Recently in Porter v. McCollum, the United States Supreme Court, citing “a long tradition of according leniency to veterans in recognition of their service,” held that a defense lawyer’s failure to present his client’s military service record as mitigating evidence during his sentencing for two murders amounted to ineffective assistance of counsel. The purpose of this Article is to assess, from the just deserts perspective, the grounds to believe that veterans who commit crimes are to be blamed less (...) by the State than offenders without such backgrounds. Two rationales for a differential treatment of military veterans who commit crimes are typically set forth. The Porter Court raised each, stating that we should treat veterans differently “in recognition of” both “their service” and “the intense stress and mental and emotional toll” of combat. The former factor suggests there being a “social contributions” or gratitude-based discount, whereas the latter factor points towards a “mental disturbance” discount. This Article analyzes the two accounts and raises some doubts about both. This Article then argues that a military veteran who commits a crime should not be blamed to the full extent of his blameworthiness, not necessarily because of his mental capacity nor because of his social contribution, but because the State’s hand in producing his criminality undermines its standing to blame him. (shrink)

As the “War on Terror” continues, the national myth of veteran-as-hero has given way to a narrative shorthand of veteran-as-villain. Films and television shows depicting the reintegration of veterans tend to focus on the struggle and alienation from the homefront that veterans feel upon their return. In contrast, comedy television portrayals such as One Day at a Time and You’re the Worst, both of which slowly but successfully reintegrate their central veteran characters, do so narratively by shifting their (...) characters’ veteran status from their defining feature to one aspect of their past. Ultimately, I argue that the process of reintegration is one paralleled in the rehumanization that these comedy television portrayals permit, ultimately offering hope that reintegration, while not easy, is possible. (shrink)

The passage of the Servicemen’s Readjustment Act of 1944 — or GI Bill — opened up a dialogue about men’s physical and mental health, for it addressed very directly what ordinary men would need to recover from extraordinary violence. Political leaders identified veterans’ “welfare,” by which they meant general well-being, as a top priority of World War II’s recovery, and the GI Bill was the centerpiece of their agenda. The bill’s passage was an impressive legislative triumph, the collective product (...) of massive medical, legal, and social science research, bipartisan politicking, and veterans’ activism. It provided education, housing, and small business assistance, along with mental and physical rehabilitation in government-funded hospitals. All of these programs, whether they served mind, body, or wallet, amounted to welfare — a set of government-sponsored policies and services designed to aid a soldier’s transition from enlisted man to healthy, productive citizen. Thus we have to think about the broad reach of the GI Bill’s welfare provision as one of the health legacies of World War II. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White (...) River Junction, Vermont to establish the V.A. National Center for Clinical Ethics. In this article I describe the organizational context, mission, operation, and future direction of the Center, which William A. Nelson, Ph.D., and I co-direct.The Veterans Health AdministrationThe Department of Veterans Affairs operates 171 hospitals providing services ranging from primary, secondary, and tertiary medical care to psychiatric hospitals, rehabilitation centers, and nursing homes. The V.A. also provides outpatient services at all hospitals and at dozens of free-standing outpatent clinics. V.A. medical centers employ over 14,000 physicians and serve approximately 4.5 million veteran patients (Hollingsworth and Bondy 1990; Mirvis 1990).The V.A. serves an important educational function, providing training sites for medical students, postgraduate physicians, and trainees in other health-related fields. Approximately 78 percent of V.A. medical centers are affiliated with medical schools. Over one-third of all American medical students and over 40 percent of interns and residents spend a portion of their training in V.A. medical centers. More than 100,000 students in all health-related fields train in V.A. facilities annually (Hollingsworth and Bondy 1990).Research is another mission of the V.A. Many academic physicians and scientists derive their research and salary funding from V.A contracts and awards. The V.A. Research Career Development Program provides the means for many medical school faculty members to achieve successful careers as scientists and clinical investigators. Although research accounts for only slightly more than 1 percent of the V.A. medical budget, two V.A. researchers have been awarded the Nobel Prize (Hollingsworth and Bondy 1990). [End Page 385]In comparison to other medical care settings, the average V.A. patient is likely to be older, poorer, male, less well-educated, more chronically ill, and more expensive to care for. Many patients first patronize the V.A. system after they have been bankrupted by the costs of a major illness. Unlike young, healthy patients ideally favored by health maintenance organizations, these patients immediately require large expenditures for hospitalizations, medications, and other treatments. Additional burdens have been placed on V.A. facilities by a record of chronic federal underfunding over the past decade, despite expanded patient censuses at every facility.Bioethical issues arise in V.A. facilities with great frequency for several reasons. Older and poorer patients are often sicker, have fewer home-support resources, and have completed fewer advance directives for health care. Chronic operational underfunding requires explicit health care rationing systemwide. Academic physicians within the V.A. system have multiple professional duties that have the potential for conflict. Although their primary duty is to their patients, they also must serve the federal government and their medical school academic supervisors. The practice of medical care rationing pits the physician's professional duty to his patient against his duty to the system (Mirvis 1990).The V.A. has responded to these bioethical demands with several initiatives. Hospital ethics advisory committees have been developed in nearly every V.A. medical center. The V.A. National Bioethics Committee has been empaneled to encourage uniform policies across the V.A. system concerning bioethical issues. Most recently, funds were provided for the V.A. National Center for Clinical Ethics.Functions of the National Center for Clinical Ethics (NCCE)The NCCE has a fourfold mission: 1) to enhance the quality of clinical ethics programs at all 171 V.A. medical centers nationwide; 2) to staff the V.A. National Bioethics Committee; 3) to assist administrators and planners in the V.A. Central Office on policy development concerning bioethical issues; and 4) to study, organize, and coordinate clinical, educational, and research bioethics programs throughout the system.Enhancing the quality of clinical ethics programs at V.A. medical centers is largely an... (shrink)

