Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...) paper, we argue for an approach that adopts the role of ethics consultants as its point of departure. In a first step, we describe empirical and ethical characteristics of evaluating clinical ethical case. We show that the mode of action and the explicit normative character of the interventions constitute two characteristics which pose challenges to the selection of appropriate quality criteria and require special attention. In a second step, we outline the way in which an analysis of the role of ethics consultants in the context of a clinical ethical case consultation services can account for the existing challenges by linking empirically measurable endpoints with normative theory. Finally, we discuss practical implications of our model for evaluation research. (shrink)

Volume 20, Issue 10, October 2020, Page W1-W3.

In all facets of our lives, humans construct meaning to understand their place in the world and their relationships to one another and to broader environments. Within this semantic web, words, stor...

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for—sometimes forced—public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study (...) uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves—whenever possible—rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience. (shrink)

Embodied Cognition holds that bodily (e.g. sensorimotor) states and processes are directly involved in some higher-level cognitive functions (e.g. reasoning). This challenges traditional views of cognition according to which bodily states and processes are, at most, indirectly involved in higher-level cognition. Although some elements of Embodied Cognition have been integrated into mainstream cognitive science, others still face adamant resistance. In this paper, rather than straightforwardly defend Embodied Cognition against specific objections I will do the following. First, I will present a (...) concise account of embodied conceptual processing and highlight some of its advantages over non-embodied accounts, specifically focusing on the role of metaphors. Second, I will detail the influence of computational metaphors on theories of cognition and evaluation of these theories. Third, I will argue that embodied cognitive mechanisms, specifically those operating through computational metaphors, may drive some of the resistance to Embodied Cognition - and that Embodied Cognition is able to offer a uniquely compelling account of this. Ultimately, this will contribute to an improved understanding of Embodied Cognition, its explanatory power, and how it ought to be evaluated. Additionally, it will shed light on the role of metaphors in shaping philosophical thought and highlight the importance of these influences. (shrink)

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over another. I (...) next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of “physician arrogance” as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of “killing suffering”; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer. (shrink)

Dementia is highly prevalent and up until now, still incurable. If we may believe the narrative that is currently dominant in dementia research, in the future we will not have to suffer from dementia anymore, as there will be a simple techno-fix solution. It is just a matter of time before we can solve the growing public health problem of dementia. In this paper we take a critical stance towards overly positive narratives of techno-fixes by placing our empirical analysis of (...) dementia research protocols and political statements in a framework of technology assessment. From this perspective, it becomes obvious that a techno-fix is just one of many ways to approach societal problems and more importantly that technologies are way less perfect than they are presented. We will argue that this narrow scope, which focusses on the usual suspects for solving illnesses, reduces dementia to organismic aspects, and may be counterproductive in finding a cure for dementia. We conclude with outlining how the narrow scope can be balanced with other narratives and why we should have a reasonable scepticism towards the usual suspects. (shrink)

The journey metaphor used by Nie and colleagues (2016) can be analyzed in terms of the way in which health care professionals can support well-being and attend to the aspects of illness that often...

There are two widespread beliefs about the use of metaphors in clinical medicine. The first is that military metaphors are harmful to patients and should be discouraged in medical practice. The second is that the metaphors of clinical practice can be judged by and standardized in reference to neutral criteria. In this article, I evaluate both these beliefs, exposing their shared flawed logic. This logic underwrites the false empiricist assumptions that metaphorical language and literal language are fundamentally distinct, play separate (...) roles in communication, and therefore can be independently analyzed, systematized, and prescribed. Next, using the resources of ordinary language philosophy, I lay out a theoretical view of medical metaphors that is grounded in metaphor use within clinician‐patient relationships. Finally, drawing on the work of philosopher Max Black, I diagram a practical conceptual framework for clinicians to use when they consider whether a metaphor is appropriate for a specific patient encounter. (shrink)

Metaphors can provide a conceptual framework for understanding complex topics and as such, they have frequently been used in COVID-19 discourse. As previous research indicates that conceptual metaphors can influence how people reason about complex topics, the metaphors used to communicate about the pandemic can influence how it is understood and how people respond. This paper investigates the influence of metaphorical framing on emotions and reasoning. An experimental study compares BATTLE and JOURNEY metaphor frames in a hypothetical text (adapted from (...) previous studies) about the pandemic. Our aim is to examine the influence of these frames on readers’ affective state, inferences about the attitudes of others and suggestions to stop the virus from spreading. The results suggest that compared to JOURNEY metaphors, BATTLE metaphors can negatively influence affective state and may influence people to suggest more restrictive solutions to reduce the spread of the virus. Yet, metaphors were not found to influence reasoning about the attitudes of others. We interpret these results in relation to previous studies, suggesting that metaphors may influence emotions and reasoning in some ways only. The results have implications for public communication surrounding the pandemic. Limitations and avenues for future research are discussed. (shrink)

This article delves into the significance and role of metaphors in shaping knowledge, perceptions, and decisions within the healthcare domain. Through a critical analysis of their impact, particularly in the dynamics between healthcare professionals and patients, three dimensions are proposed for unraveling their significance: the political dimension views metaphors as agents of power and tools for legitimizing inequalities; the cultural dimension sees them as cultural residues challenging prevailing biomedical knowledge; and the ethical dimension raises questions about the moral implications of (...) the constructed narratives. This holistic approach aims to enhance our understanding of the intricate interplay between language, cognition, and the experience of illness, ultimately advocating for more comprehensive approaches in healthcare. (shrink)

