Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

Arching action in high strength concrete slabs

The corrosion of reinforcement in bridge deck slabs has been the cause of major deterioration and high costs in repair and maintenance.This problem could be overcome by reducing the amount of reinforcement and/or altering the location.This is possible because, in addition to the strength provided by the reinforcement, bridge deck slabs have an inherent strength due to the in-plane arching forces set up as a result of restraint provided by the slab boundary conditions. This is known as arching action or Compressive Membrane Action (CMA). It has been recognised for some time that laterally restrained slabs exhibit strengths far in excess of those predicted by most design codes but the phenomenon has not been recognised by the majority of bridge design engineers. This paper presents the results of laboratory tests on fifteen reinforced concrete slab strips typical of a bridge deck slab and compares them to predicted strengths using the current codes and CMA theory. The tests showed that the strength of laterally restrained slabs is sensitive to both the degree of external lateral restraint and the concrete compressive strength.The tests particularly highlighted the benefits in strength obtained from very high strength concrete slabs. The theory extends the existing knowledge of CMA in slabs with concrete compressive strengths up to 100 N/mm[2] and promotes more economical and durable bridge deck construction by utilising the benefits of high strength concrete.

Reflexive Modernisation and Social Work in Ireland: A Response to Powell

The aim of this article is respond to some of the issues addressed by Powell (1998). It focuses on his consideration of the role and task of social work within a changing society. I argue that, before postulations about the future role of social work in Ireland can be made, consideration of its current nature and the form of its discourses are necessary. I then go on to critique Powell's analysis of social work in the context of concepts such as empowerment, participation and prevention and argue that, by failing to consider the necessarily regulatory and centralized nature of much of Irish social work currently, such an analysis remains merely rhetorical. Powell's reference to the Irish Association of Social Workers' Code of Ethics (1995) as evidence of social work entering a period of reflexive modernity is also examined. The article concludes with a call for a move away from utopian speculation within Irish social work discourse towards a more realistic and constructive analysis of both the future potential and the limitations of Irish social work, given its spatial and discursive constraints.

Pitfalls in Strategic Planning: Lessons for Legitimacy

The paper considers how planning as a political activity is underpinned by concepts of justice and how professional practitioners are consistently faced with making ethical choices in the public interest. The key objective is therefore to identify the centrality of ethics in praxis. In this context, political liberal theory is empirically useful in exploring both the role of participants and the processes employed in strategic planning. A case study analysis generates key issues which are relevant to planning in the wider arena and an extensive series of interviews provides interesting insights into the dynamic between those involved and the effectiveness of procedures followed.

Recording Memories from Political Violence: a Filmmaker's Journey

Based on the work the author has carried out with survivors groups in Northern Ireland and South Africa, this book describes and analyses the use of documentary filmmaking in recording experiences of political conflict. A variety of issues relevant to the genre are addressed at length, including the importance of ethics in the collaboration between the filmmaker and the participant and the effect of location on the accounts of participants.

Further Information:
This monograph reflects on and analyses the work of the author/director over the past decade. His documentary films have been produced in the context of how to address storytelling in post conflict societies by drawing on the disciplines of oral history, ethnography, memory studies and documentary film. All the documentary films under discussion have been produced collaboratively with NGOs, including the Victims and Survivors Trust and WAVE Trauma Centre (both Belfast) and the Human Rights Media Centre, Cape Town. Investigating the influence of location in memory stimulation and the role of collaboration on authorship during trauma recovery, the author offers insights into the process of collaboratively production, which attends to both ethical and aesthetic considerations. While most emphasis is placed on the research, production and post-production phases, thought is also given to the reception of these films and the impact they have on the participants, wider communities, and on policy decisions.

Prisons Memory Archive

Between 2006 and 2007, the Prisons Memory Archive (PMA) filmed participants, including former prisoners, prison staff, teachers, chaplains, visitors, solicitors and welfare workers back inside the Maze/Long Kesh Prison and Armagh Gaol. They shared the memory of the time spent in these prisons during the period of political violence from 1970 - 2000 in Northern Ireland, commonly known as the Troubles. Underpinning the overall methodology is co-ownership of the material, which gives participants the right to veto as well as to participate in the processes of editing and exhibiting their stories, so prioritising the value of co-authorship of their stories. The PMA adopted life-story interviewing techniques with the empty sites stimulating participants’ memory while they walked and talked their way around the empty sites. A third feature is inclusivity: the archive holds stories from across the full spectrum of the prison experience. A selection of the material, with accompanying context and links is available online www.prisonsmemoryarchive.com

Further Information:

