their own cognitive processes and representations, experts can prepare themselves for interdisciplinary understanding. Interdisciplinary collaboration is further facilitated by team metacognition about the team, tasks, process, goals, and representations developed in the team. Drawing attention to the need for metacognition, the article explains how philosophical reflection on the assumptions involved in different disciplinary perspectives must also be considered in a process complementary to metacognition and not completely overlapping with it. (Disciplinary assumptions are here understood as determining and constraining how the complex mental representations of experts are chunked and structured.) The article concludes with a brief reflection on how the process of Reflective Equilibrium should be added to the processes of metacognition and philosophical reflection in order for experts involved in interdisciplinary collaboration to reach a justifiable and coherent form of interdisciplinary integration. An Appendix of “Prompts or Questions for Metacognition” that can elicit metacognitive knowledge, monitoring, or regulation in individuals or teams is included at the end of the article. (shrink)

ABSTRACT This paper is a reflective piece on the thought processes individuals and teams have when engaging in decoloniality work in Teacher Training/Education. We argue that until the self is decolonized, the process of decolonialization becomes rhetoric. We also question how much we can decolonize whilst working in the academy whose very culture, symbols and practices are borne out of colonialism and the period of enlightenment; whose very raison d’être is to elevate some knowledge over others and to claim cultural (...) and academic superiority. The current political landscape in England approaches anti-racism as a political ideology that must be avoided in schools and education and this ideological battlefield is evident in teacher education. We aim to recognize the tensions and resistance to decolonialize, which demonstrates the messy and contingent process of moving between shifting positions and subjectivities. It confronts the challenge of the teacher–practitioner who must balance their own moral and philosophical grounding whilst attending the political imperatives of the work. This can take the form of according with the policies and procedures of the institutions in which they are situated which can often be balkanizing and debilitating. (shrink)

Studying and discussing boundary violations between people is important for potentially averting future harm. Organizations typically respond to boundary violations in retributive ways, by punishing the perpetrator. Interestingly, prior research has largely ignored the impact of sexual boundary violations and retributive dynamics on teams. This is problematic as teams provide an obvious setting not only to detect and discuss troubling behavior by peers, but also for learning how to prevent future harm. Therefore, in this study we explore team-level experiences (...) regarding sexual boundary violations and organizational responses to these incidents. Drawing on an in-depth case study, our findings shed light on the profound negative consequences of a retributive organizational response to sexual boundary violations. Additionally, our findings show how a restorative approach, inviting teams to reflect on the violations and their impact, can help teams to recover. Our main contribution involves a model that demonstrates how the interplay between sexual boundary violations, retributive, and restorative organizational responses affects teams. This model shows how combining these responses can acknowledge distress within teams, heal relationships between team members through dialogue, and open up the possibility to learn from these events. This model extends prior research focusing on individual actions and outcomes regarding violations. Additionally, by combining retributive and restorative organizational responses in one model, we extend the literature on restorative organizational responses to boundary violations. (shrink)

The gradual crowding out of singleton and small team science by large team endeavors is challenging key features of research culture. It is therefore important for the future of scientific practice to reflect upon the individual scientist’s ethical responsibilities within teams. To facilitate this reflection we show labor force trends in the US revealing a skewed growth in academic ranks and increased levels of competition for promotion within the system; we analyze teaming trends across disciplines and national borders (...) demonstrating why it is becoming difficult to distribute credit and to avoid conflicts of interest; and we use more than a century of Nobel prize data to show how science is outgrowing its old institutions of singleton awards. Of particular concern within the large team environment is the weakening of the mentor–mentee relation, which undermines the cultivation of virtue ethics across scientific generations. These trends and emerging organizational complexities call for a universal set of behavioral norms that transcend team heterogeneity and hierarchy. To this end, our expository analysis provides a survey of ethical issues in team settings to inform science ethics education and science policy. (shrink)

How a senior researcher from a developing country can build an organic academic enterprise. Drawing from childhood experience with nature, past works with the business sector, and philosophy of data-driven research, the essay presents a compelling case of letting young graduates work on big database-building projects: one on Vietnamese social sciences; the other is more than 80 years of the pioneer science in Vietnam—mathematics. Two national databases have enabled meaningful data-driven interactions with scientific policymakers.

Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members’ reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus (...) group interviews. The results revealed one main theme: ‘Lack of trust in the community health care system’s commitment to bringing about effectiveness and change, based on three themes; ‘Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members’, ‘Balancing autonomy, care and dignity’ and ‘Differences in the understanding of responsibility’. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care. (shrink)

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these (...) contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established. (shrink)

The papers included in the thesis, and summarized in this covering document, were selected, in discussion with my supervisor, Dr. Roessler, from papers I have published in the philosophy of psychiatry. In parallel to this philosophical work, I have worked clinically as a psychiatrist and academically as a research psychiatrist. My clinical work has largely been working with Early Intervention Services, both in South London and in Coventry and Warwickshire, and this work has been acting as a psychiatrist in clinical (...) teams who work with young people who may either be at risk of developing a psychotic illness, or are in the earliest stages of such an illness. My empirical work has been in the same clinical group and has used functional neuroimaging and cognitive neuropsychology to characterize those at risk of psychosis and to chart the onset of psychosis and the formation of delusions. As required by the university guidelines, a full list of publications, both empirical and philosophical, is detailed in appendix 1. The papers included in the thesis hence parallel many of these clinical and empirical interests: papers 2 and 4, in particular, examine the role neuroimaging may play in studying delusions and relate the prodromal phase of psychosis to both the neurodevelopmental and continuum models of psychosis. Paper 3 is one of two papers written with Lisa Bortolotti drawing on Richard Moran’s work and examining delusions. Paper 1 is perhaps the paper least connected to my empirical and clinical work as has a wider focus and tries to examine what mental illnesses are and to begin to describe a position Lisa Bortolotti and I later expanded on and referred to as ‘psychological realism’, with Paper 2 being a case example of this account being applied to a particular area of psychopathology, namely delusions. The papers form a progression with Paper 1 outlining a general conception of mental disorder, Paper 2 being a case study of this approach specifically in the area of delusion. Paper 3 takes the example of thought insertion and develops ideas from Paper 2 that reason giving is a crucial feature that helps highlight what is pathological about certain experiences. Paper 4 brings together the philosophical concerns regarding a wholly neuroscientific conception of psychopathology, and how this is of clinical and scientific relevance when we use psychopathology to demarcate the various stages of psychotic experience and illness. (shrink)

During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending (...) physician, social worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence. (shrink)

There are no moral cookbooks—no algorithms for whipping up moral confections to suit every occasion. But more modest and flexible tools might still be useful for practical ethics. One team describes how professionals can be taught to use a framework for understanding moral problems.

The majority of healthcare professionals regularly witness fragility, suffering, pain and death in their professional lives. Such experiences may increase the risk of burnout and compassion fatigue, especially if they are without self-awareness and a healthy work environment. Acquiring a deeper understanding of vulnerability inherent to their professional work will be of crucial importance to face these risks. From a relational ethics perspective, the role of the team is critical in the development of professional values which can help to (...) cope with the inherent vulnerability of healthcare professionals. The focus of this paper is the role of Communities of Practice as a source of resilience, since they can create a reflective space for recognising and sharing their experiences of vulnerability that arises as part of their work. This shared knowledge can be a source of strength while simultaneously increasing the confidence and resilience of the healthcare team. (shrink)

In a clinic-wide approach to establish liberal policies, a closed psychiatric ward was planned to be opened. The leaders of the multi-professional team of this ward requested continuous ethics support during the first few months after the transition from their previously closed ward into an open one. During the process of accompanying the team through this ethically sensitive period of institutional change, several variations of ethics consultation were developed: the ‘context-adjusted’ clinical ethics support. Some ethics consultations focused on (...) a retrospective evaluation of a patient case, in other ethics consultations consolidation of a previous case discussion was worked out, and/or reflections on fundamental ethical issues were included. Based on our experiences and the feedback of the team, we consider this context-adjusted clinical ethics support as feasible and effective. (shrink)