BackgroundMinorities are an underrepresented population in clinical trials. A potential explanation for this underrepresentation could be lack of willingness to participate. The aim of our study was to evaluate willingness to participate in different hypothetical clinical research scenarios and to evaluate the role that predictors could have on the willingness of minorities to participate in clinical research studies.MethodsWe conducted a mixed-methods study at the Miami VA Healthcare system and included primary care patients with hypertension. We measured willingness to participate as (...) a survey of four clinical research scenarios that evaluated common study designs encountered in clinical research and that differed in degree of complexity. Our qualitative portion included comments about the scenarios.ResultsWe included 123 patients with hypertension in our study. Of the entire sample, ninety-three patients were minorities. Seventy per cent of the minorities were willing to participate, compared to 60 per cent of the non-minorities. The odds ratio of willingness to participate in simple studies was 0.58; 95 per cent CI 0.18–1.88 p=0.37 and the OR of willingness to participate in complex studies was 5.8; 95 per cent CI 1.10–1.31 p=0.03. In complex studies, minorities with low health literacy cited obtaining benefits as the most common reason to be willing to participate. Minorities who were not willing to participate, cited fear of unintended outcomes as the main reason.ConclusionsMinorities were more likely to be willing to participate in complex studies compared to non-minorities. Low health literacy and therapeutic misconception are important mediators when considering willingness to participate in clinical research. (shrink)

Americans are very grateful to veterans. Veterans are celebrated via speeches, statues, memorials, holidays, and affirmative action. They are lavishly praised in public gatherings and private conversations. Contrary to this widespread attitude, I argue that U.S. citizens should not be very grateful to veterans. In evaluating whether the significant gratitude toward veterans is justified, I begin by exploring the nature of gratitude. On my account, one person should be very grateful to a second person just in (...) case the second person reasonably attempted to provide a significant benefit to the first and was primarily motivated by concern for the first’s well-being. I then look at whether veterans typically satisfy these conditions and argue that they do not. (shrink)