The protocols of inclusivity, co-ownership and life-story telling make this collection significant as an initiative that engages with contemporary problems of how to negotiate narratives about a conflicted past in a society emerging out of violence. Inclusivity means that prison staff, prisoners, governors, chaplains, tutors and visitors have participated, relating their individual and collective experiences, which sit side by side on the PMA website. Co-ownership addresses the issues of ethics and sensitivity, allowing key constituencies to be involved. Life-story telling, based on oral history methodologies allows participants to be the authors of their own stories, crucial when dealing with sensitive issues from a violent past. The website hosts a selection of excerpts, e.g. the Armagh Stories page shows excerpts from 15 participants, while the Maze and Long Kesh Prison page offers interactive access to 24 participants from that prison. Using an interactive documentary structure, the site offers users opportunities to navigate their own way through the material and encourages them to hear and see the ‘other’, central to attempts at encouraging dialogue in a divided society. Further, public discussions have been held after screening of excerpts with community groups in the following locations - Belfast, Newtownabbey, Derry, Armagh, Enniskillen, London, Cork, Maynooth, Clones, and Monaghan. Extracts have been screened at international academic conferences in Valencia, Australia, Tartu, Estonia, Prague, and York. A dataset of the content, with description and links, is available for REF purposes.

Extracting Query Interfaces Based on Form Structures and Semantic Similarity

Web databases are now pervasive. Such a database can be accessed via its query interface (usually HTML query form) only. Extracting Web query interfaces is a critical step in data integration across multiple Web databases, which creates a formal representation of a query form by extracting a set of query conditions in it. This paper presents a novel approach to extracting Web query interfaces. In this approach, a generic set of query condition rules are created to define query conditions that are semantically equivalent to SQL search conditions. Query condition rules represent the semantic roles that labels and form elements play in query conditions, and how they are hierarchically grouped into constructs of query conditions. To group labels and form elements in a query form, we explore both their structural proximity in the hierarchy of structures in the query form, which is captured by a tree of nested tags in the HTML codes of the form, and their semantic similarity, which is captured by various short texts used in labels, form elements and their properties. We have implemented the proposed approach and our experimental results show that the approach is highly effective.

Food Labels, Autonomy and the Right (Not) to Know

Food labelling has been overlooked in the emerging body of literature concerning the normative dimensions of food and drink policies. In this paper, I argue that arguments normally advanced in bioethics and medical ethics regarding the “right to know” and the “right not to know” can provide useful normative guidelines for critically assessing existing and proposed food labelling regimes. More specifically, I claim that food labelling ought to respect the legitimate interests and the autonomy of both consumers who seek knowledge about their food in order to make informed dietary choices and consumers who prefer to remain ignorant about the contents and effects of their food in order to avoid the emotional and psychological harm, or more simply the loss of enjoyment, which may result from receiving that information.

Evidence-based policymaking and the public interest: lessons in legitimacy

This paper draws upon an analysis of regional spatial planning to highlight the centrality of ethics in praxis. In this context political liberalism is particularly helpful in developing a deeper understanding of the activities of those engaged in planning decision making. At the most basic level it demonstrates the importance of not only using shared liberal values as the foundation for public discourses but also achieving consensus through the development of an inclusive evidence base, derived from both lay and professional knowledge. Specifically, political liberalism provides a practical critique, enabling judgments to be made on problems which pervade operational planning practice and an evaluation to be conducted of the dynamic between and actions of participants.

Match-fixing and Money-laundering

his essay is premised on the following: a conspiracy to fix or otherwise manipulate the outcome of a sporting event for profitable purpose. That conspiracy is in turn predicated on the conspirators’ capacity to: (a) ensure that the fix takes place as pre-determined; (b) manipulate the betting markets that surround the sporting event in question; and (c) collect their winnings undetected by either the betting industry’s security systems or the attention of any national regulatory body or law enforcement agency.

Unlike many essays on this topic, this contribution does not focus on the “fix”– part (a) of the above equation. It does not seek to explain how or why a participant or sports official might facilitate a betting scam through either on-field behaviour that manipulates the outcome of a game or by presenting others with privileged inside information in advance of a game. Neither does this contribution seek to give any real insight into the second part of the above equation: how such conspirators manipulate a sports betting market by playing or laying the handicap or in-play or other offered betting odds. In fact, this contribution is not really about the mechanics of sports betting or match fixing at all; rather it is about the sometimes under explained reason why match fixing has reportedly become increasingly attractive as of late to international crime syndicates. That reason relates to the fact that given the traditional liquidity of gambling markets, sports betting can, and has long been, an attractively accessible conduit for criminal syndicates to launder the proceeds of crime. Accordingly, the term “winnings”, noted in part (c) of the above equation, takes on an altogether more nefarious meaning.

This essay’s attempt to review the possible links between match fixing in sport, gambling-related “winnings” and money laundering is presented in four parts.