While work in modern corporations tends to take place in groups or teams it is not quite clear which status these groups have. Are they genuine agents or are they simply collections of individuals? The question is important because the answer is often held to determine whether collectives can be viewed as subjects of responsibility. This paper raises the question of collective responsibility and focuses on the impact the use of information systems (IS) has on it. Starting with an analysis (...) of the concept of responsibility it argues that the ascription of responsibility is admissible if it achieves certain social goals and it reviews the arguments concerning responsibility and collective subjects. Turning to information systems, it argues that their use can affect the process of ascribing responsibility both negatively and positively. It proposes the idea of ‘reflective responsibility’ and employs the reflective approach as a basis for using IS to support and enable the ascription of collective responsibility. (shrink)

What can insights from psychological science contribute to interdisciplinary research, conducted by individuals or by interdisciplinary teams? Three articles shed light on this by focusing on the micro- (personal), meso- (inter-personal), and macro- (team) level. This Introduction (and Table of Contents) to the 'Special Section on Interdisciplinary Collaborations' offers a brief description of the conference session that was the point of departure for two of the three articles. Frank Kessel and Machiel Keestra organized a panel session for the March (...) 2015 meeting of the International Convention of Psychological Science (ICPS) in Amsterdam, which was the titled “Theoretical and Methodological Contributions of Inter/Trans-Disciplinarity (ID/TD) to Successful Integrative Psychological Science.” Machiel Keestra's article analyses how metacognition and philosophical reflection complement each other by making scholarly experts aware of their cognitive processes and representations. As such, these processes contribute to individual and team interdisciplinary research. Hans Dieleman's article proposes a transdisciplinary hermeneutics that acknowledges the embodied nature of cognition and contributes to richer and more creative interdisciplinary knowledge production. The article by Lash-Marshall, Nomura, Eck & Hirsch was added later and continues by focusing on the macro-level of institutional and team arrangements and the role of facilitative leadership in supporting interdisciplinary team research. The original conference panel session's introduction by Frank Kessel and the contribution on the Toolbox Project's dialogue method by Michael O'Rourke are briefly described as well. Together, this Special Section on Interdisciplinary Collaboration offers a wide variety of insights in and practical instructions for successfully conducting interdisciplinary research. (shrink)