What is a veteran teacher, and how do veteran teachers contribute to schools and education? This international volume contributes to our understanding of veteran teachers with new conceptual studies and empirical research from different countries around the world. It is explores what we mean by a ‘veteran teacher’; the factors that encourage teachers to remain in the profession; the characteristics of a successful veteran teacher; and the values with which veteran teachers associate themselves. Rather than supporting stereotypes about teachers at (...) different stages in their professional lives, this book both scrutinises prevalent stereotypes and explores the great variety of veteranship in teaching, in different cultures and different subject matter domains. Teacher retention is an increasingly difficult issue and there are severe problems of high staff turnover and attrition in many countries - so recognition of the qualities of more experienced teachers is timely, as well as valuing the potential contributions of veteran teachers in schools. The book also addresses broader issues about teachers’ lives and identities, the vulnerability of different groups of teachers to the effects of change and reform, and the various forms of teacher knowledge and teacher development. This book was previously published as a Special Issue of _Teachers and Teaching_. (shrink)

This book expands the conversation on moral injury to include a more formal role for society in it. The author utilizes an interdisciplinary practical theology combining liberation theologies and cultural studies to interrogate how dominate ideologies can complicate moral injury reintegration among veterans.

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was (...) fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

This essay examines World War II's health consequences in the United States by looking at postwar welfare debates about the GI Bill. She reveals how citizens came to expect a robust postwar welfare state to address the health legacies of their warfare state.

Several authors have argued that traumatic experiences are processed and remembered in a qualitatively different way from neutral events. To investigate this issue, we interviewed 121 Croatian war veterans diagnosed with posttraumatic stress disorder about amnesia, intrusions , and the sensory qualities of their most horrific war memories. Additionally, they completed a self-report scale measuring dissociative experiences. In contrast to what one would expect on the basis of theories emphasizing the special status of traumatic memories, amnesia, and high frequency (...) intrusions were not particularly typical for our sample of traumatized individuals. Moreover, traumatic memories were not qualitatively different from neutral memories with respect to their stability and sensory qualities. The severity of PTSD symptoms was not significantly correlated with dissociative experiences. Our findings do not support the existence of special memory mechanisms that are unique to experiencing traumatic events. (shrink)

In this collection of essays, Camillo “Mac” Bica, Ph.D., a former Marine Corps Officer, Vietnam Veteran, and philosopher, provides a cogent analysis of why a veteran may not want to be thanked for his “service” in war. Mac’s experiential and theoretical perspective is both gut wrenching and concise. “The Philosopher speaks from the mind,” Mac writes, “the warrior from where it hurts.” With simplicity, poignancy, and power, this book, together with future installments of the War Legacy Series, works to dispel (...) the mythology of nobility and heroism by providing a window into the reality of war and its devastating effects upon all who experience its horrors. (shrink)

The federal government has a generally unquestioned obligation to provide health care to veterans for diseases or disabilities acquired during military service. Much argued, however, is the government's obligation to offer care for nonservice‐connected disorders. The Reagan administration has sharpened the debate recently by attempting to impose a means test on veterans over sixty‐five who are seeking such care. But the controversy focuses on the wrong issue. Society has a moral obligation to provide adequate health care to all (...) citizens but has no special obligation to care for nonservice‐connected health problems of veterans. (shrink)

The article shows how merit has been used to highlight pensioners as a special population in the claims-making activities of the senior rights movement in Sweden, as well as in debates about issues concerning old age. Simply put, merit refers to the claim that pensioners have built the society and they are entitled to special treatment – for instance welfare, reverence – for this reason. Merit is concluded to be a rhetorical tool with the potential of countering images of older (...) people as a burden to the young. It portrays seniors as a population worthy of welfare and reverence. Social movements that emphasize merit among seniors will however risk isolation, since such claims to some extent have become associated with populist attacks on immigrants, politicians and other groups labeled as non-merited. (shrink)

This paper will focus on physically impaired and disfigured soldiers and their perception in Roman antiquity from the late Republic until the early Imperial era (third century BC until third century AD). Based on case studies from literary sources, this paper aims to explore the integration of impaired and disfigured veterans into Roman civil society. The first part outlines the ambiguous attitudes shown towards these veterans, who were both praised and ridiculed, and seeks explanations. The second part argues (...) that few impairments and disfigurements precluded veterans from holding political or religious office. (shrink)

