Post-trauma: Is evidence based practice a fantasy?

Trauma, bereavement, and loss are universal human experiences. Much has been written about the process that the bereaved go through following the loss of a loved one. Recent events such as 9/11, earthquakes in Turkey, genocides in Rwanda, community conflict in Northern Ireland, and the Asian Tsunami Disaster have drawn unprecedented public attention to the subject of traumatic bereavement. Increasingly, it is recognised that while most people are able to cope with loss generally by eventually restructuring their lives, those bereaved in traumatic circumstance often find it extremely difficult. As a consequence, a plethora of interventions have emerged, however, to-date, little is know about their actual effectiveness in helping the bereaved. With the emphasis of health and welfare professions on evidencebased practice (EBP) greater than ever and a raising awareness of accountability as key element of ethical practice, the call for EBP in traumatic bereavement is compelling. Using examples from work carried out in Northern Ireland, we look at the backdrop of the issues involved, describe some of the most commonly used therapeutic interventions, and explore the possibility of evidence-based practice.

The ethics of ethical debates in peace and conflict research: Notes towards the development of a research covenant

This article outlines the case for peace and conflict researchers to formulate a research covenant to better shape their ethical obligations and responsibilities. This is an urgent necessity given that ethical debates have in some proponents become emotive and are not conducted in an ethical manner. In coming to this assessment, the article reviews trends in the research ethics literature and draws out some of the generic issues addressed in a review of the personal reflexivity that an assortment of individual peace and conflict researchers have engaged in when recounting their fieldwork experiences. These generic issues are reformulated in an attempt to codify appropriate ethical practice in peace and conflict research, and they go towards determining the contents of the research covenant. It is suggested that the research covenant is a more ethical way to debate the ethics of peace and conflict research.

Created relation: the translated play in performance

Summary: The process of translation restores the materiality of time and space to a play. Performance, of course, takes place only within the here and now of an audience, but a play that comes from a different time or different place prompts an encounter with the conceptual and perceptual real from sometime or somewhere else. If we are to consider translation as an ethical practice, one concerned not only to present the dislocated other to the located self, but also to protect the other from wholesale assimilation by the self, then the translated play must in some ways prove resistant to such assimilation. But of course the retention of foreignness – or what Steiner called restitution – is problematic, not least because of the attendant danger of merely exoticising. The theatre of García Lorca in English presents an interesting case study in this regard.

'Work and Emancipatory Practice: Towards a Recovery of Human Beings' Productive Capacities,'

This article argues that productive work represents a mode of human flourishing unfortunately neglected in much current political theorizing. Focusing on Habermasian critical theory, I contend that Habermas’s dualist theory of society, on account of the communicative versus instrumental reason binary which underpins it, excludes work and the economy from ethical reflection. To avoid this uncritical turn, we need a concept of work that retains a core emancipatory referent. This, I claim, is provided by Alasdair MacIntyre’s notion of ‘practice’. The notion of ‘practice’ is significant in suggesting an alternative conception of human productivity that is neither purely instrumental nor purely communicative, but rather both simultaneously, a form of activity which issues in material products and yet presumes a community of workers engaged in intersubjective self-transformation. However, we can endorse MacIntyre’s notion of ‘practice’ only if we reject his totalizing anti-modernism and insist on the emancipatory potentialities of modern institutions.

Coercion in the Community: A Situated Approach to the Examination of Ethical Challenges for Mental Health Social Workers

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion*/informal types of leverage, and the legally mandated use of Community Treatment Orders*/to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion.

Communication, recognition and social work: Aligning the ethical theories of Habermas and Honneth

The modern world is replete with ethical challenges of Orwellian proportions. The violation of human rights and misrecognition of identities are two of the most pressing examples. In this paper, the ethical theories of Habermas and Honneth are aligned as a way of addressing these specific challenges within social work. It is suggested that these theories are complementary, mutually rectifying and concordant at the meta-ethical level of analysis. The alignment is also justified, pargmatically, through the construction of three hypothetical vignettes demonstrating different kinds of practice dilemmas. The need for egalitarian communication and the imperative to recognise human identity in all its dimensions subsequently emerge as the two foundation stones for ethical deliberation in social work.

Fundamental patterns of knowing in nursing: The challenge of evidence-based practice

This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrowempirics in the formof evidence-based practice. Objections to the dominance of evidence-based practice are reviewed, and the reasons for it are examined. It is argued that it is partially the result of weaknesses in the alternative patterns of ethical, personal, and esthetic knowing, the ineffability of which compromises accountability. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidencebased practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent.

