'Murder or Mercy?' an innovative module helping UK medical students to articulate their own ethical standpoints regarding end-of-life decisions

Objectives This student selected component (SSC) was designed to equip United Kingdom (UK) medical students to respond ethically and with sensitivity to requests they might receive as qualified doctors in regard to euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and to provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment. Method The module is delivered by specialists from a number of disciplines including law, theology, medicine and nursing, each providing students with a working knowledge allowing them to actively discuss cases, articulate their own views and practise ethical reasoning through group and individual study. Visits to local intensive care units, palliative care wards and hospices are integrated effectively with theory. Student assessment comprises a dissertation, student-led debate and reflective commentary. Module impact was evaluated by analysis of student coursework and a questionnaire. Results Students found the content stimulating and relevant to their future career and agreed that the module was well-structured and that learning outcomes were achieved. They greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to real cases and to debate ethical issues with peers. Students reported an increased discernment of the ethical and legal position and practical considerations and a greater awareness of the range of professional and lay viewpoints held. Student perceptions were confirmed on analysis of their submitted coursework. Many participants were less strongly in favour of euthanasia and assisted dying on module completion than at the outset but all felt better equipped to justify their own viewpoint and to respond appropriately to patient requests. Conclusions The multi-disciplinary nature of this course is helpful in preparing students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position.

A 'ruin of all space, shattered glass and toppling masonry': Joyce's Orientalism in the Context of 11 September 2001 and 1922

Chapters 3 and 15 of Joyce's Ulysses exhibit glimpses of three dreams, fantasies and eventual nightmares linked to the figure of 'Haroun al Raschid.' Historically speaking, the latter was a powerful Caliph of Baghdad, a medieval potentate about whom many of the most memorable of The Thousand and One Nights or The Arabian Nights' Entertainments were once and then again spun as tales of pleasure. Joyce seizes upon the figure of 'Haroun al Raschid' as a fictive measure to articulate the 'orientalist' fantasies of Stephen Dedalus and Leopold Bloom. However, this evocative figure of Near Eastern history, of fabulous narrative and the progressively converging fantasies of two modern European literary characters is riddled with paradox. Such material provides Joyce a perceptive and proleptic sense of the paradoxes and brutal historical contradictions through which Western and Eastern dreams of theocratic nationalism, ethnic zealotry, colonial rebellion and Zionism are to be played out. W. B. Yeats' poem 'The Gift of Harun al-Raschid', written in 1923, the year after the book publication of Ulysses, provides both a fitting foil and a significant socio-historical point of reference for Joyce's own figurative use of the Caliph of Baghdad.

Presbyterian Religion, Historiography and Ulster Scots Identity, c. 1800 to 1914

The links between Presbyterians in Scotland and the north of Ireland are obvious but have been largely ignored by historians of the nineteenth century. This article addresses this gap by showing how Ulster Presbyterians considered their relationship with their Scottish co-religionists and how they used the interplay of religious and ethnic considerations this entailed to articulate an Ulster Scots identity. For Presbyterians in Ireland, their Scottish origins and identity represented a collection of ideas that could be deployed at certain times for specific reasons – theological orthodoxy, civil and religious liberty, and certain character traits such as hard work, courage, and soberness. Ideas about the Scottish identity of Presbyterianism were reawakened for a more general audience in the first half of the nineteenth century, during the campaign for religious reform and revival within the Irish church, and were expressed through a distinctive denominational historiography inaugurated by James Seaton Reid. The formulation of a coherent narrative of Presbyterian religion and the improvement of Ulster laid the religious foundations of a distinct Ulster Scots identity and its utilization by unionist opponents of Home Rule between 1885 and 1914.

The Role of Dignity in Equality Law: Lessons from Canada and South Africa

This paper examines the link made on occasion between the concept of dignity and substantive equality; it is further noted that dignity can have very different meanings in different contexts. While the notion of dignity does not often play a substantive role in the resolution of decisions, sometimes the underlying understanding of dignity does matter. However, in all cases, judges should avoid the temptation to rely on unarticulated value judgments or subjective notions of dignity. When judges make reference to dignity, they should articulate the values underpinning their conception of it.