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these (...) contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension, we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflections on Futures for Music Education PhilosophyEstelle R. JorgensenIn 1990, when I convened the first International Symposium for the Philosophy of Music Education at Bloomington, Indiana, there was one dominant philosophy of music education in the United States and another was about to make its appearance. The five succeeding symposia (Toronto, Canada, in 1994, led by David Elliott; Los Angeles, United States, in 1997, led by Anthony Palmer and (...) Frank Heuser; Birmingham, United Kingdom, in 2000, led by Mary Reichling and Forest Hansen; Lake Forest, Illinois, United States, in 2003, led by Iris Yob, Frank Heuser, and Forest Hansen; and Hamburg, Germany, in 2005, led by Charlene Morton, Paul Woodford, Frede Nielsen, and Jürgen Vogt) have promoted other philosophies. And this burgeoning of different voices and perspectives has greatly enriched the philosophical underpinnings of music education and moved us from relying on a narrow range of philosophical views towards a plethora of them.In our infant society, the International Society for Philosophy of Music Education (ISPME), we are creating and institutionalizing a forum that can nurture and critique ideas and practices and sustain the work of philosophical reflection in music education over the longer term. We have also benefited from long-term commitments by the Indiana University School of Music and Indiana University [End Page 15] Press to publishing the Philosophy of Music Education Review, now in its fourteenth volume (building on three years of publication of the Philosophy of Music Education Newsletter), and the Counterpoints: Music and Education series that provides an important venue for publishing cutting-edge scholarship in our field. And over the past two years, we have begun to build an international team of philosophers committed to establishing a strong philosophical society in music education.Beyond institutionalizing philosophical scholarship in music education, our society is committed to creating a genuinely international community that offers a global perspective. In the past, music education grew up within national borders and its work was often nationalistic in emphasis. Now, we face new challenges of thinking beyond these national commitments to a world of music education. This world might be seen as what Maxine Greene aptly terms "multiplicities and pluralities,"1 the many differing groups forged within language groups, religious perspectives, political ideologies, economic strictures, and familial obligations. And as philosophers, we work especially within our various linguistic and cultural traditions as we also seek to transcend these traditions in a common discourse.How shall we address philosophically the multiplicities and pluralities, commonalities and differences in music education internationally? Radical relativism and pluralism offer contrasting perspectives.2 Radical relativism sees the host of different music education beliefs and practices around the world as incommensurable and focuses on differences between them. For example, viewing Japanese and British music education within this stance would suggest that since Japanese and British music education reflect Japanese and British society and culture respectively, each cannot be understood in terms of the other, they are different and incommensurate with the other, and it is important to understand each in its own terms. Pluralism, however, sees differences as commensurable and focuses on shared attributes. Since human beings are the creators of culture and society, common threads amidst the differences emerge from this common humanity. For example, as a reflection of their different societies and cultures, although we expect to encounter differences between British and Japanese music education, we may also observe commonalities since they both bear the imprint of a shared humanity.Notwithstanding that musics and educational systems seem, upon first glance and when considered specifically, to be incommensurable, a deeper and more general examination turns up evidence supporting a pluralist perspective.3 Historically, cultures regularly borrow from different others as if there were common human threads. Maurice Ravel, Carl Orff, and Paul Simon are among twentieth-century composers to draw on cultures from the Far East and Africa. In music [End Page 16] education, Masafumi Ogawa's study of the introduction of Luther Whiting Mason's ideas into Japan in the nineteenth century,4 the dissemination of Shinichi Suzuki's ideas into the United States, the spread of Zoltán Kodály's, Émile Jaques-Dalcroze's, and Carl Orff's and Gunild... (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Through two exchanges in this journal, a type of relativism has been advanced by a group of authors from Loughborough University with a view to demolishing what they see as ‘bottom line’ arguments for critical realism in the social sciences. Jauntily dismissing realism, they also soberly disown the supposed ‘extreme’ consequences that some realists insist follow naturally from relativist conceptions of social inquiry. In this article, I contest the Loughborough team’s arguments. Their presentation of relativism itself can be reconstructed (...) in at least three different ways, none of which suffices to undermine a generally realist account of explanatory endeavour. The most productive note in the critics’ conceptual register highlights the utility of rhetorical analysis; yet this can proceed effectively only if it is neutral with respect to different epistemic and ontological stances. The most productive thematic possibility raised in their articles, and shared with several other recent discussions, signals that realism and relativism may not be anything like fixed and opposed stances; yet the polemical thrust of their anti-realism compromises this insight. (shrink)

Based on interviews with guide dog users from Sweden, Estonia and Germany and participatory observation of the teams’ work, the article discusses three kinds of semiotic challenges encountered by the guide dog teams: perceptual, sociocultural and communicative challenges. Perceptual challenges stem from a mismatch between affordances of the urban environment and perceptual and motoric abilities of the team. Sociocultural challenges pertain to the conflicting meanings that are attributed to dogs in different social contexts and to incompatible social norms. Challenges (...) related to intrateam communication and interpretation of the other counterpart’s behavior are mostly tied to the difficulties of placing the other’s activities in the right context. Germany, Estonia and Sweden differ in their history of guide dog institutions and the organisation of guide dog work, but the challenges of the guide dog users appear to be fairly similar. However, differences appear in the stress laid on one or another type of challenge as well as in the explanations provided by the informants for the background of the challenges. The challenges, as analysed in the article, reflect not only the existing problems of guide dog users, but also their expectations for a social and physical environment, in which the teams would feel welcome. (shrink)

Anonymized reflection was employed as an innovative way of teaching ethics in order to enhance students' ability in ethical decision making during a `Care of the Dying Patient and Family' module. Both qualitative and quantitative data were collected from the first two student cohorts who experienced anonymized reflection ( n = 24). The themes identified were the richness and relevance of scenarios, small-group work and a team approach to teaching. Students indicated that they preferred this style of teaching. This (...) finding was verified by a postal questionnaire conducted four months later. The conclusions drawn from this study suggest that using anonymized reflection is an effective method for teaching ethics to nurses and indicates that learning about ethical issues in this way reduces uncertainties. (shrink)

