End-of-life care in Ireland: ethical challenges and solutions. Opening Statement to the Houses of the Oireachtas Joint Committee on Health and Children, 24 October 2013.

Children Report on End of Life and Palliative Care in Ireland, Volume 1.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Article

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Article

Moral Masculinities: Ethical Self-fashionings of Professional Chinese Men in London

Through qualitative interviews and examination of textual sources, this essay investigates the gendered, class and cultural subjectivities of transnational, highly-educated Chinese men living and working in London. Narrative analysis of the interviews of two participants suggests that they exhibit hybrid “bricolage masculinities,” which incorporate elements from Western educational and corporate cultures, and also appropriate concepts and practices from the Confucian tradition of moral self-cultivation. A discussion of contemporary texts that support the revival of Confucian masculinities illuminates the discursive context in which the participants’ ethical self-fashionings take place. The study argues that the cosmopolitan yet culturally embedded masculinities of the participants are suggestive of how professional Chinese men, as they step onto the world stage, seek to insert themselves more advantageously into local and global power relations of gender, class and nation.

Law, Rights and Reproduction: Reproductive Autonomy in Ethical Rationalism

As medical technology has advanced, so too have our attitudes towards the level of control we can expect to hold over our procreative capacities. This creates a multi-dimensional problem for the law in terms of access to services which prevent conception, access to services which terminate a pregnancy and recompensing those whose choices to avoid procreating are frustrated. These developments go to the heart of our perception of autonomy. In order to evaluate these three issues in relation to reproductive autonomy, I set out to investigate how the Gewirthian theory of ethical rationalism can be used to understanding the intersection between law, rights, and autonomy. As such, I assert that it is because of agents’ ability to engage in practical reason that the concept of legal enterprise should be grounded in rationality. Therefore, any attempt to understand notions of autonomy must be based on the categorical imperative derived from the Principle of Generic Consistency (PGC). As a result, I claim that (a) a theory of legal rights must be framed around the indirect application of the PGC and (b) a model of autonomy must account for the limitations drawn by the rational exercise of reason. This requires support for institutional policies which genuinely uphold the rights of agents. In so doing, a greater level of respect for and protection of reproductive autonomy is possible. This exhibits the full conceptual metamorphosis of the PGC from a rational moral principle, through an ethical collective principle, a constitutional principle of legal reason, a basis for rights discourse, and to a model of autonomy. Consequently, the law must be reformed to reflect the rights of agents in these situations and develop an approach which demonstrates a meaningful respect of autonomy. I suggest that this requires rights of access to services, rights to reparation and duties on the State to empower productive agency.

The recent development and performance of ethical investments

In this chapter, we assess the recent development and performance of ethical investments around the world. Ethical investments include both socially responsible investments (following Environmental, Social and Governance criteria) and faith-based investments (following religious principles). After presenting the development of each type of funds in a historical context, we analyse their ethical screening process, highlighting similarities and differences across funds and regions. This leads us to investigate their characteristics in terms of return and risk, and finally evaluate their historical performance using various risk-adjusted performance measures on a small sample of US funds. Hence we are able to not only compare the performance of each fund with each other and with traditional investments, but also assess their relative resilience to the 2007-08 financial crisis.

The Legal, Medical and Cultural Regulation of the Body: Transformation and Transgression

The regulation of the body provides an important concern in law, medical practice and culture. This volume contributes to existing research in the area by encouraging experts from a range of related disciplines to consider the legal, cultural and medical ways in which we regulate the body, further exploring how conceptions of self, liberalism, property and harm inform and influence contentious legal and ethical questions about what we can and cannot do to or with our own bodies.

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.

Conditions for Teaching and Learning in Religious Education (RE) : Perspectives of Teachers and Pupils at the Beginning of the 6th Grade in Sweden

