K. Anne

Recent global events, including the COVID-19 pandemic, wars and migration streams, have highlighted the promise of digital infrastructures while also showcasing how dependent we are on digital systems for accessing welfare services such as healthcare, social services and education, as well as for accessing public service media. Notably, in the context of welfare provision, different people and social groups are affected in distinct ways by such digital systems. This Crosscurrent contribution conceptualizes the notion of digital vulnerabilities, which captures some of the contemporary challenges posed to societies increasingly interconnected with and dependent on digital systems. Drawing on feminist moral philosophy, we suggest three layers of digital vulnerabilities: vulnerabilities through digital infrastructures, vulnerabilities in digital infrastructures and vulnerabilities of digital infrastructures. We illustrate these three layers with examples from four critical welfare domains, namely healthcare, education, social services and public service media. We conclude with a call for additional empirical research on how digital vulnerabilities play out in practice, across welfare domains and in welfare regimes beyond the Global North. Such issues need to be explored further to meet contemporary challenges.

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings.

This chapter discusses imaginary technologies that do not exist yet but are expected to be implemented in clinical work in the near future. Adopting a phenomenological view on the politics of organizational time, we illuminate how the rhetoric of futurity and protentional anticipation dominate managerial acts in healthcare organizations. This future-oriented management includes strategies of risk assessment, investments in emerging technologies, and other actions to reduce external uncertainty and move towards an enhanced capacity to cope with potential challenges. However, we suggest that potentially harmful consequences of emerging technologies cannot be established reliably in advance by investigation, experiments, and risk assessments. The phenomenological notion of embodied information infrastructure allows us to consider how visions of complex technologies intertwine with clinical practices in healthcare professionals’ work. We use two examples of imaginary technologies—automated decision-making systems and care robotics—to concretize how the line between imaginary technologies and existing technologies becomes increasingly volatile in healthcare organizations.

During the corona pandemic, politicians have been forced to make urgent decisions under pressure while balancing between challenging options: protecting citizens’ health or causing major social and economic difficulties through security measures. Part of the dilemma has been whether the chosen security measures are oversized, causing fundamental economic and social problems, or not sufficiently enough, thus putting people’s lives at risk. In illustrating our discussion with actions taken by press conferences (PCs) of the Finnish Government, we discuss how nonknowing has governed political decision-making in the corona crisis and how tackling the pandemic has required politicians and experts to develop a capability of dealing with the epistemic conditions of nonknowledge. When information about the virus was constantly updated, the epistemic states of ‘not-yet-known’ or ‘partly-known’ substantially affect the rhythms in which political decisions are made in managing the spread of COVID-19. We suggest that Prime Minister Marin and her cabinet developed a policy of epistemic humility where the legitimation of decision is not based on scientific knowledge but rather on the temporality of nonknowing. The crisis created a favourable momentum for addressing issues of nonknowing in politics, which are easily kept outside of the public attention.

The novel coronavirus pandemic (COVID-19) has had far-reaching effects on public health around the world. Attempts to prevent the spread of the disease by quarantine have led to large-scale global socioeconomic disrup- tion. During the outbreak, public authorities and politicians have struggled with how to manage widespread ignorance regarding the virus. Drawing on insights from social epistemology and the emerging interdisciplinary field of ignorance studies, this article provides evidence that the temporality of non- knowing and its intersection with knowing is a force that leads political decision-making during a crisis. Illuminating the epistemic analysis with statements given by the Finnish government to the media in decision- making documents and in press conferences, this paper proposes that a crisis situation, itself, seems to demand from political decision-makers dynamic action while simultaneously knowing little (‘non-knowing’) about the different fronts of tackling the pandemic. We conclude that non-knowing must be recognized explicitly as an enduring and central condition in deci- sion-making, which we call ‘epistemic humility.’

Value-based decisions are an integral part of our life. Many disorders are characterized by aberrant choices with, at times, detrimental consequences for the physical and mental health of an individual. In the past decades, the field has progressed by optimizing tasks and computational models to better describe canonical decision-making processes. However, concerning clinical applications, important gaps remain that relate to various limitations of conventional laboratory-based assessments. In this chapter, we will outline opportunities and challenges of leaving the lab to attain more naturalistic applications that may ultimately help improve the prediction of behavior and the classification of disorder-related states. To this end, we will discuss psychometric principles, provide examples for suitable designs, and briefly review hierarchical modeling approaches to exploit the information contained in large, naturalistic data sets. Consequently, these emerging lines of research offer great promise for computational psychiatry in monitoring treatment effects over time and tailoring therapy-related decisions to changes in latent decision-making processes.