Health metaphors are commonly used in a variety of contexts. While war metaphors are common in medicine, there are also other conceptualizations and other metaphors employed in different contexts. In policies, metaphors can play an important role in framing thought and discourse, and have an important effect, and even more so in educational policy. In this article, we analyze the two South African policies regarding HIV and AIDS in the educational context – the first policy from 1999, and the one (...) that replaced it in 2017. The focus is on identifying and categorizing the metaphors directly related to HIV and AIDS. We identified 29 such metaphors in policy 1, and 71 in policy 2, using the principles from the MIPVU, and thematic discourse analysis was used to categorize the metaphors into themes. The most prominent changes in the metaphors from policy 1 to policy 2 regard the focus of the imagery, as well as the conceptualization of HIV itself. These are then interpreted in the Southern African context. (shrink)

In this paper, we analyse the particular phenomena of COVID-19 pandemic shaming. We examine Sartre’s account of the undifferentiated other in the experience of ‘the look’, and his insistence on shame as a foundational relational affect, in order to give a robust theoretical frame to understand how pandemic shaming circulated both online and offline, in targeted and diffuse manners. We focus on two features of pandemic shaming. First, we draw attention to the structural necessity of an audience in acts of (...) pandemic shaming, where the shamer acts on behalf of a community of others, the audience, to perform and enforce a set of standards, values or norms. We turn to the we-experience and collective emotions literature and discuss how the shamer believes themselves to be ‘speaking’ on behalf of a community who share their outrage along with their values. Second, we discuss how the presumption of a collective emotion was frequently mistaken in acts of pandemic shaming, where shaming frequently led to shame backlashes, where the audience revealed themselves not to share the emotion and values of the shamer, consequently shaming the shamer. We argue that Jean-Paul Sartre’s voyeur example is usefully illustrative of the tripartite structure of (1) shamed, (2) shamer and (3) shamer of the shamer that occurs in iterative processes of pandemic shaming, which are accompanied by shaming backlashes. We conclude by reflecting on the socio-historical context for Sartre’s accounts of shame and ‘the look’, namely the German occupation of Paris and Sartre’s experience of the French Resistance movement, and how these yield a particular socio-historical framing that makes evident how the extraordinary pseudo-wartime conditions of COVID-19 rendered atmospheres of distrust and suspicion prevalent. (shrink)

The prioritisation of scarce resources has a particular urgency within the context of the COVID‐19 pandemic crisis. This paper sets out a hypothetical case of Patient X (who is a nurse) and Patient Y (who is a non‐health care worker). They are both in need of a ventilator due to COVID‐19 with the same clinical situation and expected outcomes. However, there is only one ventilator available. In addressing the question of who should get priority, the proposal is made that the (...) answer may lie in how the pandemic is metaphorically described using military terms. If nursing is understood to take place at the ‘frontline’ in the ‘battle’ against COVID‐19, a principle of military medical ethics—namely the principle of salvage—can offer guidance on how to prioritise access to a life‐saving resource in such a situation. This principle of salvage purports a moral direction to return wounded soldiers back to duty on the battlefield. Applying this principle to the hypothetical case, this paper proposes that Patient X (who is a nurse) should get priority of access to the ventilator so that he/she can return to the ‘frontline’ in the fight against COVID‐19. (shrink)

Although political discourse is essentially expected to be fact-based and objective, both practice and research show that literal language in political discourse is very often compounded with figurative language. The paper at hand tackles figurative language use in political interviews. For the purposes of this research, we conducted a critical discourse analysis of a corpus of political interviews given by a former Macedonian female politician – Radmila Shekerinska. The corpus consists of six interviews (with a total duration of about 3 (...) h) in which she answers questions about the political climate and the challenges of North Macedonia in the last couple of decades. The selected interviews are all conducted in English as they are aimed at international audiences and they all fit into the time frame from 2017 to 2021, which practically overlaps with the final years of Shekerinska’s long-standing political career. This study uses a descriptive qualitative research design and focuses, first, on ascertaining the presence of different types of figures of speech in her answers (e.g. metaphors, simile, metonymy, synecdoche, personification, rhetorical questions, idiomatic expressions, proverbs, etc.); then, on identifying the pragmatic functions they perform in the context in which they are used, and finally, on establishing an interface between the figurative language use and the political ideology propagated by this politician. The results point to an extraordinarily resourceful use of a wide spectrum of figurative devices, skillfully intertwined with fact-based political discourse, primarily for addressing highly sensitive political issues, but also for driving important political points home; also, for gaining support from both the domestic and international community regarding the political ideology of this political figure as well as for enhancing the criticism addressed to political adversaries with an additional layer of creative flourish. (shrink)

The commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a (...) fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms ofsolidaritybetweencomrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice. (shrink)

In the aftermath of the ongoing COVID-19 pandemic, there is a predicted (and emerging) increase in experiences of mental illness. This phenomenon has been described as “the next pandemic”, suggesting that the concepts used to understand and respond to the COVID-19 pandemic are being transferred to conceptualize mental illness. The COVID-19 pandemic was, and continues to be, framed in public media using military metaphors, which can potentially migrate to conceptualizations of mental illness along with pandemic rhetoric. Given that metaphors shape (...) what is considered justifiable action, and how we understand justice, I argue we have a moral responsibility to interrogate who benefits and who is harmed by the language and underlying conceptualizations this rhetoric legitimates. By exploring how military metaphors have been used in the context of COVID-19, I argue that this rhetoric has been used to justify ongoing harm to marginalized groups while further entrenching established systems of power. Given this history, I present what it may look like were military metaphors used to conceptualize a “mental illness pandemic”, what actions this might legitimate and render inconceivable, and who is likely to benefit and be harmed by such rhetorically justified actions. (shrink)

Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...) the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards. (shrink)

BackgroundThe pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research.MethodsWe conducted a scoping review of the growing HIV cure (...) research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing.DiscussionDespite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation).ConclusionHIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time. (shrink)