Inside ‘Inside View’: reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre-natal screening policy and practice

Background The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of ‘Inside View’.1 Objectives The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. Methods ‘Inside View’ was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Findings Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing.

Use of general practice prescribing data as a surrogate estimate of statin compliance

Background and Objective: To maximise the benefit from statin therapy, patients must maintain regular therapy indefinitely. Non-compliance is thought to be common in those taking medication at regular intervals over long periods of time, especially where they may perceive no immediate benefit (News editorial, 2002). This study extends previous work in which commonly held prescribing data is used as a surrogate marker of compliance and was designed to examine compliance in those stabilised on statins in a large General Practice. Design: Following ethical approval, details of all patients who had a single statin for 12 consecutive months with no changes in drug, frequency or dose, between December 1999 and March 2003, were obtained. Setting: An Eastern Birmingham Primary Care Trust GP surgery. Main Outcome Measures: A compliance ratio was calculated by dividing the number of days treatment by the number of doses prescribed. For a once daily regimen the ratio for full compliance_1. Results: 324 patients were identified. The average compliance ratio for the first six months of the study was 1.06 ± 0.01 (range 0.46 – 2.13) and for the full twelve months was 1.05 ± 0.01 (range 0.58 – 2.08). Conclusions: The data shown here indicates that as a group, long-term, stabilised statin users appear compliant. However, the range of values obtained show that there are identifiable subsets of patients who are not taking their therapy as prescribed. Although the apparent use of more doses than prescribed in some patients may result from medication hording, this cannot be the case in the patients who apparently take less. It has been demonstrated here that the compliance ratio can be used as an early indicator of problems allowing targeted compliance advice can be given where it will have the most benefit. References: News Editorial. Pharmacy records could be used to enhance statin compliance in elderly. Pharm. J. 2002; 269: 121.

Restoring phronesis and practice: marketing's forgotten p's

Purpose – The purpose of this paper is to examine the evolution of marketing’s philosophical conversation over the past 120 years, focusing on the emergent meaning of the notion that marketing should become more “scientific”. Design/methodology/approach – This paper focuses on the US academic marketing literature, primarily journal articles and books published in the first half of the 20th century. Findings – The Aristotelian distinction between techné, epistemé and phronesis provides a rich basis for framing philosophical discussion in marketing, and should supplant the art-science debate and Anderson’s distinction between science1 and science2. Prior to 1959, the marketing journals provided a forum for phronesis, though this diminished as the academic marketing community largely abandoned the inductive, contextual approach in favour of a deductive, “scientific” methodology. The Ford Foundation played an important role in effecting this change. Practical implications – The paper highlights the importance of forums where practitioners can reflect on the ethical and social implications of their practices and then work to enhance these practices for the greater social good. Social implications – Questions the value of distinctions between marketing theorists and practitioners and the consequential focus of marketing journals. Originality/value – Advances the concept of phronesis in the marketing literature and distinguishes it from epistemé, which has dominated academic marketing discourse over the past 60 years.

An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.

In Western industrialized countries, it is well established that legally competent individuals may choose a surrogate healthcare decision-maker to represent their interests should they lose the capacity to do so themselves. There are few limitations on who they may select to fulfill this function. However, many jurisdictions place restrictions on or prohibit the patient's attending physician or other provider involved with an individual's care to serve in this role. Several authors have previously suggested that respect for the autonomy of patients requires that there be few (if any) constraints on whomever they may appoint as a proxy. In this essay we revisit this topic by first providing a survey of current state laws governing this activity. We then analyze the clinical and ethical circumstances in which potential difficulties could arise. We take a more nuanced and circumspect view of prior suggestions that patients should have virtually unfettered liberty to choose their healthcare proxies. We suggest a strategy to balance the freedom of patients' right to choose their surrogates with fiduciary duty of the state as regulator of medical practice. We identify six domains of possible concern with such relationships and suggest straightforward methods of mitigating their potential negative effects that could be plausibly be incorporated into physician practice.