Serious illness communication is at the core of palliative care, aligning care with patient preferences and improving patient and family experience. Artificial Intelligence (AI) methods have increasingly been applied to palliative care and provide promising opportunities for measuring and enhancing communication (e.g., capturing speech patterns and delivering feedback). Yet, given known disparities in palliative care and the limitations afforded by our natural communication datasets, this task must be approached with caution. Focusing on the study of communication, we consider assumptions that may be baked into our models (e.g., in data, definitions, measurements, and outcomes) and ways to mitigate potential harm across stages of model development—from setting priorities for AI research and applications in our field, to conducting new data collection efforts which are inclusive and more representative, to incorporating patient-family feedback. Transparency and thoughtfulness in this line of innovation may help us leverage AI to provide more equitable, higher-quality serious illness care (see Figure 1).Fig. 1.Visual abstract.

Serious illness communication is at the core of palliative care, aligning care with patient preferences and improving patient and family experience. Artificial Intelligence (AI) methods have increasingly been applied to palliative care and provide promising opportunities for measuring and enhancing communication (e.g., capturing speech patterns and delivering feedback). Yet, given known disparities in palliative care and the limitations afforded by our natural communication datasets, this task must be approached with caution. Focusing on the study of communication, we consider assumptions that may be baked into our models (e.g., in data, definitions, measurements, and outcomes) and ways to mitigate potential harm across stages of model development—from setting priorities for AI research and applications in our field, to conducting new data collection efforts which are inclusive and more representative, to incorporating patient-family feedback. Transparency and thoughtfulness in this line of innovation may help us leverage AI to provide more equitable, higher-quality serious illness care (see Figure 1). Fig. 1. Visual abstract.

This chapter considers the contemporary contingencies of representing queerness in transmedia storytelling. Transmedia poses an inherently queer potential, as an unruly, unfixed narrative landscape that transits and undermines seemingly natural oppositions. The logic of calling transmedia narratives ‘storyworlds’ suggests more room for diverse characters and storylines to unfold. Yet, as I argued in ‘Transmediating Difference,’ a pattern has developed wherein franchises sequester diverse characters and politically contentious storylines in low(er) cost and low(er) distribution transmedia extensions while still delivering a high cost, and thus high risk, core property led by a straight, white, able-bodied male character. Hypocritically, companies can receive accolades for diversity and inclusivity while also profiting from a sanitized and thus normatively hetero-patriarchal and white supremacist central property. Although many scholars argue that we are now in an age of unparalleled LGBTQIA+ visibility, transmedia storytelling has not been at the forefront of these developments. Examining the Ahsoka series and Marvel films featuring Carol Danvers helps to unravel persistent inequalities and silences within transmedia storyworlds. This chapter concludes by considering the differing and incommensurate conditions required to create LGBTQIA+ visibility in transmedia versus creating queer transmedia, arguing that queerness is simultaneously impossible and omnipresent in transmedia storyworlds.

Der Text gibt einen Einblick in die protestantische Hermeneutik, die darauf zielt, dass ein Mensch sich selbst zu verstehen vermöge. Christliches Selbst-Verstehen wird grundlegend in der Auseinandersetzung mit biblischer Überlieferung gewährt. Doch ist hierzu nötig, dass die biblische Überlieferung keinesfalls buchstäblich gelesen, sondern von ihrem Sachgehalt her ausgelegt werde. Die Sache, die aus evangelischer Sicht in den biblischen Texten verkündigt wird, ist Gottes Heilswirken am Menschen. Um in das Anliegen protestantischer Hermeneutik einzuführen, werden die hermeneutischen Positionen Martin Luthers, Friedrich Schleiermachers und Rudolf Bultmanns herangezogen.

BackgroundFor the benefits of advance care planning to be realised during a hospital admission, the treating team must have accurate knowledge of the law pertaining to implementation of advance care directives (ACDs) and substitute decision making.AimsTo determine in a sample of Junior Medical Officers (JMOs): (1) knowledge of the correct order to approach people as substitute decision makers if a patient does not have capacity to consent to treatment; (2) knowledge of the legal validity of ACDs when making healthcare decisions for persons without capacity to consent to treatment, including the characteristics associated with higher knowledge; and (3) barriers to enacting ACDs. MethodsA cross-sectional survey was conducted at five public hospitals in New South Wales, Australia. Interns, residents, registrars, and trainees on clinical rotation during the recruitment period were eligible to participate. Consenting participants completed an anonymous pen-and-paper survey.ResultsA total of 118 JMOs completed a survey (36% return rate). Fifty-five percent of participants were female and 56.8% were aged 20–29 years. Seventy-five percent of JMOs correctly identified a Guardian as the first person to approach if a patient did not have decision-making capacity, and 74% correctly identified a person’s spouse or partner as the next person to approach. Only 16.5% identified all four persons in the correct order, and 13.5% did not identify any in the correct order. The mean number of correct responses to the questions assessing knowledge of the legal validity of ACDs was 2.6 (SD = 1.1) out of a possible score of 6. Only 28 participants (23.7%) correctly answered four or more knowledge statements correctly. None of the explored variables were significantly associated with higher knowledge of the legal validity of ACDs. Uncertainty about the currency of ACDs and uncertainty about the legal implications of relying on an ACD when a patient’s family or substitute decision maker disagree with it were the main barriers to enacting ACDs.ConclusionJMOs knowledge of the legal validity of ACDs for persons without decision making capacity and the substitute decision making hierarchy is limited. There is a clear need for targeted education and training to improve knowledge in this area for this cohort.

