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BACKGROUND: In Myanmar, ongoing conflict since the 2021 military coup d'etat has been characterized by targeted violence against health workers (HWs), particularly those participating in the pro-democracy movement. Existing knowledge about the challenges faced by health workers in Myanmar is scant, including their perspectives on mitigating their suffering and the broader impact on community health. This knowledge gap prompted our study to assess the extent of the violence, its impact on the workers and the community, and identify resource priorities. METHODS: This qualitative study employed purposive and snowball sampling to recruit health workers affiliated with the Civil Disobedience Movement (CDM). We interviewed 24 HWs in Myanmar between July and December 2022, predominantly physicians and nurses. We used a semi-structured interview guide and conducted interviews remotely due to the security situation. We adopted content analysis to understand participation in the CDM movement, experiences of violence, personal and professional impacts, the sequelae to community health, how HWs responded as well as their ongoing needs. RESULTS: Thematic content analysis revealed that violence was both individually targeted and widespread. Health workers faced professional, financial, and personal impacts as a result. The health system as a whole has been severely diminished. Health workers have had to adapt to continue to provide care, for example some fled to rural areas and worked clandestinely, exchanging their services for food and shelter. In those settings, they continued to face insecurity from airstrikes and arrests. Health workers have also experienced moral distress and burden due to their resistance and protest against the regime. CONCLUSION: The coup and ensuing violence severely disrupted the healthcare system, resulting in shortages of supplies, reduced quality of care, and exacerbated challenges during the COVID-19 pandemic. Despite facing significant hardships, HWs remained resilient, engaging in resistance efforts within the CDM and seeking support from local communities and international organizations. They expressed a need for increased awareness, financial assistance, and concrete support for the health system to address the crisis.

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In the article "Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience," Abram L. Brummett, Tanner Hafen, and Mark C. Navin reject what they call the "referral asymmetry" in U.S. conscientious objection law in medicine, which recognizes rights of conscientiously objecting physicians to withhold referrals for medical interventions but does not (yet) recognize rights of physicians to make referrals for medical interventions to which they are morally committed but to which their health care institutions are morally opposed. This commentary concentrates on a second asymmetry, namely, the relationship of a health care provider's referral or nonreferral to the medical standard of care. The commentary argues that this second asymmetry seems to require action more appropriately recognized as civil disobedience than conscientious provision of referral.

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The world's understanding of the climate and ecological crises rests on science. However, scientists' conventional methods of engagement, such as producing ever more data and findings, writing papers and giving advice to governments, have not been sufficiently effective at persuading politicians to act on the climate and ecological emergency. To date, governments' decisions (such as continuing with vast subsidies for fossil fuels) clearly show that powerful vested interests have been much more influential than the amassed scientific knowledge and advice. We argue that in the face of this inaction, scientists can have the maximum amount of influence by lending their support to social movements pressing for action, joining as active participants and considering civil disobedience. Scientists seeking to halt continued environmental destruction also need to work through our institutions. Too many scientific organizations, from national academies of science to learned societies and universities, have not taken practical action on climate; for example, many still partner with fossil fuel and other compromised interests. We therefore also outline a vision for how scientists can reform our scientific institutions to become powerful agents for change.

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Since the U.S. Supreme Court's decision in Dobbs vs. Jackson Women's Health Organization, a growing web of state laws restricts access to abortion. Here we consider how, ethically, doctors should respond when terminating a pregnancy is clinically indicated but state law imposes restrictions on doing so. We offer a typology of cases in which the dilemma emerges and a brief sketch of the current state of legal prohibitions against providing such care. We examine the issue from the standpoints of conscience, professional ethics, and civil disobedience and conclude that it is almost always morally permissible and praiseworthy to break the law and that, in a subset of cases, it is morally obligatory to do so. We further argue that health care institutions that employ or credential physicians to provide reproductive health care have an ethical duty to provide a basic suite of practical supports for them as they work to ethically resolve the dilemmas before them.