‘Med Hondo’s Sarraounia: The musical articulation of cultural transformation’

This article examines music in Med Hondo’s Sarraounia, considering how it contributes to the dramatic form of the movie while concurrently articulating narratives regarding cultural transformation through both its extrinsic (cultural) and intrinsic (formal) dimensions. Examining how the use of traditional and contemporary African music politicises diegetic space by referring us to the relationships between indigenous musical forms and their global, culturally hybrid descendents, it then demonstrates the complex manner in which the film uses the formal specificities of African and Western musical idioms to articulate a narrative regarding the cultural transformations that occur when an oral culture (Africa) encounters a literate, modernised culture (the West).

On the Problems of Mixing RCTs with Qualitative Research: The Case of the MRC Framework for the Evaluation of Complex Healthcare Interventions

In the perceived hierarchy of research designs, the results from randomized controlled trials are considered to provide the highest level of evidence. Indeed these trials have been upheld as the gold standard in research. The benefits and limitations of the randomized controlled trial as a method of evaluating the effectiveness of healthcare interventions are presented. The article then examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness. In an effort to provide a solution to this problem, the Medical Research Council produced a framework to assist investigators to develop and evaluate complex healthcare interventions. The framework is described with reference to an example of implementing and evaluating protocols for weaning patients in the intensive care unit. The framework is critiqued on the basis that it involves an ambiguous or contradictory ontology, which fails to articulate the relationship between the positivism of randomized controlled trials with the relativism of qualitative approaches. It is concluded that the use of realist strategies in combination with randomized controlled trials provides the most coherent solution to this quandary

Reconceptualising employee silence: problems and prognosis

A growing literature has emerged on employee silence, located within the field of organisational behaviour. Scholars have investigated when and how employees articulate voice and when and how they will opt for silence. While offering many insights, this analysis is inherently one-sided in its interpretation of silence as a product of employee motivations. An alternative reading of silence is offered which focuses on the role of management. Using the non-union employee representation literature for illustrative purposes, the significance of management in structuring employee silence is considered. Highlighted are the ways in which management, through agenda-setting and institutional structures, can perpetuate silence over a range of issues, thereby organising employees out of the voice process. These considerations are redeployed to offer a dialectical interpretation of employee silence in a conceptual framework to assist further research and analysis.

The Housing Triangulation: A discourse on Quality, Affordability and Lifestyles in India

Since 1991 with the advent of globalization and economic liberalisation, basic conceptual and discursive changes are taking place in housing sector in India. The new changes suggest how housing affordability, quality and lifestyles reality is shifting for various segments of the population. Such shift not only reflects structural patterns but also stimulates an ongoing transition process. The paper highlights a twin impetus that continue to shape the ongoing transition: expanding middle class and their wealth - a category with distinctive lifestyles, desires and habits and corresponding ‘market defining’ of affordable housing standards - to articulate function of housing as a conceptualization of social reality in modern India. The paper highlights the contradictions and paradoxes, and the manner in which the concept of affordability, quality and lifestyles are embedded in both discourse and practice in India. The housing ‘dream’ currently being packaged and fed through to the middle class population has an upper middle class bias and is set to alienate those at the lower end of the middle-and low-income population. In the context of growing agreement and inevitability of market provision of ‘affordable housing’, the unbridled ‘market-defining’ of housing quality and lifestyles must be checked.