This paper provides practitioner and academic insights into the importance of examining non-technical skills in a multiteam system emergency response. The case of public health professionals is highlighted, illustrated with unique qualitative field data which focused upon the use of non-technical skills at a meso level of analysis. Results reflected the importance of context upon the multiteam system and highlighted seven non-technical skills used by public health professionals to support an effective response. Recommendations for future research and implications for practice (...) are noted for this hard to access professional group, located within emerging advances in the scientific inquiry of complex and increasingly evident, multi-team systems. (shrink)

Through two exchanges in this journal, a type of relativism has been advanced by a group of authors from Loughborough University with a view to demolishing what they see as ‘bottom line’ arguments for critical realism in the social sciences. Jauntily dismissing realism, they also soberly disown the supposed ‘extreme’ consequences that some realists insist follow naturally from relativist conceptions of social inquiry. In this article, I contest the Loughborough team’s arguments. Their presentation of relativism itself can be reconstructed (...) in at least three different ways, none of which suffices to undermine a generally realist account of explanatory endeavour. The most productive note in the critics’ conceptual register highlights the utility of rhetorical analysis; yet this can proceed effectively only if it is neutral with respect to different epistemic and ontological stances. The most productive thematic possibility raised in their articles, and shared with several other recent discussions, signals that realism and relativism may not be anything like fixed and opposed stances; yet the polemical thrust of their anti-realism compromises this insight. (shrink)

This paper draws on the experience of one research project in action to evaluate the usefulness of research ethics frameworks when the environment surrounding project negotiation, data collection and dissemination is seriously disturbed by critical incidents. The paper questions the lack of emphasis in research ethics codes on the competence and capacity of agencies when commissioning and sponsoring research. Using events that surrounded one project, the paper researches the research. It explores what impacted on the creation of the context for (...) ethical and effective research and how the researchers responded to the ethical challenges that emerged. Different theoretical understandings and ethical models are drawn upon to explore how a research team translated ethical research in theory into ethical research in practice within an organization in turmoil. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

This issue of Narrative Inquiry in Bioethics explores the concerns and point of view of parents who have had to confront the devastating diagnosis of a pediatric brain tumor. This commentary, written by a general pediatrician, is a synthesis of several narrative themes which touch on a range of topics from relapse to long-term sequelae and other issues that effect a growing population of pediatric brain tumor patients. It offers a glimpse into the problems that need to be addressed by (...) health professionals, educators and support teams who provide short and long term care to these patients and their families. (shrink)

In this paper the authors, starting from the experience described and commented on in earlier work by Mancini and Sbordone, deal with the three main epistemological problems that the research group they participated in had to face:The conflicting and ambiguous relationship between psychoanalysis and social researchThe classical epistemological problem of the relationship between the subject and object of research within the perspective of action researchThe problem arising from their experience, i.e., the risk of manipulation, and the way to deal with (...) it from an epistemic perspectiveThe three problems are dealt with one at a time, but from a common perspective, i.e., the attempt to integrate the richness and variety of human subjectivity in social research. As to the relationship between psychoanalysis and social research, a special section is devoted to the implications of an integrated or convergent methodology on team-working in organisations. (shrink)

The current case study focused on a crucial match in the qualification for the Norwegian Premier League. In the match, the participants of the study experienced a radical change in performance toward the end of the second half, from being behind by several goals to scoring 3 goals in 6 min and winning the qualifying game. The purpose of this study was therefore to examine the perceptions and reflections of players and coaches on what occurred within their own team (...) and within the opposing team. The momentum shift in the opposition team can be described as a collective collapse. In the study, the theoretical collective collapse process model was used as a guide for the design of the interview questions where five semi-structured interviews were conducted with participants involved in the match. The participants watched excerpt clips from the match to recall the main events, which they subsequently reflected on. The results highlighted the importance of the “before-game” aspects, the “during-the-game” behavior and the cognitive and emotional reactions to the match unfolding. In addition, social contagion processes were evident in both teams relating to emotion and behavior. Overall, the data from this study investigated the general structure of the process model of collective sport team collapse and found support for the notion of a temporal cascade of causes for a team collapse. Future research is encouraged to examine this model, to provide guidance to teams, coaches, and sport psychologists in order to make recommendations for dealing with collective collapse in sport teams. (shrink)