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Resumo: A partir de uma perspectiva decolonial, o objetivo da pesquisa foi compreender os lugares do negro na Psicanálise atualmente. Para isto, foram realizadas 13 entrevistas semiestruturadas com psicólogas e psicanalistas negras com prática clínica. A partir de análise categorial-temática, identificamos quatro categorias: escolha da Psicanálise, articulações entre Psicanálise e relações raciais, descobrindo-se negra e a cor da Psicanálise e das (não) psicanalistas. Diante do reconhecimento das limitações da Psicanálise, foi a experiência vivida do negro o motor de deslocamento ontológico que viabilizou desobediências epistêmicas configuradas na articulação da Psicanálise com teorias sociais. Este resultado evidencia o entrelaçamento da colonialidade do saber e do ser na matriz colonial do poder e enfatiza a desobediência ontológica como via fundamental para práticas psis antirracistas.

Resumen: Desde una perspectiva decolonial, el objetivo de la investigación fue comprender los lugares de las personas negras en el Psicoanálisis hoy. Para ello, se realizaron 13 entrevistas semiestructuradas a psicólogas y psicoanalistas negras con práctica clínica. A partir de un análisis categorial-temático identificamos cuatro categorías: elección del Psicoanálisis, articulaciones entre Psicoanálisis y relaciones raciales, descubrirse negra y el color del Psicoanálisis y de las (no) psicoanalistas. Dado el reconocimiento de las limitaciones del Psicoanálisis, fue la experiencia vivida por las personas negras el motor del desplazamiento ontológico que permitió la desobediencia epistémica configurada en la articulación del Psicoanálisis con las teorías sociales. Este resultado resalta el entrelazamiento de la colonialidad del conocimiento y el estar en la matriz colonial de poder y enfatiza la desobediencia ontológica como un camino fundamental hacia las prácticas psi antirracistas.

Abstract: From a decolonial perspective, the aim of the research was to understand the places of black people in Psychoanalysis today. For this, 13 semi-structured interviews were carried out with black psychologists and psychoanalysts with clinical practice. From a categorical-thematic analysis, we identified four categories: choosing Psychoanalysis, articulating Psychoanalysis and racial relations, discovering oneself as black and the color of Psychoanalysis and of (non) psychoanalysts. Given the recognition of Psychoanalysis's constraints, it was the lived experience of black people that was the engine of ontological displacement that enabled epistemic disobedience configured in the articulation of Psychoanalysis with social theories. This result highlights the intertwining of the coloniality of knowledge and being in the colonial matrix of power, emphasizing ontological disobedience as a fundamental path to anti-racist psychological practices.

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In this article, we examine the citational practices of US medical anthropology and seek to decenter Western-centric theory to minimize its theoretical dominance in the field. We call for a robust engagement with a broader variety of texts, genres of evidence, methodologies, and interdisciplinary forms of expertise and epistemology in response to the unbearable whiteness of the citational practices we critique. The practices are unbearable in that they do not support or scaffold the work we need to do as anthropologists. We hope this article invites readers to move in different citational directions to build foundations and epistemologies that support and enrich the capacity for anthropological analysis.

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The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, eliminating the national right to abortion, poses challenges to psychiatrists and patients. Abortion laws now vary widely from state to state and are constantly changing and being challenged. The laws affect both patients and health care professionals; some prohibit not only the performance of abortion but efforts to inform and assist patients seeking abortion. Patients may become pregnant during and/or because of episodes of clinical depression, mania, or psychosis, and recognize that their current circumstances will not allow them to become adequate parents. Some laws allowing abortion to protect a woman's life or health explicitly exclude mental health risks; many prohibit transfer of a patient to a permissive venue. Psychiatrists working with patients contemplating abortion can convey the scientific evidence that abortion does not cause mental illness and help them identify and work through their own beliefs, values, and likely responses to the decision. Psychiatrists will also have to decide whether medical ethics or state laws will govern their own professional behavior.

