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Background This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. Discussion There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-maker’s research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. Conclusions This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant.

Recent visual theory on the decolonization of the photographic frame offers an important alternative to thinking of photographs as artifacts of the past. Here, the authors build on Ariella Azoulay’s idea of ‘watching’ photographs—as opposed to ‘looking’—to restore and reinscribe links to the past in order to locate ‘potential histories’ in the construction of America (2008, 2013). In ‘watching’ photographs in American engineer Maxwell Waide Smith’s albums of the Kansas City, Mexico Orient Railway (1907-1908) and the Panama Canal construction project (1913-1914), the authors explore the arena of action and actors beyond the frame of the photographs to contextualize the social and political histories in which the albums were made. Approaching photography as an event rather than an artifact enables consideration of the encounters recorded by the camera and the relations, responsibilities and repercussions generated by the photographic situation, from the perspectives of those implicated in the picture-making process. These photographic albums provide an opportunity for exploring the engineer’s perspective, contrasting it with views of laborers and local communities caught up in American nation-building activities. Between the albums, a clear transition appears through the lens of the young, naïve engineer in his first field project in Mexico, taking on a more imperialist perspective as a seasoned engineer in Panama. Presented is a reflection—founded on historical photographic analysis—on (discounted) opportunities to build a cooperative rather than competitive America, and to explore the internal cultural changes that took place within the U.S. as the nation moved from a progressive engine of modernity to an agent of expansionist imperialism., Iperstoria, No 11 (2018): American Constructions of Photography / Photographic Constructions of America

Since the invention of photography, the medium has played an increasingly central role in shaping spectators’ imagination of distant suffering and calamitous experiences. The discourse of humanitarianism has evolved alongside photography and has relied on the medium to give it shape. Indeed, humanitarianism is and always has been a photographic situation, which is to say, photography has played and continues to play a significant role in constituting the very terms of humanitarianism, including how it is referenced, conceived, understood, and practiced. This dissertation is concerned with the historical role of photography in shaping the humanitarian imagination, as well as the ways the medium has given form to and mediated the relations between its central actors. It also argues that knowing this history is crucial for advancing humanitarian photography and humanitarian relations writ large. Regarding Aid: The photographic situation of humanitarianism takes a cultural history approach that enables an exploration of the way in which photography can present links to the past, revealing the origins and the longstanding nature of some of the practices and debates around humanitarian photography. Using a variety of visual theories, I define photography as an event rather than a technology for producing pictures. The dissertation is built around three case studies: 1) Henry Dunant’s graphic language in A Memory of Solferino; 2) Lewis Hine’s European photographs for the American Red Cross taken during and immediately after the First World War; and, 3) a journalist’s photograph of the French army in Rwanda during the 1994 genocide which is prominently used in a memorial site. These case studies allow for an exploration of photography’s role in altering people’s perceptions with regard to distant suffering, in focusing on particular types of subjects, and in mediating humanitarian relations. I examine the ways in which humanitarian actors and Western spectators have been prioritized in aid discourse at the expense of the objectified suffering “other,” but coinciding with a recent movement within the humanitarian ecosystem, I also explore the way that photography might reshape aid in more collaborative and de-imperialized ways.

Patients are offered implantable defibrillators (ICDs) for the prevention of sudden cardiac death (SCD). However, patients' decision-making process (DMP) of whether or not to accept an ICD has not been explored. We asked patients about their decision making when offered an ICD.A grounded theory methodology was employed. Patients were recruited from three ICD centres. Those who received an ICD underwent interviews the first month after implant. Declining patients had interviews at their convenience. In-depth analysis of transcripts was completed. Identified themes were placed along process pathways in a DMP model and tested.Forty-four patients consented to participate (25% women). Thirty-four accepted an ICD and 10 (23%) declined. Ages ranged from 26 to 87 (mean = 65; SD = 12.5). Participants were retired (65%), had ischaemic heart disease (64%) and some post-secondary education (52%). The DMP was triggered when patient's risk for SCD was communicated. The physician's recommendation and a new awareness SCD risk were motivators to accept the ICD. Patient's decision-making approaches fell along a continuum, from active and engaged to passive and indifferent. Patient's approaches were influenced most by the following: (i) trust; (ii) social influences and (iii) health state.Health-care providers need to recognize the DMP pathways in which ICD candidacy and SCD risk are understood. The factors that influence a patient's decision warrant discussion pre-implant. It is imperative that patients comprehend the meaning of ICD candidacy to make an informed decision. Participants did not recall alternatives to receiving ICD therapy.

Canada, the first country to implement graphic-image health-warning labels on tobacco-product packaging, has been hailed as a world leader in tobacco-reduction strategies. Health Canada's intention with the warning labels is to encourage smokers to reduce the amount of tobacco they use or altogether quit smoking, and to prevent non-smokers from starting to smoke. Using semiotics, a multi-sited ethnographic approach and media ethnography, I analysed the responses of members of the target audience to look at how their interpretations of the labels affect their everyday lives. I found that all the smokers I interviewed have been feeling stigmatised as a result of this warning label campaign and the anti-smoking environment in which they reside. Established smokers and those long-time smokers who have recently quit smoking feel this stigma to a much higher degree than do younger people who have smoked for less than a decade. Looking at the "preferred readings" of the labels in conjunction with the context in which individuals interpret and internalise the meaning they derive from the intended messages, I found that some older individuals have been able to reduce, downplay, or contest the stigma by relocating themselves into locales and identities where they can be accepted as smokers. Younger smokers have been able to apply the "preferred reading" of a few labels to the entire campaign, thus dismissing the warnings entirely and avoiding the full weight of the stigma. I conclude with a discussion of the ways Health Canada can look towards tobacco company marketing practices and the efforts of other health promoters to produce tobacco-reduction strategies, including labelling campaigns, that do not generate feelings of fear, guilt and stigmatisation in smokers, but instead offer positive encouragement and alternatives to tobacco-use. Master of Arts (MA)