Stephen Kershnar’s main argument in Gratitude toward Veterans is that Americans should not be very grateful towards veterans. More precisely, he not only argues that veterans do not deserve the gratitude that many Americans offer them, but also that it is morally objectionable to be grateful towards them. His argument is applicable to war veterans generally, not only to those in the USA. Yet, it does have specific relevance to the United States given that, as Kershnar (...) demonstrates, public gratitude towards veterans is particularly widespread and pronounced there, at least in comparison to many other Western democracies.Moreover, in arguing for his main thesis, Kershnar also provides sustained defenses of his additional claims that the military draft is morally wrong and that the obligation to obey military orders is weak. . .. (shrink)

This essay explores the utility of critical pedagogy by looking at competing definitions and considering the response of Turkish-American Afghanistan War veteran, Eymen, and his Introduction to Poetry classmates to interviews with Afghan Nobel peace laureate Malala Yousafzai and poetry written by Taliban fighters. Students develop profoundly negative feelings about the Taliban through specific sources, if they did not already feel that way; then, are exposed to a sentimental side of these fighters, who use the medieval ghazal poetry form to (...) express loss of their beloved homeland in registers that ring overtly Occidentalist and distinctly dystopic. The essay concludes with a discussion of the difficulty of teaching about the September 11th attacks, the aim being to get students to hold two contradictory viewpoints in their heads and try to retain the ability to be objective. (shrink)

My reflections on the Vietnam Veterans Memorial were provoked some time ago in a quite natural way, by a visit to the memorial itself. I happened upon it almost by accident, a fact that is due at least in part to the design of the Memorial itself . I found myself reduced to awed silence, and I resolved to attend the dedication ceremony on November 13, 1982. It was an extraordinary event, without question the most moving public ceremony I (...) have ever attended. But my own experience of the Memorial on that and other occasions is far from unique. It is almost commonplace among the many visitors to the VVM—now the most visited of all the memorials in Washington—a fact so striking as to have compelled journalists, art historians, and architects to write countless articles about the monument. And although philosophers traditionally have had little to say about architecture in general or about that of memorials in particular, there is much in the VVM and its iconography worthy of philosophical reflection. Self-knowledge includes, I hazard to say, knowledge of ourselves as members of the larger social and political context, and so includes knowledge of that context.Architecture need not memorialize or symbolize anything; or it may symbolize, but not in a memorializing way, let alone in a way that is tied to a nation’s history. The structures on the Washington Mall belong to a particular species of recollective architecture, a species whose symbolic and normative content is prominent. After all, war memorials by their very nature recall struggles to the death over values. Still further, the architecture by which a people memorializes itself is a species of pedagogy. It therefore seeks to instruct posterity about the past and, in so doing, necessarily reaches a decision about what is worth recovering. It would thus be a mistake to try to view such memorials merely “aesthetically,” in abstraction from all judgments about the noble and the base. To reflect philosophically on specific monuments, as I propose to do here, necessarily requires something more than a simply technical discussion of the theory of architecture or of the history of a given species of architecture. We must also understand the monument’s symbolism, social context, and the effects its architecture works on those who participate in it. That is, we must understand the political iconography which shapes and is shaped y the public structure in question. To do less than this—if I may state a complex argument in hopelessly few words—is to fall short of the demands of true objectivity, of an understanding of the whole which the object is. To understand the meaning of the VVM requires that we understand, among other things, what the memorial means to those who visit it. This is why my observations about the dedication of the VVM and about the Memorial’s continuing power over people play an important role in this essay. Charles L. Griswold, associate professor of philosophy at Howard University, is the author of Self-Knowledge in Plat’s “Phaedrus” and has published widely in the areas of Greek philosophy, German Idealism, hermeneutics, and political philosophy. He is an editor of the Independent Journal of Philosophy and a recipient of numerous awards and fellowships. Currently he is working on a project which centers on Adam Smith’s notion of the “self” and Smith’s relationship to Stoicism and to the American Founding. (shrink)