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This paper seeks to investigate and assess a particular form of relationship between the State and its citizens in the context of the COVID-19 pandemic, namely that of obedience to the law and its related right of protest through civil disobedience. We do so by conducting an analysis and normative evaluation of two cases of disobedience to the law: (1) healthcare professionals refusing to attend work as a protest against unsafe working conditions, and (2) citizens who use public demonstration and deliberately ignore measures of social distancing as a way of protesting against lockdown. While different in many aspects, both are substantially similar with respect to one element: their respective protesters both rely on unlawful actions in order to bring change to a policy they consider unjust. We question the extent to which healthcare professionals may participate in civil disobedience with respect to the duty of care intrinsic to the medical profession, and the extent to which opponents of lockdown and confinement measures may reasonably engage in protests without endangering the lives and basic rights of non-dissenting citizens. Drawing on a contractualist normative framework, our analysis leads us to conclude that while both cases qualify as civil disobedience in the descriptive sense, only the case of healthcare professionals qualifies as morally justified civil disobedience.

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Neste trabalho objetiva-se compartilhar e analisar uma experiência de ensino-aprendizagem que buscou articular a formação acadêmica de estudantes de graduação em psicologia com a formação profissional de trabalhadores(as) da Política Nacional de Assistência Social, configurando-se simultaneamente como processo político-pedagógico e de intervenção. A experiência foi desenvolvida no âmbito de uma disciplina do curso de graduação em psicologia de uma universidade federal no Nordeste do Brasil, considerando preceitos relativos à prática da extensão universitária como ação política e epistemológica da universidade, bem como a Política Nacional de Formação Permanente do Sistema Único de Assistência Social. Utilizamos uma metodologia dialógica de construção do trabalho, que passou por várias etapas de negociação envolvendo docentes, gestores(as), discentes e trabalhadores(as), que é aqui apresentada. Os encontros realizados foram marcados pela indissociabilidade entre prática e teoria. As reflexões evidenciaram a importância da qualificação e politização das práticas de ensino-aprendizagem da psicologia e da atuação de profissionais inseridos(as) na política de assistência social. Do mesmo modo, pontuou-se as complexidades que caracterizam o trabalho com populações que vivem em situações de desigualdade e exclusão social, detendo-se nas especificidades do contexto brasileiro e local, com a abordagem de questões como a racialização e generificação da pobreza. A avaliação da experiência realizada nos permite afirmar que é possível fazer da sala de aula um espaço de compartilhamento de práticas e saberes, integrado aos campos de exercício profissional, com a criação de processos de aprendizagem contra-hegemônicos com relação às perspectivas tradicionais, fazendo de todos(as) copartícipes de sua própria formação.(AU)

In this work, we intend to share and analyze a teaching-learning experience that tried to articulate the academic formation of undergraduates in Psychology with the professional formation of workers of the Social Assistance National Policy, configuring itself simultaneously as a political-pedagogic and an intervention process. The experience was developed within a discipline of the Psychology undergraduate course in a federal university in Brazil Northeast region, considering precepts related to the practice of university extension as political and epistemological action, and to the National Policy of Permanent Education of the Unified Social Assistance System. We used a dialogical methodology to construct the work, which entailed several negotiation stages involving teachers, managers, students, and workers, as shown in this text. The meetings were marked by the indissociability between practice and theory. The reflections highlighted the importance of qualification and politicization of teaching-learning practices in Psychology and of the action of workers inserted in the social assistance policy. Likewise, they pointed out the complexities that characterize the work with populations that live in situation of inequality and social exclusion, concentrating on the specificities of both Brazilian and local contexts, approaching issues such as racialization and gendering of poverty. The evaluation of the experience carried out allows us to state that turning the classroom into a space for sharing practices and knowledges, integrated to the fields of professional practice, with the creation of counter-hegemonic learning processes against the traditional perspectives, making everyone co-participant in their own education, is possible.(AU)