Bereavement Assessment Practice in Hospice Settings: Challenges for Palliative Care Social Workers

The management and delivery of bereavement support services in palliative care settings presents practical and ethical challenges. A national survey, conducted in 2007, examined bereavement practice in ten Marie Curie hospices across the United Kingdom. This qualitative study was undertaken using semi-structured telephone interviews with Bereavement Service Leaders located in each hospice. Although findings revealed that bereavement services were in operation and had been reviewed in response to the National Institute for Clinical Excellence Guidance (2004), and all bereaved families were offered support, there was no standardisation of service delivery across sites. Multi-disciplinary team meetings facilitated shared decision-making for bereavement follow-up, and expanded and clarified documentation completed by nursing staff around the time of the patient’s death. However, there was ambiguity regarding professional ‘duty of care’ and agency responses to bereaved individuals who were suicidal. Questions were raised around clinical effectiveness, reliability and professional accountability. The study highlighted ethical issues centred on documentation, user participation and consent, and found staff training was variable across the 10 hospices. The findings have informed the development of a post-bereavement service model which has been subsequently implemented across Marie Curie Cancer Care.

The good, the bad and the 'not so bad': reflecting on moral appraisal in practice

The aim of this paper is to facilitate reflection on the moral merit of practitioners in various contexts. Insight is gained from Aristotelian and Kantian accounts of moral character and an original framework for reflection is presented as an adjunct to ethical theory and principles considered when appraising others. In relation to states of character there is an irreconcilable difference between Kantian (deontic) and Aristotelian (aretaic) conceptions of the nature of full virtue (excellence of character), but at the same time it can be argued that in relation to practice their approaches complement each other. It is also argued that in relation to caring for the vulnerable, Aristotle’s conception of full virtue is more compelling than Kant’s. On the other hand, Kant’s notion of self - serving action is important in nursing and it therefore needs to be considered when reflecting on professional conduct. The conclusion reached is that Aristotelian and Kantian accounts of character appraisal should be used in a combined approach to moral appraisal. This approach draws on the accounts of both philosophers and offers valuable insight into moral character, professional conduct and, in a more formal setting, fitness to practise.

Breast cancer genetics: Unsolved questions and open perspectives in an expanding clinical practice

Breast cancer is the most common cause of cancer death in the United Kingdom, with a lifetime risk of one in nine in women. Only 5-10% of all cancers is thought to be due to strongly penetrant inherited predisposing genes, such as BRCA1 and BRCA2. However, other less penetrant genes, including some autosomal recessive genes, are likely to be of etiological importance in other families. This review addresses the current knowledge of breast cancer susceptibility genes and explores the possibilities for future developments. Features of tumor pathology, prognosis, and the scope for targeted treatments in mutation carriers are discussed, and the management of known carriers and those at increased risk for developing breast cancer are evaluated. Genetic testing for cancer susceptibility may become widely available in the future, and has important ethical and management implications. (C) 2004 Wiley-Liss, Inc.

In pursuit of parrhesia: an investigation into knowledge selection in inquisitorial planning practice

Drawing upon interviews with procedural actants from Public Inquiry and Examination in Public fora, I draw upon relevant theoretical frameworks to evaluate modes of discourse in inquisitorial planning practice. In the investigation, which is based primarily upon an empirical study, I focus upon the role of evidence, the selection and handling of multiple knowledges, the behaviour of participants, and the methodology underpinning the process. It is established that such arenas can be effective mechanisms for testing complex evidence; and suggestions are made for improved practice, procedure, and future research. I conclude by raising serious ethical questions concerning participant behaviour, particularly on the part of advocates and especially chartered town planners.

Educational assessment policy and practice - a matter of ethics

Long-standing concerns within the field of educational assessment consider the impact of assessment policy and practice as matters of equity, inequality and social justice.Yet educational assessment policy and practice continues to have powerful social consequences for key users such as children and young people.This paper re-positions these consequences as a matter of ethics.It uses the work of Messick to frame how ethical matters extend beyond test instruments into the realm of uses and impact. A case study of the 11+ school transfer system in Northern Ireland is presented to illustrate ethical dilemmas emerging as a consequence of actions and decisions of using assessment systems for particular purposes.In looking forward to how we might attend to ethical matters in assessment policy and practice, a consideration of a children’s rights approach is outlined that may provide a moral and legal framework for action.

Ethical dilemmas for clinical psychologists in conducting qualitative research

Clinical psychologists often use qualitative methods to explore sensitive topics with vulnerable individuals, yet there has been little discussion of the specific ethical issues involved. For clinicians conducting qualitative research, there are likely to be ethical dilemmas associated with being both a researcher and a practitioner. We argue that this overarching issue frames all other ethical issues raised. This article provides an overview of the range of ethical issues that have been discussed in general in relation to qualitative research and considers the specific nature of these in relation to the discipline of clinical psychology. Such issues will be exemplified by reference to some of our own research and practice and the extant literature. We conclude with some suggestions for good practice, although our aim is to trigger debate rather than to establish prescriptive guidelines.