Given the vital importance of the board of directors, firms seek to staff their boards with competent individuals who bring valuable skills and expertise to assist a firm. Especially following crises, firms should be interested in appointing directors who possess not only superior decision-making skills under pressure, but who also may be inclined to behave more ethically to prevent future breaches of stakeholder trust. Applying a social identity perspective, we argue that directors with U.S. military experience are decidedly valuable to (...) firms because of their human capital. Using a sample of 144 U.S. based, publicly-traded firms that experienced a Securities Class Action Lawsuit between 2002 and 2012, we test hypotheses predicting that following crises, firms are more likely to appoint directors with military experience. Our findings extend the social identity view of an individual from the self or how individuals view themselves to include how others may view them. (shrink)

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic’s advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing (...) moral injury—particularly its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury. (shrink)

The military service of combat soldiers may pose many threats to their well being and often take a toll on body and mind, influencing the physical and emotional make-up of combatants and veterans. The current study aims to enhance our knowledge about the combat experiences and the challenges that female soldiers face both during and after their service. The study is based on qualitative methods and narrative analysis of in-depth semi-structured personal interviews with twenty military veterans. It aims (...) to analyze the narratives of American and Israeli female combat soldiers regarding their military service, with emphasis on the soldiers’ descriptions, in their own words, about their difficulties, challenges, coping and successes during their service and transition to civilian life. A recurring theme in the interviews with the veterans of both militaries was the need to be heard and the fact that societies, therapists, and military institutions do not always truly listen to female veterans’ experiences and are not really interested in what actually ails them. Our research suggests that conventional methods used in research relating to veterans might at times be inadequate, because the inherent categorization might abstract, pathologize, and fragment a wide array of soldiers’ modes of post-combat being. Moreover, female veterans’ voices will not be fully heard unless we allow them to be active participants in generating knowledge about themselves. (shrink)

Growing Up White is for everyone who wants to know more about our schools, our community, our country, and ourselves. Julie Landsman takes the reader on an inventory of her life, pulling from events and scenes, a set of lessons learned. She discloses honestly and unflinchingly the privileges she has experienced as a white person and connects those to her presence in city classrooms where she taught for over 25 years. As a teacher Julie made mistakes, learned from them, made (...) more and concludes that understanding race in America is an ongoing process. Her book is rich with suggestions for working in our schools today, where we find a primarily white teaching force and an expanding population of students of color. She believes that these students make our schools rich and exciting places in which to work. Landsman also believes that white teachers can reach their students in deep and positive ways. Because she invites you to go along with her in revealing the basis of her upbringing and her choices, the story itself is engaging. Readers arrive at the final chapters with an appreciation not only for the complexity of our history as individuals around race, gender and class but with real hope in education as a way to create a place where all children get a fair chance at success. (shrink)

A soldier who suffers a debilitating casualty on the battlefield is a wounded warrior. Awaiting that individual is a complex safety net, composed of public and private assistance. Should this same...

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and (...) outside of VA. During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

Many servicemen and women began suffering from a variety of symptoms and illnesses soon after the 1991 Gulf War. Some veterans believe that their illnesses are related to toxic exposures during their service, though scientific research has been largely unable to demonstrate any link. Disputes over the definition, etiology, and treatment of Gulf War-related illnesses continue. The authors examine the roles of science, policy, and veteran activism in developing an understanding of GWRIs. They argue that the government’s stress-based explanation (...) of GWRIs and its insistence on a scientific link between service in the gulf and veteran illnesses forced veterans to shift from pleas for care, treatment, and compensation on moral grounds to engagement in the scientific process and debates over the interpretation of scientific findings. The authors compare the experiences of veterans to those of breast cancer activists to explain the stages of illness contestation in general. (shrink)