Este trabajo tiene por objetivo compartir y analizar una experiencia de enseñanza-aprendizaje que buscó articular la formación académica de estudiantes de pregrado en psicología con la formación profesional de los/as trabajadores/as de la Política Nacional de Asistencia Social, configurándose simultáneamente como proceso político-pedagógico y de intervención. Se desarrolló la experiencia en una asignatura en el curso de pregrado de psicología en una universidad federal en el Nordeste de Brasil, considerando los supuestos relacionados con la extensión universitaria como acción política y epistemológica de la universidad, así como Política Nacional para la Formación Continua del Sistema Unificado de Asistencia Social. Se aplicó una metodología dialógica de construcción del trabajo, que pasó por varias etapas de negociación con la participación de maestros/as, gerentes, estudiantes y trabajadores/as. Los encuentros realizados estuvieron marcados por la inseparabilidad entre la práctica y la teoría. Las reflexiones mostraron la importancia de calificar y politizar las prácticas de enseñanza-aprendizaje de la psicología y la acción de profesionales insertados en la política de asistencia social. Asimismo, se resaltaron las complejidades que caracterizan el trabajo con poblaciones que viven en situaciones de desigualdad y exclusión social, centrándose en las especificidades del contexto brasileño y local, abordando cuestiones como la racialización y la generificación de la pobreza. La evaluación de la experiencia realizada nos permite afirmar que es posible hacer de las clases un espacio para compartir prácticas y conocimientos, integrado con los campos de la práctica profesional, con la creación de procesos de aprendizaje contrahegemónicos a las perspectivas tradicionales, haciendo de todos/as coparticipantes en su propia formación.(AU)

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The proper role of conscience in healthcare continues to be a topic of deep interest for bioethicists, healthcare professionals, and health policy experts. This issue of HEC Forum brings together a collection of articles about features of these ongoing discussions of conscience, advancing the conversations about conscience in healthcare from a variety of perspectives and on a variety of fronts. Some articles in this issue take up particularly challenging cases of conscientious objection in practice, such as Fleming, Frith, and Ramsayer's contextually rich piece on midwives in Scotland or Harter's professionally grounded analysis; others engage the changing institutional landscapes which impact considerations of conscience, such as Cummins' work on the role of employers in institutional policies about conscience and Ben Moshe's discussion of publicity and institutional committees. Pieces by Howard and Pilkington both raise conceptual considerations about how we think about the role of conscience in medicine, questioning the use of "conscientious objection" in these discussions, and Byrnes pushes back on the most influential work in this area by Mark Wicclair. The issue concludes with a piece by Wicclair, which engages each of these distinct offerings, further extending the discussions of conscience in healthcare and helpfully connecting key themes discussed by authors in this issue to his contributions and to the longer tradition of discussions of conscience in medicine. This issue challenges readers to engage different arguments from different perspectives and asks them-in some cases-to be open to revising how they think about the role of conscience and the existence of and justification for conscientious objection in the dynamic, interdisciplinary fields of healthcare.

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South African speech-language and hearing (SLH) professions are facing significant challenges in the provision of clinical services to patients from a context that is culturally and linguistically diverse (CLD) due to historic exclusions in higher education training programmes. Over 20 years postapartheid, little has changed in training, research, as well as clinical service provision in these professions. In line with the Health Professions Council of South Africa's (HPCSA) SLH Professional Board's quest to transform SLH curriculum and in adherence to its recently published Guidelines for Practice in a CLD South Africa, in this review article, the authors deliberate on re-imagining practice within the African context. They do this within a known demand versus capacity challenge, as well as an existing clinician versus patients CLD incongruence, where even the clinical educators, a majority of whom are not African, are facing the challenge of an ever more diverse student cohort. The authors systematically deliberate on this in undergraduate clinical curriculum, challenging the professions to interrogate their clinical orientation with respect to African contextual relevance and contextual responsiveness (and responsibility); identifying gaps within clinical training and training platforms; highlighting the influencing factors with regard to the provision of linguistically and culturally appropriate SLH clinical training services and, lastly, making recommendations about what needs to happen. The Afrocentric Batho Pele principles, framed around the concept of ubuntu, which guide clinical intervention within the South African Healthcare sector, frame the deliberations in this article.

