Bioethics through the telescope: institutional ethics in the NHS

The article argues for a broader conception of bioethics. The principles that dominate current thinking are generally individualistic and do not represent the real world inhabited by patients, doctors, hospitals and the NHS as a whole. Rather than focus almost exclusively on the micro-end of the analytical spectrum, bioethics, and medical lawyers in particular, should take the institutional dimensions of health and health care more seriously, ie use a telescope to understand the dynamics that drive the subject, not just a microscope.

Truth - the essential dimension of ethics in scholarship, teaching, learning and research

The introduction of metrics, league tables, performance targets, research assessment exercises and a range of other pressures placed by society, funding bodies and employers on scholars, teachers and students have resulted in diminished value being placed on the essential ethical criterion of truth. The impact of reduced valuation for truth has a huge impact on the standing of science and not least horticultural science in the eyes of the general public at a time when this should be a primary concern. This contribution discusses examples of the impact of diminished valuation of truth, the causes of this phenomenon, the results that come from this situation and remedies that are needed.

Tactical ethics: how the discourses of fairtrade and black economic empowerment change and interact in wine networks from South Africa to the UK.

This paper explores the spaces and power relations of ethical foodscapes. Ethics can offer a commodity a valuable unique selling point in a competitive marketplace but managing the changeable and multiple motivations for stakeholder participation throughout the commodity chain in order to utilise this opportunity is a complex negotiation. Through exploring the spaces and relations within three South African– UK ethical wine networks, the discursive tactics used to sustain these are uncovered. The discourses of Fairtrade, Black Economic Empowerment and organics are highly adaptive, interacting with each other in such a way as to always be contextually appealing. This ‘tactical mutability’ is combined with ‘scales of knowing’, which, this paper argues, are essential for network durability. ‘Scales of knowing’ refers to the recognition by stakeholders of the potential for different articulations of a discourse within the network, which combines with ‘tactical mutability’ to allow for a scalar, contextual and ’knowing’ (im)mutability to ensure the discourse’s continued appeal. However, even when one discourse is the ‘lead’ it always folds within it linkages to other ethical discourses at work, suggesting that ethical practice is mutually supportive discursively. This means that at the producer end ethical interactions may offer more capacity to enact genuine transformation than the solo operations of a discourse.

Ethics of care in supporting disabled forced migrants: interactions with professionals and ethical dilemmas in health and social care in the South-East of England

This article explores the interactions between disabled forced migrants with care needs and professionals and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with 45 participants in the South-East of England. In-depth interviews were conducted with 15 forced migrants who had diverse impairments and chronic illnesses (8 women and 7 men), 13 family caregivers and 17 support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family caregivers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision, and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.

What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

Design considerations in the sequential analysis of matched case–control data

A role for sequential test procedures is emerging in genetic and epidemiological studies using banked biological resources. This stems from the methodology's potential for improved use of information relative to comparable fixed sample designs. Studies in which cost, time and ethics feature prominently are particularly suited to a sequential approach. In this paper sequential procedures for matched case–control studies with binary data will be investigated and assessed. Design issues such as sample size evaluation and error rates are identified and addressed. The methodology is illustrated and evaluated using both real and simulated data sets.

‘Scripture its own interpreter’: Mary Martha Sherwood, the Bible and female autobiography

This is a reading of the work of Mary Martha Sherwood, the Victorian Evangelist and Children’s Author (and pupil at the Abbey School, Reading). Based upon research on Sherwood’s private correspondences and diary conducted at UCLA with the aid of a Mitzi Myers (this before my arrival at Reading), the essay offers a radical reinterpretation of her work. Previously understood in terms of a rigid, if self-contradictory and ‘anxious’, Evangelism, the essay reads the diary through Sherwood’s little known Biblical scholarship. Through this I argue that Sherwood grants her own writing the status of Biblical truth precisely because of its contradictions and ‘anxiety’.

Emerging social norms in the UK and Japan on privacy and revelation in SNS

Semi-structured interviews with university students in the UK and Japan, undertaken in 2009 and 2010, are analysed with respect to the revealed attitudes to privacy, self-revelation and revelation by/of others on SNS.