The social ecological model (SEM) is a conceptual framework that recognizes individuals function within multiple interactive systems and contextual environments that influence their health. Medical Legal Partnerships (MLPs) address the social determinants of health through partnerships between health providers and civil legal services. This paper explores how the conceptual framework of SEM can be applied to the MLP model, which also uses a multidimensional approach to address an individual’s social determinants of health.

Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...) goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well‐being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work. (shrink)

Issues surrounding the inclusion of transgender and intersex athletes in the women’s category in sport have spurred vigorous, and sometimes vicious, debate. The loudest voices on one edge of the de...

For qualitative researchers seeking the perspectives of people with unusual characteristics or circumstances, compliance with expectations about participant anonymity can be difficult, if not impossible. In the age of internet communications and emerging research methodologies, traditional strategies require ongoing re-examination to ensure cohesion between a project’s ethical framework and its research practice. This paper reflects on the approach to informed consent used in a study with parent carers whose children had high-level support needs. A two-step process of written consent was (...) developed in response to concerns about the possible re-identification of these parents as a result of their highly individual circumstances. This approach acknowledged the potential for identification, and maximised participants’ agency in choosing the level of risk that they were comfortable to accommodate. The paper discusses the researcher’s and participants’ responses to the adapted consent process and recommends that researchers and ethics review committees remain open to the development of collaborative and innovative approaches that are also culturally and contextually relevant, to enable people to contribute perspectives that might otherwise be silenced by the very ethical frameworks that purport to protect their interests. (shrink)

There is a growing trend in Australia to require lawyers to certify reasonable prospects of success for the cases they bring and defend. New South Wales has led the way with the Legal Profession Act 2004 (NSW) Pt 3.2 Division 10 requiring legal practitioners to certify reasonable prospects of success in all claims for damages. The requirement places a significant onus on lawyers to make a judgment about the merits of a case before it is begun, yet the common law (...) has long provided mechanisms to ensure that cases without prospects of success do not go to trial. This article considers Australian legislative provisions requiring lawyers to certify reasonable prospects of success of cases. It examines the application of the NSW legislation by the courts highlighting the difficulties of interpretation of what constitute 'reasonable prospects of success' and the application of the legislation in the context of the dynamic litigation process. It is argued that these legislated obligations on lawyers will have a detrimental effect on access to justice by denying parties, in particular plaintiffs, the opportunity to have their cases properly and fully determined in the courts. This article examines common law mechanisms for dissuading cases without prospects and argues that the general law is an effective system for ensuring that cases without prospects of success are not maintained. The Australian experience is instructive for consideration of optimal reform packages for the administration of justice and to evaluate the role of any litigation lawyer within the judicial and court process. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

This paper examines the extent to which parents have absorbed New Right ideas about education and acted accordingly. What emerges is that their commitment to the rhetoric of school choice is strong. However, concepts such as the market and competition are viewed less favourably. An important theme here is the avoidance by parents of any collective agenda in discussing education policy, a factor that may thwart those who attempt to predict their responses to government policy for schools.

A survey of the philosophy of sport literature reveals that arguments regarding the issue of sex segregation in athletics have been advanced from time to time, but there has been little sustained discussion, no consensus, and no change in existing practice. In this paper, an effort to advance the conversation, I begin with Jane English’s seminal 1978 article as a springboard and employ existing literature on the question of sex segregation in order to raise difficulties with English’s analysis and outline (...) the basic alternative positions that have been taken on the issue. My own contribution to the conversation is in the introduction of four distinctions – between individual and team sports, direct and indirect competition, contact and non-contact sports, and amateur and professional sports – that have not been part of the discussion about the conditions under which men and women might compete against one another. These distinctions resolve several difficulties noted by others and suggest a more nuanced conclusion about desirable changes to the structure of sporting competition. (shrink)

Nurses’ bodywork: is there a body of work? The work that many nurses do involves the use of their own body as one of the tools of their occupation. Being a nurse, in many cases, means controlled, purposeful use of her or his own body oriented to the patient. This paper discusses some of the ways in which nurses’ bodies and the work that those bodies do are represented in professional and academic research accounts and made relevant in literature. Using (...) instances of bodies and bodily activity mentioned in a variety of literature, the paper discusses three categories of accounts of nursing bodywork: those which are problematised and where the nurse's body is seen as a topic for investigation, and those which are unproblematised either explicitly discussing bodily activity (for example, touch) or implicitly dealing with bodywork (for example, taking blood pressure). Four ways in which nurses’ bodies are made relevant in accounts are proposed: relational, corporate, instrumental and human.The paper discusses the prominence (or not) nurses’ bodies are given in professional and academic accounts, as a contribution to preliminary work of generating a topic for investigation and concludes with some suggestions as to how this investigative project might be taken forward, focusing primarily on an examination of methodic practices, or how bodywork is brought off and executed as a skilled but taken‐for‐granted activity. (shrink)