Multiculturalism, freedom of religion, equality, and the British constitution: The JFS case considered

In the JFS case, the Supreme Court of the United Kingdom held that the admissions policy of a Jewish faith school constituted unlawful racial discrimination because it used the Orthodox Jewish interpretation of who is Jewish as a criterion for determining admission to the school. A detailed discussion of the case is located in the context of two broader debates in Britain, which are characterized as constitutional in character or, at least, as possessing constitutional properties. The first is the debate concerning the treatment of minority groups, multiculturalism, and the changing perceptions in public policy of the role of race and religion in national life. It is suggested that this debate has become imbued with strong elements of what has been termed “post-multiculturalism”. The second debate is broader still, and pertains to shifting approaches to “constitutionalism” in Britain. It is suggested that, with the arrival of the European Convention on Human Rights and EU law, the U.K. has seen a shift from a pragmatic approach to constitutional thinking, in which legislative compromise played a key part, to the recognition of certain quasi-constitutional principles, allowing the judiciary greatly to expand its role in protecting individual rights while requiring the judges, at the same time, to articulate a principled basis for doing so. In both these debates, the principle of equality plays an important role. The JFS case is an important illustration of some of the implications of these developments.

Inclusive development? State-led land development model in New Town, Kolkata

Urban land development in India is changing under the auspices of economic liberalisation. Kolkata has been in the forefront of this transformation through development of new townships in the urban peripheries based on a distinctive state-led land development model. Within this context New Town, Kolkata (also known as Rajarhat) provides a highly illuminative case to articulate the ways in which the state is implementing its neoliberal agenda in land development. It rides on political and ideological high ground by seeking to create a ‘model development’ of state–market partnership for dual goals of fostering capitalist interest while fulfilling welfarist principles. Interesting insights have emerged that point to a policy paradox. On one hand, the process follows market principles of efficacy and efficiency; on the other hand, state’s keenness to extend control persists, thereby creating a highly uneven terrain for state–market interaction. New Town reflects a typical quasi-market condition shaped by the monopolistic state, the poorly structured role of the private sector, an absence of civic bodies, and minimal land and housing provision for the poor. In India, as internationally, the economic liberalisation market ideology is increasingly construed as good governance. In this context New Town is a step in the right direction, but the progress is patchy, uneven, and still evolving.

Children, the environment and participatory planning

Public participation in the planning system is well established in both academic and practice based research. The failure to engage the 'public' effectively has resulted in costly and unpopular decisions and produced a debate about how, when and with whom to participate. Children have tended to be marginal or ignored in land use planning but this paper suggests that, given the right techniques, they can be articulate, reasonable and clear thinkers about the type of environment they live in and how it should change. It draws on Mental Mapping and Environmental Affordance methodologies to show how eleven year old children can read their neighbourhood, identify barriers and highlight the benefits they extract from a deeper cognitive understating of their place. The paper concludes by suggesting that these techniques are transferable globally, especially where literacy and numeracy is weak and where planners reliance on formalised consultations reflect the interests of state and economic elites rather than the wider population.

Public health education for midwives and midwifery students: a mixed methods study

Background: Current national and international maternity policy supports the importance of addressing public health goals and investing in early years. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health. Midwives are in a unique position, given the emphasis of the philosophy of midwifery care on building relationships and incorporating a holistic approach, to support women to make healthy choices with the aim of promoting health and preventing ill health. However, exploration of the educational preparation of midwives to facilitate public health interventions has been relatively limited. The aim of the study was to identify the scope of current midwifery pre registration educational provision in relation to public health and to explore the perspectives of midwives and midwifery students about the public health role of the midwife.

Methods: This was a mixed methods study incorporating a survey of Higher Educational Institutions providing pre registration midwifery education across the UK and focus groups with midwifery students and registered midwives.

Results: Twenty nine institutions (53% response) participated in the survey and nine focus groups were conducted (59 participants). Public health education was generally integrated into pre registration midwifery curricula as opposed to taught as a discrete subject. There was considerable variation in the provision of public health topics within midwifery curricula and the hours of teaching allocated to them. Focus group data indicated that it was consistently difficult for both midwifery students and midwives to articulate clearly their understanding and definition of public health in relation to midwifery.

Conclusions: There is a unique opportunity to impact on maternal and infant health throughout the reproductive period; however the current approach to public health within midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.