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This paper critically analyses conscientious objection to abortion in the context of the new regulation of pregnancy termination in Chile. It argues that adequate regulation should not be blind: The bioethical requirements that seek to balance the interests involved must consider the legal regulation of the interests at stake, the context in which they are implemented, and, fundamentally, the effectiveness of the solutions adopted. Attention should be paid to the risks involved in the political use of conscientious objection to prevent the implementation of women's reproductive rights. In describing the process of the entrenchment and expansion of conscientious objection to abortion in Chile, we show how this process has overprotected conscience and how the risks of undermining the effectiveness of the new abortion legislation hinder the enjoyment of rights entrenched by the law.

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The distribution of credit, resources and opportunities in science is heavily skewed due to unjust practices and incentives, hardwired into science's rules, guidelines and conventions. A form of resistance widely available is to break those rules. We review instances of rule-breaking in scientific authorship to allow for a redefinition of the concept of civil disobedience in the context of academic research, as well as the conditions on which the label applies. We show that, in contrast to whistleblowing or conscientious objection, civil disobedience targets science's injustice on a more systemic level. Its further development will ease critical evaluation of deviant actions as well as helping us evaluate deviance, defiance and discontent in science beyond issues of authorship. However, empirically, civil disobedience in science engenders uncertainties and disagreements on the local status of both act and label.

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The present research aims to investigate the psychosocial phenomena of obedience and disobedience in young adults residing in the United States, as a replication of a previous study by Pozzi, Fattori, Bocchiaro, and Alfieri (2014). We utilize social representation theory as a means to better understand and define (dis)obedience, a behavioral dimension of the concept of authority. The analysis was conducted using a concurrent mixed methods design. One hundred and fifty-one participants completed a self-report online questionnaire. The results indicate that participants see both obedience and disobedience as related to an authority. Obedience was mostly perceived as an ability to be responsive to laws, social norms, or physical authorities, as well as a positive social object. Disobedience, instead, was defined as a failure of a negative line of conduct. These results differ from previous research, contributing meaningfully and pragmatically to the theoretical debate on (dis)obedience. Theoretical and practical implications of these findings are discussed.

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BACKGROUND: In 2006, a local collective combating homelessness set up an 'experimental squat' in an abandoned building in Marseille, France's second largest city. They envisioned the squat as an alternative to conventional health and social services for individuals experiencing long-term homelessness and severe psychiatric disorders. Building on what they learned from the squat, some then joined a larger coalition that succeeded in convincing national government decision-makers to develop a scientific, intervention-based programme based on the Housing First model. This article analyses the political process through which social movement activism gave way to support for a state-funded programme for homeless people with mental disorders. METHODS: A qualitative study of this political process was conducted between 2006 and 2014, using a hybrid theoretical perspective that combines attention to both top-down and bottom-up actions with a modified Advocacy Coalition Framework. In addition to document analysis of published and grey literature linked to the policy process, researchers drew on participant observation and observant participation of the political process. Data analysis consisted primarily of a thematic analysis of field-notes and semi-structured interviews with 65 relevant actors. RESULTS: A coalition of local activists, state officials and national service providers transformed knowledge about a local innovation (an experimental therapeutic squat) into the rationale for a national, scientifically based project consisting of a randomised controlled trial of four state-supported Housing First sites, costing several million euros. The coalition's strategy was two-pronged, namely to defend a social cause (the right to housing) and to promote a scientifically validated means of realising positive outcomes (housing tenure) and cost-effectiveness (reduced hospitalisation costs). CONCLUSION: Activists' self-agency, especially that of making themselves audible to public authorities, was enhanced by the coalition's ability to seize 'windows of opportunities' to their advantage. However, in contrast to the United States and Canadian Housing First contexts, which are driven by implementation science and related approaches, it was grassroots activists who promoted a scientific-technical approach among government officials unfamiliar with evidence-based practices in France. The windows of opportunity nevertheless failed to attract participation of those most in need of housing, raising the question of whether and how marginalised and/or subordinate groups can be integrated into collaborative research when a social movement-driven innovation turns into a scientific approach. TRIAL REGISTRATION: The current clinical trial number is NCT01570712 . Registered July 17, 2011. First patient enrolled August 18, 2011.