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the (...) debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

In this paper, we examine the case of Ronda Rousey, a high profile female Mixed Martial Arts fighter in the Ultimate Fighting Championship. We argue that Rousey represents a female athlete who can be considered a gender transgressor yet simultaneously a Glamazon. The case of Rousey will be applied to gender transgressor theories to demonstrate that Rousey counters traditional discourse which holds that exhibiting stereotypically masculine traits implies not being an authentic woman. Female fighters face criticisms for being “unfeminine” or (...) “manly” because they participate in such an aggressive sport. Despite her gender divergent behaviour, as much as she transgresses, Rousey is also pinned by sporting and societal sexist culture that reinforces sex binaries and exposes pressures to adhere to hyperfemininity and heterosexual ideals. Finally, using the notions of self and power found in Michel Foucault’s later work as a springboard, we examine whether Rousey’s embrace of the Glamazon identity is an act of autonomy or evidence of false consciousness. (shrink)

It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research study (...) that indicate that, although there is a shared conceptualization of ethics as "patient-centered care", there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather than exclusively on how they philosophically think about ethical dilemmas, the insights can be translated into practical strategies that can be utilized to strengthen the process of ethical decision making within the health care system. (shrink)

Two contrasting theories-actor-network theory and nondecision making-are separately applied to the same case study, namely, technologies for automatically identifying road vehicles. By this process, the strengths and weaknesses of each approach are highlighted: The actor-network approach is useful for understanding local processes but lacks tools for easily illuminating patterns across countries; by contrast, the concept of nondecision making is useful for explaining the general lack of implementation of technology for automatic vehicle identification but not for explaining variations between developments in (...) different countries. This study highlights the importance of attempting to compare theories by using the same case study. (shrink)

This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre‐registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice‐Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre‐registration nursing students is not only (...) supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. (shrink)

Plato famously characterized philosophy as practice for dying and death; contemporary philosophers in bioethics have produced a vast literature on the quest for a good death. Yet there is a relativ...

Roller derby, once known for scripted theatricality that made it more like a stage play than a sport, has reinvented itself as a legitimate athletic endeavour. Since its rebirth as the Women's Flat Track Derby Association in the early 2000s, it has experienced exponential growth, from 30 flat track derby leagues in 2005 to more than 450 leagues in 2010. This translates to more than 15,000 skaters worldwide. Roller derby provides a unique case of a women's sport that is not (...) derived from, or a diminutive version of, a men's sport, proudly stating as its philosophy a commitment to be?by the skaters, for the skaters?. This do-it-yourself aspect opens the way for examination of what a sport wholly created by women looks like and how that differs from sports created by men. The WFTDA claims that roller derby is empowering and revolutionary, yet some critics have claimed that the skaters reinforce rather than dismantle gender stereotypes. Using tools from previous gender critiques, I analyse several aspects of roller derby for their emancipatory potential and conclude that, while not completely unproblematic, the sport can function as a force for reshaping ideas about women, femininity, and sport. (shrink)

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and (...) bioethics and bring to light areas of further research. (shrink)

“Look Great Naked!” “Sexy Legs Now!” “Score a Perfect 10 Body!” These invitations appear regularly on the covers of glossy fitness magazines, always beside a photograph of a too-perfect-not-to-be-airbrushed, generally scantily clad, young woman. Are they really invitations or are they imperatives? What should we make of the apparently presumed connection between fitness and sex? These are the questions that drive this article, in which we distinguish between fitness and sport and provide a feminist account of fitness to set the (...) stage for analysis of the conflict between norms of femininity and heteronormativity in sport and in the fitness industry. We examine the medicalization of fitness to show that women’s... (shrink)

Medical ethics has traditionally been governed by two guiding, but sometimes conflicting, principlesthe Substituted Judgment Standard shows our concern for autonomy, whereas the Best Interest Standard shows our commitment to benevolence. Both standards are vulnerable to criticisms. Further, the principles can seem to offer conflicting prescriptions for action. The criticisms and conflict figure prominently in discussion of advance directive decisionmaking and Alzheimer's disease. After laying out each of the current standards and its problems, with Alzheimer's issues as my central concern, (...) I offer a new standard that avoids the problems while honoring our concerns for both autonomy and benevolence. (shrink)