Uses of expertise:Sources, quotes, and voice in the reporting of genetics in the news

Science journalists call upon experts for background and for clarification and comment on scientific findings. This paper examines how science writers choose and use experts, and it focuses on several cases of reporting about genetics and behavior. Our research included two sources of data: interviews with 15 science reporters and three print media samples of coverage of genetics and behavior - alcoholism (between 1980-1995), homosexuality (in 1993 and 1995), and mental illness (between 1970-1995). Science reporters seek relevant and specific experts for nearly every story. Good sources are knowledgeable, are connected to prestigious institutions, are direct and articulate and don't overqualify statements, and they return phone calls. The mean number of experts quoted was 2.8 per story, differing for alcoholism (3.5), homosexuality (2.8), and mental illness (2.6). Researchers and scientists predominated among experts quoted. Quotes were used to provide context, give legitimization, as explication, to provide a kind of balance, and to outline implications. For the homosexuality sample, a significantly greater percentage of activists and advocates were quoted (21 percent compared with 5 percent and 1 percent in other samples, X <0.0001). "Lay" quotes for alcoholism and mental illness were minimal. Except for homosexuality, whose advocates are organized, those "affected" do not have a voice in genetics news stories.

The Senses of Muriel Rukeyser’s The Book of the Dead

When Muriel Rukeyser travelled to Gauley Bridge in 1936 to report on the industrial disaster that had led to the deaths of over 700 miners, her findings led her to write what is arguably her masterpiece – the 1938 poem series The Book of the Dead. Of all Rukeyser's writings, this hybrid work of documentary techniques and metaphors, of testimony and elegy, has attracted the most critical attention. However, analyses of the series have tended to focus on the ways in which the poet adopted and adapted documentary methods in order to offer a leftist ideological critique on capitalist-born social injustice. The purpose of this article is not to negate such readings, but to offer alongside them insight into a more ethical-philosophical approach that I believe guided Rukeyser's entire career. Via an examination of the ways in which Rukeyser employs the human senses to articulate the complexities of human political, metaphysical and social relations, this article explores the influence of the Zionist Martin Buber on the poet. Rukeyser acknowledged Buber's writings in her later work, but I contend here that they played a large part in the formation of her poetics, especially in connection with her documentary aesthetic. Whilst several critics have noted, albeit often superficially, the Marxist flavour of Rukeyser's poetry in The Book of the Dead, I argue for the influence of Buber over Marx in terms or responsibility, community and dialogue. Both Rukeyser's and Buber's methods of expressing and promoting these ethical necessities rely on a synaesthetic response to the world. Where Buber advances a dialogue between the self and alterity through transcendent personal encounter, Rukeyser locates such encounter in the poem, arguing for an exchange that leads to creation, and to personal and interpersonal growth.

Negative Silence: The unspoken future of Northern Ireland

The premise for finding common ground between unionism and nationalism in Northern Ireland in the 1998 Agreement centred on an accepted compromise regarding what the future of the province might be: continued union within the UK was assured but could be changed if unity with the Republic of Ireland was the will of the majority. In this way, Northern Ireland was suspended as if on a see-saw between the ‘two traditions’. As a consequence, the very success of power-sharing has made it difficult for parties to articulate a shared vision of Northern Ireland’s future. This paper identifies a ‘negative silence’ regarding the outlook for Northern Ireland and seeks to uncover some of its implications by analysing three of its constitutive elements. First, how the aspirational discourse of the four largest political parties has remained largely entrenched in oppositional gullies. Second, how the debate around the Shared Future framework and Cohesion, Sharing and Integration programme ironically embodies deep differences in political visions of a ‘shared’ future for Northern Ireland. Finally, interview-based reflections on how an inability to articulate a future for Northern Ireland affects the young ‘Agreement generation’ and their (dis)empowerment as citizens. The paper concludes that the thicker the fog of silence grows over the subject of Northern Ireland’s future, the bleaker this future is likely to be