First, some context will be given to what is meant by money laundering, how it is currently policed internationally and, most importantly, how the growth of online gambling presents a unique set of vulnerabilities and opportunities to launder the proceeds of crime. The globalisation of organised crime, sports betting and transnational financial services now means that money laundering opportunities have moved well beyond a flutter on the horses at your local racetrack or at the roulette table of your nearest casino. The growth of online gambling platforms means that at a click it is possible for the proceeds of crime in one jurisdiction to be placed on a betting market in another jurisdiction with the winnings drawn down and laundered in a third jurisdiction and thus the internationalisation of gambling-related money laundering threatens the integrity of sport globally.

Second, and referring back to the infamous hearings of the US Senate Special Committee to Investigate Organised Crime in Interstate Commerce of the early 1950s, (“the Kefauver Committee”), this article will begin by illustrating the long standing interest of organised crime gangs – in this instance, various Mafia families in the United States – in money laundering via sports gambling-related means.

Third, and using the seminal 2009 report “Money Laundering through the Football Sector” by the Financial Action Task Force (FATF, an inter-governmental body established in 1989 to promote effective implementation of legal, regulatory and operational measures for combating money laundering, terrorist financing and other related threats to the integrity of the international financial system), this essay seeks to assess the vulnerabilities of international sport to match fixing, as motivated in part by the associated secondary criminality of tax evasion and transnational economic crime.

The fourth and concluding parts of the essay spin from problems to possible solutions. The underlying premise here is that heretofore there has been an insularity to the way that sports organisations have both conceptualised and sought to address the match fixing threat e.g., if we (in sport) initiate player education programmes; establish integrity units; enforce codes of conduct and sanctions strictly; then our integrity or brand should be protected. This essay argues that, although these initiatives are important, the source and process of match fixing is beyond sport’s current capacity, as are the possible solutions.

Governing Public Health: EU Law, Regulation and Biopolitics

This book contributes towards EU studies and the growing discourse on law and public health. It uses the EU’s governance of public health as a lens through which to explore questions of legal competence and its development through policy and concrete techniques, processes and practices, risk and security, human rights and bioethics, accountability and legitimacy, democracy and citizenship, and the nature, essence and ‘future trajectory’ of the European integration project. These issues are explored first, by situating the EU's public health strategy within the overarching architecture of governance and subsequently by examining its operationalisation in relation to the key public health problems of cancer, HIV/AIDS and pandemic planning.

The book argues that the centrality and valorisation of scientific and technical knowledge and expertise in the EU's risk-based governance means that citizen participation in decision-making is largely marginalised and underdeveloped – and that this must change if public health and the quality, accountability and legitimacy of EU governance and its regulation are to be improved. Subsequently the book goes on to argue that the legitimating discourses of ethics and human rights, and the developing notion of EU (supra-)stewardship responsibility, can help to highlight the normative dimensions of governance and its interventions in public health. These discourses and dimensions provide openings and possibilities for citizens to power ‘technologies of participation’ and contribute important supplementary knowledge to decision-making.

The obligation to provide information where valid consent is not needed

Accounts of consent in medical ethics typically assume that consent plays the same role irrespective of the type of treatment. In this paper I argue that this assumption is false. Because of this, obligations to provide information to patients that stem from the need for consent to be valid will not apply to all types of treatment. This does not mean that there are no reasons to provide such information. The second part of the paper maps out what these reasons are and argues that they are grounded in the obligation of beneficence and a duty to warn, not in considerations of respect for autonomy.

Nursing Revalidation

This article details the Nursing and Midwifery Council revalidation requirements essential for all registered nurses and midwives in the United Kingdom. Nursing revalidation is effective from April 2016 and is built on the pre-existing Post-registration education and practice. Unlike the previous process, revalidation provides a more robust system which is clearly linked to the Code and should assist towards the delivery of quality and safe effective care

Morality, Power and the Planning Subject

Ethical issues are at the heart of planning. Thus, planning theory has long displayed an interest in debating both the ethical justification for planning and how the activity of planning can be rendered more ethically sensitive. However, comparatively little attention has been shown to how the very constitution of the planner as a ‘moral subject’ may be ethically problematic for planning practice. This article addresses this lacuna through an engagement with the philosophy of Michel Foucault. In contrast to how his work is normally applied, this article accords with Foucault’s own direction that his later examination of ethics be used as a lens through which to read his earlier analysis of power and knowledge. Accordingly, the article first outlines Foucault’s innovative reinterpretation of how power and knowledge operate in society before setting this within his novel reconception of ethics. This theoretical exposition is then employed to interpret the material drawn from in-depth qualitative interviews with 20 planning officers working in a range of different contexts. The article subsequently employs Foucault’s ethically informed reading of power and knowledge to identify ethical issues arising from the approaches used by practitioners to justify their planning activities. The article concludes by suggesting how such issues can be resolved.