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives (ACDs), or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: (1) their legal compliance and decision-making process related to treatment decisions; (2) the factors influencing their clinical decision-making; and (3) the factors associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: (1) bacterial pneumonia; or (2) suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded (35% consent rate). In Vignette 1, 58% of respondents (n = 67/116) selected the legally compliant option (i.e. not commence treatment). Participants who chose the legally compliant option perceived ‘following patient wishes’ (n = 32/67; 48%) and ‘legal requirements to follow ACDs’ (n = 32/67; 48%) as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’ (n = 14/37; 38%). In Vignette 2, 72% of respondents (n = 83/116) indicated they would commence treatment (i.e. not follow the ACD) and 18% (n = 21/116) selected they would not commence treatment. (i.e. follow the ACD). Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required.

Background: The interest in the children’s role in pediatric care is connected to children’s health-related autonomy and informed consent in care. Despite the strong history of children’s rights, nurses’ role in the everyday nursing phenomenon, that is, restraint in somatic pediatric care, is still relatively seldom reported. Aim: The aim of this study is to describe nurses’ perceptions of the use of restraint in somatic pediatric care. The ultimate aim is to deepen the understanding of the phenomenon of restraint, whose previous study has been fragmented. Methods: Qualitative approach was selected because of the lack of previous information. Due to the sensitivity of the research question, individual interviewees were selected among voluntary nurses (n = 8). All participants were registered nurses with general work experience as nurses of 5–16 years on average and specifically 1.5–10 years in pediatric nursing. Inductive content analysis was used for aiming to produce a synthesis of the research phenomenon. Ethical considerations: The research received organizational approval by the university hospital, and informed consent and confidentiality were ensured. Results: Restraint in pediatric nursing was process-like, but occurred without advanced planning. The restraint-related process included five categories: (a) identification of the situations where restraint may occur, (b) finding preventive methods, (c) identification of different forms of restraint, (d) rationing the use of restraint, and (e) post-restraint acts. Restraint was seen as a part of pediatric nursing which occurred daily and involved several professionals. According to the nurses’ illustrations, restraint means doing things even when a child is not agreeable. Conclusion: Restraint is part of somatic pediatric nursing, described as the last, but in some cases, the only resort for carrying out care or treatment. Restraint is not a goal in itself, but an instrumental tool and procedure in carrying out care. In the future, more information about nurses’ role and the use of restraint in pediatric nursing is still needed.

The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering.

Recent controversies concerning the interaction of science and society have altered the science-society relationship. Technological possibility has required the scientific institution to turn to society for answers. This study explored the elements of each necessary to the decision making process. Challenges to the exclusionary existence of science provided several areas for rhetorical inquiry. ;This research addressed three issues under the rubric of rhetoric, particularly within the areas of public moral argument and decision making. First, public moral argument was examined as a rhetorical construct. The bi-directional nature of interaction between rhetoric and ethics was postulated and its importance addressed. Could the need for public moral argument be met with the development and implementation of a narrative model for ethical decision making? Second, this study developed a framework for narrative ethical decision making. This framework was posited as both a guide for practical decision makers and the critics of those decisions. Third, a case study allowed for the analysis of the rhetorical concept of the public in terms of public moral argument. The importance of public moral argument to a resurgence of the public sphere and the formation of publics was central to this examination.

Differences between men and women in the performance of tests designed to measure spatial abilities are explained by evolutionary psychologists in terms of adaptive design. The Hunter-Gatherer Theory of Spatial Ability suggests that the adoption of a hunter-gatherer lifestyle (assuming a sexual division of labor) created differential selective pressure on the development of spatial skills in men and women and, therefore, cognitive differences between the sexes. Here, we examine a basic spatial skill—wayfinding (the ability to plan routes and navigate a landscape)—in men and women in a natural, real-world setting as a means of testing the proposition that sex-based differences in spatial ability exist outside of the laboratory. Our results indicate that when physical differences are accounted for, men and women with equivalent experience perform equally well at complex navigation tasks in a real-world setting. We conclude that experience, gendered patterns of activity, and self-assessment are contributing factors in producing previously reported differences in spatial ability.