Sports coaching and the law of negligence: implications for coaching practice

The ordinary principles of the law of negligence are applicable in the context of sport, including claims brought against volunteer and professional coaches. Adopting the perspective of the coach, this article intends to raise awareness of the emerging intersection between the law of negligence and sports coaching, by utilising an interdisciplinary analysis designed to better safeguard and reassure coaches mindful of legal liability. Detailed scrutiny of two cases concerning alleged negligent coaching, with complementary discussion of some of the ethical dilemmas facing modern coaches, reinforces the legal duty and obligation of all coaches to adopt objectively reasonable and justifiable coaching practices when interacting with athletes. Problematically, since research suggests that some coaching practice may be underpinned by “entrenched legitimacy” and “uncritical inertia”, it is argued that coach education and training should place a greater emphasis on developing a coach’s awareness and understanding of the evolving legal context in which they discharge the duty of care incumbent upon them.

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.

Good looks and good practice: the attitudes of career practitioners to attractiveness and appearance

Empirical evidence attests the impact that career image has on objective career success, yet little is known of how career practitioners conceptualise and operationalise this information. This article presents the quantitative findings of an online survey of career practitioners (n=399, 74% female, 89% white, 75% from the UK) exploring their attitudes and practices towards issues of appearance and attractiveness. Career practitioners who participated in this survey acknowledged that beauty, self-presentation and interpersonal skills influence career success, and 96% of them considered conversations about career image as part of their professional remit. The career practitioners felt relatively comfortable and well informed in their discussions in this arena, but would welcome further guidance and training to inform their practice. Ethical and practical implications for the profession are considered.

The Anuvrat Movement: Theory and Practice

The slogan: “Self-restraint is life,” forms the philosophical ideal behind the Anuvrat Movement. The purpose of my thesis is to evaluate the Anuvrat Movement introduced by Acharya Tulsi as a non-sectarian, ethical-spiritual movement. The study considered in some detail the historical context within which the movement emerged. The thesis provides a much-needed analysis of the 11 vows formulated by Tulsi in the model of the traditional vows in Jainism. It explored the question whether these vows are relevant and effective in the contemporary Indian society, and whether Tulsi’s movement can cross the geographical boundaries of the Indian sub-continent to be a part of larger global initiatives. The study explored the social significance of the concepts of nonviolence, social justice and sustainability in the wider global community. The study suggests a positive association between the exemplary charismatic role of a leader and the popularity and longevity of social movements in India.

Ethical-moral courses of action and active citizenship in health students

Abstract Introduction: The practice of active citizenship, ethical-moral courses of action and civic, moral and ethics education are essentials for ethical decision making in health. Objetive: To determine if gender influences students’ ethical- moral course of action. Methods: Descriptive study with a non-probabilistic sample of 85 students enrolled in the 1st cycle of the health degree. Results: Of the participants surveyed 61.2% were found to say that action should take into account their moral principles, with ethical/ moral subjectivism prevailing; 44.7% consider that one should “Do what will have the best consequences for the greatest number of people”, with the principle of utilitarianism being significant; 55.3% think that “An action is ethically good” if “It is in accordance with morality”, thereby highlighting subjectivism/relativism; 45.9% believe that “ethical-moral values” “are relative and vary from society to society” agreeing with relativism as an explanatory principle for action. Males showed a greater tendency to support their decision-making with the principle of objectivism, (Fischer=.010). Conclusion: The results suggest that students’ ethical-moral education is required to promote an ethical-moral course of action in their professional practice. Thus, universities with their health courses should be at the forefront of this education, making their graduates ambassadors/interveners of a way of knowing and of being as well as promoters of the dignity of the citizen of the modern world.

Forms, Foundations, and the Ethos of Foremost: Zen Practice, Epistemology, and Ontology in Reflective Knowledge Organization

In reflecting on the practice of knowledge organization, we tacitly or explicitly root our conceptions of work and its value in some epistemic and ontological foundation. Zen Buddhist philosophy offers a unique set of conceptions vis-à-vis organizing, indexing, and describing documents.When we engage in knowledge organization, we are setting our mind to work with an intention. We intend to make some sort of intervention. We then create a form a realization of an abstraction (like classes or terms) [1], we do this from a foundation of some set of beliefs (epistemology, ontology, and ethics), and because we have to make decisions about what to privilege, we need to decide what is foremost in our minds. We must ask what is the most important thing?Form, foundation, and the ethos of foremost require evoke in our reflection on work number of ethical, epistemic, and ontological concerns that ripple throughout our conceptions of space, “good work”, aesthetics, and moral mandate [2,3]. We reflect on this.