Following previous work that shows engineering students possess different levels of understanding of ethics—implicit and explicit—this study focuses on how students’ implicit understanding of engineering ethics influences their team discussion process, in cases where there is significant divergence between their explicit and implicit understanding. We observed student teams during group discussions of the ethical issues involved in their engineering design projects. Through the micro-scale discourse analysis based on cognitive ethnography, we found two possible ways in which implicit understanding influenced (...) the discussion. In one case, implicit understanding played the role of intuitive ethics—an intuitive judgment followed by reasoning. In the other case, implicit understanding played the role of ethical insight, emotionally guiding the direction of the discussion. In either case, however, implicit understanding did not have a strong influence, and the conclusion of the discussion reflected students’ explicit understanding. Because students’ implicit understanding represented broader social implication of engineering design in both cases, we suggest to take account of students’ relevant implicit understanding in engineering education, to help students become more socially responsible engineers. (shrink)

This open access book addresses the question of how God can providentially govern apparently ungovernable randomness. Medieval theologians confidently held that God is provident, that is, God is the ultimate cause of or is responsible for everything that happens. However, scientific advances since the 19th century pose serious challenges to traditional views of providence. From Darwinian evolution to quantum mechanics, randomness has become an essential part of the scientific worldview. An interdisciplinary team of Muslim, Christian and Jewish scholars—biologists, physicists, (...) philosophers and theologians—addresses questions of randomness and providence. (shrink)

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study (...) to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (shrink)

The procedures for structuring clinical ethics case reflections in a childhood cancer care setting are presented, including an eight-step model. Four notable characteristics of the procedures are: members of the inter-professional health care team, not external experts, taking a leading role in the reflections; patients or relatives not being directly involved; the model explicitly addressing values and moral principles instead of focussing exclusively on the interests of involved parties; using a case-based rather than principle-based method. By discusing the advantages (...) and disadvantages of the proposed procedures, our paper aims to contribute to the literature on models and procedures for ethical analysis that can be used in clinical settings. It is suggested that our proposed procedures have some advantageous features when it comes to promoting health care staff’s learning to structure their thinking about ethical issues. (shrink)

Suppose that a team of neurosurgeons and bioengineers were able to remove your brain from your body, suspend it in a life-sustaining vat of liquid nutrients, and connect its neurons and nerve terminals by wires to a supercomputer that would stimulate it with electrical impulses exactly like those it normally receives when embodied. According to this brain-in-a-vat thought experiment, your envatted brain and your embodied brain would have subjectively indistinguishable mental lives. For all you know—so one argument goes—you could (...) be such a brain in a vat right now.1 Daniel Dennett calls this sort of philosophical thought experiment an “intuition pump” (Dennett 1995). An intuition pump is designed to elicit certain intuitive convictions, but is not itself a proper argument: “intuition pumps are fine if they’re used correctly, but they can also be misused. They’re not arguments, they’re stories. Instead of having a conclusion, they pump an intuition. They get you to say ‘Aha! Oh, I get it!’ (Dennett 1995, p. 182). Philosophers have used the brain-in-a-vat story mainly to raise the problem of radical skepticism and to elicit various intuitions about meaning and knowledge (Putnam 1981). The basic intuition the story tries to pump is that the envatted brain, though fully conscious, has systematically false beliefs about the world, including itself. Some philosophers reject this intuition. They propose that the envatted brain’s beliefs are really about its artificial environment or that it.. (shrink)