In this article empirical findings from interviews with teachers of three classes of 12-year-old pupils are presented, together with questionnaire-responses from these 54 pupils. The interviews focus on teaching aims for Religious Education (RE), a subject that in Sweden, besides dealing with religion, also explores other kinds of beliefs, ethics and life questions. In the questionnaire the pupils are asked to solve four RE tasks with content that is central from a Swedish curriculum perspective. The research involves pupils at the beginning of the sixth grade and the purpose of this article is to look at the teachers’ aims and the pupils’ responses, and consider what these may indicate about conditions for teaching and learning RE in these classes. The findings show that the perspectives of the pupils at the beginning of the sixth grade seem to be rather far from the expectations of the RE syllabus. The pupils’ statements are rather vague with regard to religion as a phenomenon and there are few examples of pupils interpreting religious symbols in a way that is useful in further analysis. While existential and ethical plots, messages and point of views are comparatively easy to describe, it is harder to express multiple perspectives, reasons, comparisons and questions. A problem for the teachers in developing the perspectives of their pupils is that they find it hard to say what kind of general difficulties pupils have in RE, a fact that makes it hard to direct the teaching. Another challenge is that the teachers’ RE-aims are rather overarching and primarily related to fostering fundamental values. What improves the conditions for teaching and learning is the teachers’ concern for the pupils and their relationships with the teacher and with each other, a factor which is of vital importance for learning and which can also be used as a specific teaching method in subject matter education.

Microbiota assessment in optical shops: an ignored concern to public health

The presence of microorganisms in ophthalmic instruments and surfaces can lead to the exposure of patients to several infections. However, there is no information regarding fungal and bacteria contamination in optical shops. This study aims to characterize fungi and bacteria contamination in air and surfaces from 10 optical shops covering also ophthalmic instruments. Air samples were collected through an impaction method onto malt extract agar (MEA) supplemented with chloramphenicol (0.05%) used for fungi and Tryptic Soy Agar (TSA) supplemented with nystatin (0.2%) used for bacteria. Outdoor samples were also performed to be used as reference. Surface and equipment’s swab samples were also collected side-by-side. All the collected samples were incubated at 27ºC for 5 to 7 days (fungi) or at 30º for 7 days (bacteria). Regarding fungal distribution, thirteen different species/genera were found in the air, being the most common Alternaria sp. (62.0%). Eight different species/genera were identified in the surfaces, ranging from 2 to 5x104 CFU/m2, being the most common A. versicolor complex and Penicillium sp. (40.0%). The trial frames were the most contaminated equipment, since 50.0% of the collected samples were with countless colonies. The airborne bacterial population indicated higher concentrations in the contactology office (average: 133 CFU/m3) than in the client’s waiting rooms (average: 126 CFU/m3). The surface samples indicated bacterial concentrations ranging from 2x104 to 1x106 CFU/m2, pointing out the automatic refractometer as the surface with higher bacterial load.

Prevalence of Aspergillus section Fumigati in Portuguese slaughterhouses: a fungal and mycotoxin concern

Introduction - Within the Aspergillus genus, Aspergillus fumigatus species is one of the most ubiquitous saprophytic fungi and is considered the species with higher clinical relevance. The fungi belonging to the Fumigati section are the most common cause of invasive aspergillosis and a major source of infection related mortality in immunocompromised patients. One of the most abundant metabolites produced by Aspergillus fumigatus is the metabolite gliotoxin, which exhibits a diverse array of biologic effects on the immune system. Further, environments contaminated with A. fumigatus may be the cause or enhance respiratory problems in the workers of those specific settings. These species produce specific allergens and mycotoxins that could cause respiratory disorders. Aim of the study - The aim of the present work was to determine the prevalence of Aspergillus section Fumigati by cultural and molecular methods in poultry; swine and bovine; and large animal (bovine and horses) slaughterhouses.

Economics of Ethical and Prosocial Behavior: Experiments on Social Responsibility, Ignorance, and Cheating

In this thesis I experimentally investigate prosocial and ethical behavior in economic interactions. The thesis consists of three experimental research papers that have a broad range of research questions on social responsibility, ignorance and cheating. With these experiments I aim to better understand when and why people behave ethically and/or prosocially and which consequences it has on their own and other players’ payoffs, and on overall efficiency. The results from the three experimental studies suggest that (i) donations to charity by employees are rewarded in an experimental setting, and the effect is driven by reciprocal concerns; (ii) there is a significant fraction of people who decide not to know about negative consequences of own actions, and the sorting of social agents of a low type into ignorance drives self-interested behavior of ignorant agents; and (iii) if the possibility of being exposed as a liar is small, the tendency to lie increases with incentives, indicating that some people have positive and finite costs of lying. Furthermore, when the participants lie, they lie to the full extent, which suggests that the intrinsic cost of lying is fixed.