The Lex Plotia Agraria is known to us only by name through a single reference in one of Cicero's letters, from which we can extract nothing more than a terminus ante quern and a very general notion of its probable scope. Gabba in a short article, after reviewing the different hypotheses about this law, decided in favour of a suggestion put forward originally by Zumpt, that it belongs probably to the year 70/69 B.C.; and identifying it with a law referred (...) to in a passage of Dio, he argued that the law was passed on behalf of Pompey's and Metellus Pius' veterans of the Spanish war. Following a suggestion of Niccolini he identified Plotius with the Plotius, tribune 70/69 B.C., who was responsible for the Lex Plotia de reditu Lepidanorum, and the date of his tribunate he put in 70 B.C. With Gabba's reasoning and general conclusions the present writer is in agreement, namely, that the law belongs to 70/69 B.C., and aimed at providing land for the veterans of Pompey and Metellus; the object of this note is to draw attention to a piece of evidence which has hitherto been strangely neglected, and to draw some possible inferences about the scope and fate of the law. (shrink)

Tort claims have been studied for various reasons. Several studies have found that most tort claims are not related to negligent adverse events and most negligent adverse events do not result in tort claims. Several studies have examined the disposition of tort claims to understand the likelihood of payment once a claim has been made. Still others have proposed that tort-claims trend analysis may help administrators target their quality-improvement efforts and identify problems with quality that would not otherwise be captured.In (...) this article, we conduct a tort-claims analysis to explore areas for quality improvement, specifically for patient safety, in the Veterans Health Administration. Patient safety is an increasingly highlighted aspect of health-care delivery. Failure to assure patient safety can result in bad clinical outcomes, additional costs of care, and a negative organizational image. Filing a tort claim is one way for an individual to express concern about an organization. For our analysis, we draw from resolved tort claims in the Veterans Health Administration from fiscal years 1989 to 2000. (shrink)

Monument or memorial? Defeat or withdrawal? The Vietnam Veterans Memorial in Washington DC pays tribute to more than 58,000 Americans who died fighting an unpopular war. Yet today the ‘Wall’, as it is known to most Americans, is the most visited site managed by the US National Park Service. Weekend visitors will happen upon an almost festive place as thousands of people pass by looking at the names – what do they think, imagine? This chapter discusses not only the (...) story and controversy behind the building of the ‘Wall’, but also how it reflects the collective memory of a society and its values, and how these are constructed. (shrink)

Considerable efforts have been made in recent years to improve the safety of human subjects who participate in research. However, there are no data to demonstrate that we have made human research safer. There is a critical need to determine whether we have achieved our goal of better protecting research subjects. We have developed 16 quality indicators for assessing the quality of human research protection programs at the Department of Veterans Affairs. Our experience implementing these quality indicators at the (...) VA may help other institutions to develop appropriate quality indicators for assessing their own human research protection programs. (shrink)