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From 1989 through September 2017, Chile's highly restrictive abortion laws exposed women to victimisation and needlessly threatened their health, freedom and even lives. However, after decades of unsuccessful attempts to decriminalise abortion, legislation regulating pregnancy termination on three grounds was recently enacted. In the aftermath, an aggressive conservative drive designed to turn conscientious objection into a pivotal new obstacle, mounted during the congressional debate, has led to extensive, complex arguments about the validity and legitimacy of conscientious objection. This article offers a critical review of the emergence of conscientious objection and its likely policy and ethical implications. It posits the need to regulate conscientious objection through checks and balances designed to keep it from being turned into an ideological barrier meant to hinder women's access to critical healthcare.

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Resumo Este escrito busca compartilhar reflexões, tensionamentos e intenções que o contato com o pensamento decolonial pode provocar nos estudos sobre gênero e ciência, significando um possível movimento de insubmissão capaz de potencializar a crítica feminista à ciência. Os caminhos aqui percorridos pelas ideias são produzidos pela imersão no pensamento decolonial, por meio de pesquisa bibliográfica, em confronto com uma trajetória de pesquisas realizadas sobre as expressões da discriminação de gênero nas universidades e na Política de Ciência, Tecnologia & Inovação no contexto do Nordeste brasileiro. Como maior contribuição, traz para o centro do debate a desobediência epistêmica como necessária à crítica feminista - como contraposição não somente ao sexismo de modo abstrato, mas que o compreenda como parte indissociável das relações raciais, étnicas, econômicas e epistêmicas.

Resumen Este escrito busca compartir reflexiones, tensiones e intenciones que el contacto con el pensamiento decolonial puede provocar en los estudios sobre género y ciencia, significando un posible movimiento de insumisión capaz de potenciar la crítica feminista a la ciencia. Los caminos aquí transitados por las ideas son producidos por la inmersión en el pensamiento decolonial, por medio de investigación bibliográfica, en confrontación con una trayectoria de investigaciones realizadas sobre las expresiones de la discriminación de género en las universidades y en la Política de Ciencia, Tecnología e Innovación en el Nordeste de Brasil. Como mayor contribución, aporta al centro del debate la desobediencia epistémica como necesaria para la crítica feminista, como contraposición no sólo al sexismo de modo abstracto, sino que lo comprenda como parte indisociable de las relaciones raciales, étnicas, económicas y epistémicas.

Abstract This paper requests to share reflections, tensions and intentions that the decolonial thought can provide in the studies on gender and science, meaning a possible movement of insubmission capable of fortification the feminist critique of science. In this, the ideas are produced by the bibliographical research on decolonial thinking in contrast with a trajectory of previous researches on gender discrimination in the universities and Policy of Science, Technology & Innovation in the Northeast of Brazil. As a principal contribution, it puts epistemic disobedience as necessary to feminist critique - as contraposition to sexism only in an abstract way, but to understand it as an inseparable part of racial, ethnic, economic, and epistemic relations.

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A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of 'conscientious objection' (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and 'obstructionist CO', based on the motivations or actions of various objectors. This paper argues that 'CO' in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.

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Across six Experimental conditions with university student participants (N=600), we examined some of the dynamics underlying expressed defiance to unjust authority. Results revealed disobedience was best enacted by participants low in right-wing authoritarianism and was more likely to occur when: 1) in physical proximity of other rebels, 2) the authority made two demanding requests instead of one, and 3) there had been an earlier opposition to injustice. Results are discussed within the theoretical framework of bounded rationality.