Behavioral and physiological synchronization have important implications for work teams with regard to workload management, coordinated behavior and overall functioning. This study extended previous work on the nonlinear statistical structure of GSR series in dyads to larger teams and included subjective ratings of workload and contributions to problem solving. Eleven teams of 3 or 4 people played a series of six emergency response (ER) games against a single opponent. Seven of the groups worked under a time pressure instruction at the (...) beginning of the first game. The other four groups were not given that instruction until the beginning of the fourth game. The optimal lag length for the teams, which appeared to be phase-locked, was substantially shorter than that obtained previously for loosely-coupled dyads. There was a complex nonlinear effect from the time pressure manipulation on the autocorrelation over time that reflected workload and fatigue dynamics that were operating. The R2 values for linear and nonlinear statistical models differed by less than.01. The average amount of influence from one ER team member to another was 4.5-4.7% of the variance in GSR readings. ER team members were classified as drivers and empaths, based on the autocorrelations and transfer influences to and from other players in the GSR time series. Empaths were rated by their peers as making more types of positive contributions to the problem solving discussions than others, and drivers received the lowest ratings. Larger Lyapunov exponents that were calculated from the GSR time series were positively correlated with individuals’ ratings of subjective workload and were negatively correlated with leadership indicators. Several directions for further research are outlined. (shrink)

Tom Andersen’s reflecting team process, which allowed families to witness and respond to the talk of professionals during therapy sessions, has been described as revolutionary in the field of family therapy. Reflecting teams are prominent in a number of family therapy approaches, more recently in narrative and dialogical therapies. This way of working is considered more a philosophy than a technique, and has been received positively by both therapists and service users. This paper describes how dialogical therapists (...) conceptualise the reflective process, how they work to engage families in reflective dialogues and how this supports change. We conducted semi-structured, reflective interviews with 12 dialogical therapists with between 2 and 20 years of experience. Interpretative Phenomenological analysis of transcribed interviews identified varying conceptualisations of the reflecting process and descriptions of therapist actions that support reflective talk among network members. We adopted a dialogical approach to interpretation of this data. In this sense, we did not aim to condense accounts into consensus but instead to describe variations and new ways of understanding dialogical reflecting team practices. Four themes were identified: Lived experience as expertise; Listening to the self and hearing others; Relational responsiveness and fostering connection; and Opening space for something new. We applied these themes to psychotherapy process literature both within family therapy literature and more broadly to understand more about how reflecting teams promote helpful and healing conversations in practice. (shrink)

The aim of this study was to illuminate nurses’ reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews (...) were analysed using qualitative content analysis. Our interpretations of participants’ reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to ‘do good’ and ‘be good’. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to ‘do good’ for patients and ‘be good’ nurses. (shrink)

These days CSIRO is focusing on providing holistic solutions to Australia's major problems. For example, the organisation hopes to address significant natural resource management problems of Australia by combining the wisdom of a wide array of disciplines. A number of recent measures have been initiated towards this end, which are described in this paper. Implicitly, CSIRO has recognised that cultural change is needed if the organisation is to contribute to the resolution of long-standing "wicked" problems. Innovations to achieve a more (...) integrated approach are described and assessed in terms of their ability to meet recommendations derived from a formal review of past attempts to conduct multidisciplinary or interdisciplinary research. Much of the interpretation however is personal, reflecting changes observed in thirty years of service within CSIRO. The discussion concentrates on the pragmatics of the creation and performance of teams with differing disciplinary backgrounds in natural resource management. In addition the paper discusses the wider ongoing changes to the roles of scientists as society evolves. It outlines the issues of defining the appropriate questions for research and the changing interaction between scientific and community knowledge. The potential contribution of complex systems theory to assist in creating productive integrated research is discussed. It is concluded that the CSIRO case study provides compatible findings with other analyses of integrated research performance and also other descriptions of the evolving role of scientists within wider society. (shrink)

Since 1990 I have been deeply involved in the development of Latin American ecofeminist thought and its theological, ethical and spiritual perspectives as a founding member of the Con-spirando Collective, a team of women working in the areas of ecofeminist theology, ethics and spirituality in Santiago, Chile. This article describes the results of a research project I conducted based on interviews with twelve faith-based activist women who had historically aligned themselves with liberation theology and its practice and who now (...) describe themselves as ecofeminists. The aim was to document the shift that took place in their identities and their growing ecofeminist awareness. This is made visible through the ways that these women perceive themselves in relation to the rest of the Earth community and to the Universe as a whole; in the way they re-image/re-name Ultimate Mystery; in their beliefs about death and rebirth; and in their spiritual and ethical practice. (shrink)