Sea-level rise (SLR) is a threat to coastal areas and there is growing interest in how social values, risk perception and fairness can inform adaptation. This study applies these three concepts to an urban community at risk of SLR in Botany Bay, Australia. The study engaged diverse groups of residents via an online survey. Cluster analysis identified four interpretive communities: two groups value work-life balance, are concerned about SLR and would likely engage in collective adaptation. The third group value everything about Botany Bay and are active in organisations that could prove to be an important outreach. The fourth group were older men, disengaged from both SLR and policy but could respond to individual consultation and targeted communication. Thus, multifarious approaches can engage diverse communities in fair decision-making and transform community-facilitated adaptation.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:In Search of Personal Welfare: A View of Ancient Chinese ReligionAnne Behnke KinneyIn Search of Personal Welfare: A View of Ancient Chinese Religion. By Mu-chou Poo. Albany: State University of New York Press, 1998. Pp. xiii + 331. $21.95.In Mu-chou Poo's new book, In Search of Personal Welfare: A View of Ancient Chinese Religion, the author argues that "by studying relatively 'ordinary' factors, one reaches the basic stratum of the religious mentality of everyday, private life" (p. 3). Poo describes the religious mentality of ancient China at its most fundamental level as being based on a concern for personal welfare and personal access to mantic knowledge. His book investigates broadly shared religious beliefs and practices from China's earliest period up through the Han dynasty, taking into account not just the yearly religious cycle of the common people, but also the relationship between official and local cults.Poo begins with a discussion of archaeological evidence from the late Neolithic period and posits three levels in the development of religious expression in China. The first, appearing perhaps in the late Neolithic and certainly in Shang times, was a form of religious expression directed toward ancestors and nature deities that was divided according to the richness of ritual acts and distinctions derived from an increasingly [End Page 627] stratified society. The second level of religious expression, embraced by the ruling elite of the early Zhou and closely related to agricultural cycles, posited the idea of a moral Heaven that benefited the ruler and the entire state. The third, propounded by intellectuals of the Eastern Zhou, stressed personal piety toward a supreme being, but with little stress on material gain. Despite this threefold development, Poo points out the existence of a more fundamental religious mentality that extended from court to commoner, typified by its emphasis on gaining personal protection from evil spirits and establishing contact with benevolent spirits. Magic, mantic techniques, shamanic rites, and prayers were all utilized toward these ends. As Poo states, "The important matter was propitiation, not where or how the powers came from, or why the powers existed at all" (p. 207). Poo also argues that propitiation of extra-human powers and the use of efficacious apotropaic techniques mattered more than moral behavior, and reliance on these techniques resulted in a confidence that extra-human powers could be successfully dealt with before death. The central theme of religious beliefs in early China was therefore the search for personal welfare: to seek happiness and avoid misfortune.Poo has used a rich array of sources—traditionally transmitted texts as well as recently excavated archaeological texts and artifacts—to examine topics such as divination, exorcism, rishu or "daybooks," immortality, apotheosis, and the netherworld. Poo makes judicious use of the highly limited sources concerning the religious practices of ordinary individuals in early China, though these sources are far more numerous than one might imagine. Given these limitations, Poo's study is highly ambitious and raises questions that must be considered if our view of early China is not to be hopelessly skewed. Poo's reconstruction of the religious practices of the common people is moreover an important contribution to the study of religion in early China in that it helps correct the tendency to represent elite Eastern Zhou culture as the pervasive culture of all periods of early China. [End Page 628]Anne Behnke KinneyUniversity of VirginiaCopyright © 2000 University of Hawai'i Press...

Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically “at risk” are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers’ accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.

As precision oncology has evolved, patients and their families have become more involved in efforts to access these treatments via fundraising and campaigning that take place outside of the larger cancer charities. In this paper, we explore the solidarities, networks, and emotional work of the UK-based access advocates, drawing on the stories of nine advocates, which included interviews and content analyses of their social media posts and coverage of their case in news, commentary, and fundraising websites. We consider the emotional and knowledge work of building networks that spanned consumerist and activist agendas, forged individual and collective goals, and orientations toward the public, private, and third sectors as part of securing support and access. Through these various practices, the actors we have studied cultivated personal advantage and solidarities with other patients and advocates, and in so doing engaged in self and collective advocacy alongside and beyond mainstream cancer charities.

Cosmopolitanism is currently one of the most prominent topics in the social sciences and humanities, and a key concept for understanding globalization. This collection of essays, featuring a line-up of leading international scholars, argues that most work on cosmopolitanism uses a normative model, rather than fully interrogating the issue empirically, comparatively and globally. This ambitious and ground-breaking collection will push the boundaries of the debate on cosmopolitanism into new areas, opening up new lines of inquiry and analysis that will have an impact on the study of globalization and global process for years to come."--Publisher's website.