IntroductionMilitary personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released (...) Veterans buffers the impact of Veterans’ health on caregiver burden, subsequently impacting spouses’ relationship satisfaction.MethodsData were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans’ mental and physical health and spouses’ caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling.ResultsThere was a significant indirect association between Veterans’ health and spouses’ relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans’ health and caregiver burden at low levels of social support compared to high levels.ImplicationsFindings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families’ well-being. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A National Shrine to Scapegoating? The Vietnam Veterans Memorial Washington, D.C. Jon Pahl Valparaiso University In a recent survey I conducted of visitors to the Vietnam Veterans Memorial in Washington, D.C, 92 percent agreed that "the memorial is a sacred place, and should be treated as such."1 Clearly, this place, by some reports the most visited site in the U.S. capital, draws devotion. But how does a (...) pilgrimage to this memorial function?2 Does pilgrimage to "the wall" serve to "heal a nation," as its builders intended, or does pilgrimage to the memorial ironically legitimize structures of violence like those which led the United States into the Vietnamese conflict in the first place?3 My argument builds upon the work of René Girard to suggest that pilgrimage to the Vietnam Veterans Memorial can legitimize the violence of American culture by 'The survey was of 185 pilgrims attending ceremonies during Veterans Day, November 11, 1993 and 1994. Several recent works explore the interface between civil religion and violence, notably John E. Bodnar, Karal Ann Marling, and Edward T. Linenthal. On sacred places, the pioneering work of Mircea Eliade, The Sacred and the Profane, remains important but must be supplemented by Jonathan Z. Smith's Imagining Religion. 1 Victor and Edith Turner argue cogently that "if a tourist is half pilgrim, a pilgrim is half tourist" (20). Many visitors to the Vietnam Veterans Memorial understand themselves only as tourists, but their behavior appears to me to warrant treatment under the category of "pilgrimage." 3 I assume a "maximalist" definition of violence, which understands the word to refer not only to physical harm to individuals, but also to systemic, social structures of exclusion (such as racism), and ideological (or symbolic) justifications of violence (see Robert McAfee Brown; for a minimalist approach, see Gerald Runkle). 166Jon Pahi reinforcing scapegoating.4 At the same time, however, the established religious pluralism and voluntarism of American culture—evident in this pilgrimage process—diffuses violence. Furthermore, the democratic character of this pilgrimage empowers pilgrims to critique idolatrous worship of the nation, and to witness to authentic reverence for life. Mimesis on the mall A brief impressionistic portrait ofthe way visitors experience the Vietnam Veterans Memorial will demonstrate how the memorial draws pilgrims into a mimetic process—a key feature of Girard's theory. Many pilgrims stop at the memorial as part of a National Park Service 'Tourmobile' circuit of museums and memorials, or as part of another bus tour (school and senior citizens groups are especially common ). These busses disembark pilgrims at the base of the Lincoln Memorial, directly in front of the reflecting pool on the national mall, in sight of the Washington Monument and the Capitol. Pilgrims may, or may not, first climb the steps of the Lincoln Memorial (a powerful shrine with implications for understanding violence in its own right). Moving north, they eventually proceed along a sidewalk lined with Fig. 1 "Three Men Statue".,. several tents where veterans organizations sell T-shirts, medals, bumper-stickers, books, and other memorabilia. The first stop for many pilgrims is the "Three Men Statue" (Fig. 1) located in a grove just past the tents. 4 I summarize Girard's theory as follows: Beginning with mimetic desire, rivalry for an object escalates and threatens the social order. Religion—and notably sacrifice of the scapegoat—creates sufficient unanimity to restore a sense of social order, but does so through violence itself, masking through myth and ritual a vicious cycle of aggression we know as the history of human culture. A National Shrine to Scapegoating?167 This bronze statue (and the American flag which flies nearby) was not part ofthe original design for the memorial, and was dedicated in 1985, three years after the wall of names. It was the result of a compromise between founders of the Vietnam Veterans Memorial Fund led by veteran Jan Scruggs and a group led by 1992 Presidential candidate H. Ross Perot which was dissatisfied with the wall and felt the need for a more 'heroic' representation of the survivors ofthe war.5 Most pilgrims understand little of the history behind the statue, or its intent to create a more heroic... (shrink)

Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same‐sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of (...) “spouse,” “parent,” or “family.” Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the “Don't Ask, Don't Tell” policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long‐standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging.The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that “[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation.” To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. (shrink)

Tort claims have been studied for various reasons. Several studies have found that most tort claims are not related to negligent adverse events and most negligent adverse events do not result in tort claims. Several studies have examined the disposition of tort claims to understand the likelihood of payment once a claim has been made. Still others have proposed that tort-claims trend analysis may help administrators target their quality-improvement efforts and identify problems with quality that would not otherwise be captured.In (...) this article, we conduct a tort-claims analysis to explore areas for quality improvement, specifically for patient safety, in the Veterans Health Administration. Patient safety is an increasingly highlighted aspect of health-care delivery. Failure to assure patient safety can result in bad clinical outcomes, additional costs of care, and a negative organizational image. Filing a tort claim is one way for an individual to express concern about an organization. For our analysis, we draw from resolved tort claims in the Veterans Health Administration from fiscal years 1989 to 2000. (shrink)