An innovative gateway MBA course, Personal Development and Social Responsibility, is the focus of this paper. We describe the course and show how it is related intimately to the missions and traditions of our university and college; various themes are integrated; and our interactions as developers of and instructors for the course mirror some of the issues addressed in it. We include an evaluation of the efficacy of the course, based on student course and self evaluations. We do not write (...) with the expectation that others will necessarily replicate what we have done but with the hope that they will (1) consider carefully the relationship between what and how they teach with the missions and traditions of their universities and colleges; (2) examine the integration of content and process; and (3) reflect on their collegial associations with one another. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Black Horseman Lane: A ReflectionJanet PniewskiI felt a sinking feeling in the pit of my stomach upon getting the news this particular patient, let’s call him Stan, had burned through yet another nurse case manager and it would now be my responsibility to take charge of his care. As the medical director read aloud his patient profile, “Sixty–eight year old frail appearing Caucasian male with a terminal diagnosis of...” (...) I was already formulating excuses in my head as to why I would not be able to accept this charge. However, when she finished, I dutifully replied, “Ok, I’ll give it my best shot.” At the time, I was well aware that this assignment would test my resolve and commitment to providing the same high quality compassionate [End Page 117] care to every patient, but what I did not realize was how much I would grow personally and professionally in the process.Stan was well known in the organization for being “non–compliant” and “difficult.” Through his past actions he earned the label of racist and misogynist, having zero tolerance for people whom he perceived as different from him in any way. He was profoundly disrespectful toward women and was known to abuse his animals. Having been raised in a liberal household in New Jersey, surrounded by civil rights activists, animal activists and feminists, I was genetically programmed to abhor social injustice and raised to serve as an advocate for the disenfranchised and vulnerable. Since childhood, I’ve experienced visceral reactions to acts of injustice or cruelty of any kind. The very idea of someone like Stan was appalling.I found myself assigned to Stan’s case by default. He fired his first nurse because she was African American and painted her as dishonest and incompetent. He fired his second nurse because he was male and therefore must be gay. He fired his social worker because she was overweight, which certainly meant she was lazy. He fired the chaplain because he was not Catholic and thus unworthy of having any meaningful spiritual discourse. He would not accept the recommendations of our medical director because she was a woman. His family had given up on him a long time ago. His wife left him shortly after his youngest child had gone off to college, and all four of his children were estranged. Stan’s disease was progressing, despite therapy, and he was becoming too weak to care for himself at home without hospice support. His oncologist pleaded with us to give it one more try, even though we were running out of staff. These people that Stan had dismissed so unpleasantly were my colleagues and friends. The first nurse Stan dismissed served as my ever patient and knowledgeable preceptor when I was new to hospice and fumbling my way through unfamiliar protocols. The second nurse Stan rejected was a dedicated colleague and devoted friend, supporting me through several life challenges. I had witnessed our chaplain, judged as unworthy by Stan, tirelessly provide comfort to patients, family members and staff members in the darkest of hours. I knew them all as well–meaning, competent and compassionate team members and Stan’s disrespect for them offended me.Apparently, Stan was offended as well. His oncologist revealed to us that Stan was angered by his referral to hospice. He felt abandoned. I was Stan’s last hope; however, he didn’t see it that way. Neither Stan nor I was enthusiastic about our impending partnership.Stan was an engineer by trade, and apparently very successful in business. He lived on a sprawling plantation located at the end of his private road, which he named Black Horseman Lane. As I turned down the drive, aware of his reputation as a bigot, I contemplated how Stan might have arrived at this name. With the assistance of my smartphone, I was able to ascertain that there was, indeed, a Black Horseman of the Apocalypse, which was associated with famine. Delving further, into Wikipedia, my interpretation was that the Black Horseman’s famine decimated the grain crop, sparing the olive groves and grapevines, driving up the price of grain but leaving oil and wine... (shrink)