The Discussion Group for Mortals

Yann Martel expresses his Orientalism and describes Pi’s Re-Orientalism in Life of Pi. Martel’s Orientalism presents the typical postcolonial writing model, which constructs a postcolonial exotic. Pi’s Re-Orientalism reflects a diasporic Eastern boy’s desire and identity in the West. The survival story for Pi and the Bengal tiger is a metaphor for Pi to grow up to be a true western man. Martel uses paratexts such as the author’s note, author’s interview with the protagonist Pi, records for a Japanese investigation on the truth, and inserts into the protagonist Pi’s narration, which expose the hidden intention for latent cultural hegemony. The departure of Richard Parker represents Pi’s final conforming to Western culture.

Following recent advancements in science and technology, cancer treatment options have increased remarkably alongside improved survival rates. Yet, some individuals diagnosed with breast cancer refuse treatment. This study aimed to explore how breast cancer patients' personal beliefs and ideas influence their decision to refuse medical treatment. Thirteen participant interviews were selected from a larger cohort for a secondary analysis using the grounded theory approach. The decision to forgo medical treatment was influenced mainly by personal beliefs, which were framed as: 1. Triangle of religion, superstition, and ignorance, 2. Ghanaian traditional belief system, 3. My destiny, 4. Frail patient-staff relationships, 5. Futile appointments, and 6. Endless journey. Together, these fit into two overall themes-fatalism and poor communication patterns between healthcare providers and patients. Personal beliefs and managerial gaps within the health system mainly influence the growing trend of refusal of medical treatment among breast cancer patients in Ghana. These findings highlight the need for breast cancer education, professional counselling, and psychological support services.

Background There was uncertainty over the words to use to describe the care we provide and type of patients we support, particularly following the transfer of an NHS service to our hospice management in 2015. Other hospices use inconsistent language, so there was no clear direction to follow to create our own language. Aim In March 2016, we undertook some research to enable us to understand the best phrases to use with supporters, the general public and patients/relatives. Methods Quantitative research using an online survey was undertaken with 533 supporters and general public; qualitative research through six discussion groups was undertaken with staff, volunteers, patients, carers, supporters and general public; and telephone interviews with seven local GPs. Results ”Illness” was preferred as descriptor, over others like “condition” or “disease”. ‘Terminal illness’ was established as the best phrase for those receiving hospice care and chosen equally by both supporters and general public, but should be softened by saying “living with a terminal illness” to make it more positive and hopeful. Rejected words: Life-limiting, Life-changing, Incurable, Serious Progressive, Advanced. ‘Hospice care’ is used our name, so does not to be in the descriptor of the type of care. On its own it can suggest that we only provide care in a hospice building, for in-patients only. ‘End of life care’ was established as the best phrase to describe type of care, as it was safe, specialised, supportive and inclusive, but we should also include ‘Supportive Care’, as it suggests that the family are supported as well as the patient, and we also provide non-physical care for the patient. Rejected words: Palliative, Holistic, Specialist, Rehabilitative, Care in the last days Conclusion Phyllis Tuckwell Hospice Care provides supportive and end of life care for patients and families living with a terminal illness.

Heart-sparing radiotherapy in patients with breast cancer: What are the techniques used in the clinical routine?: A pattern of practice survey in the German-speaking countries

This participatory action research study was based on the tenets of critical literacy as well as the philosophy of phenomenology. The goal was to determine if a critical pedagogy would foster the development of critical consciousness in students. The class studied was a group of ten at-risk students in tenth grade in a small school district in upstate New York. The yearlong interactions of students and teachers were presented as a descriptive portraiture. Teachers and students collaborated in the construction of understandings through continual dialogue based on fictional works as well as through news articles. Both students and the researcher journaled their personal beliefs and reactions. Criteria for both the dialogues and journaling were used to determine if critical consciousness was developing. The findings of the current study show that each student developed critical consciousness, and praxis, or social action, was evidenced in the students’ creation of a blog designed to help parents and young people deal with bullying. Critical literacy’s applicability to the Common Core is discussed as implications.

Colours can draw an identity to all living things. Natural colours can either calm down or disturb a person’s inner Self. At the times of crisis, it tends to give the individual soul wit and hope. Colours also have alchemical significance and can impact every man’s mind in certain ways. Colour representations have been used by many symbolists throughout literary history from the past to the present. Symbolists point out the importance of symbols in the poems of symbolist poetry. Moreover, the use of colour symbolism in literature contributes to the treasure of literary forms. In Canadian literature, Yann Martel holds a prominent position for his adaption of symbols and uses them to portray the inner quest of his characters. Frequently, his symbolism embodies a deep search for a spiritual quest with a religious component. Colour is one of the most important aspects in deciphering the psyche of his heroes. He has constructed various symbolic interpretations that exhibit the spiritual longing of individuals. Many colours like red, black, white, green, orange, etc have been used as symbolic representations to decode the mind set and religious beliefs. Among them, black and white colours play a vital role in an in-depth portrayal of the leading characters. The religious quest of the characters has been satisfied through the identification of colour representations and ancient relics. They were satisfied at the end. Hence, his works depict that colours have symbolic dramatic elements that naturally novelize the central theme of the search for Self. It also emphasizes the development of the Self with the supremacy of faith in the Almighty God. This paper deciphers the black and white colour symbols in the novels, “Self”, “Life of Pi”, “Beatrice and Virgil”, and “The High Mountains of Portugal” of Yann Martel.

Background: Most patients with metastatic cancer request information regarding their prognosis, most notably when death is clearly approaching. Several clinical indices are used to predict the prognosis of end-stage cancer based on performance status and clinical factors. For example, the Palliative Prognostic Index (PPI) includes a range of scores from 0-15 based on factors that include performance status, oral intake, presence of edema, dyspnea at rest, and delirium. For scores greater than six, survival for an additional three weeks was predicted with a sensitivity of 80% and a specificity of 85%. However, the predictive power of these indices is currently insufficient; the quality of life of end-stage breast cancer patients would be markedly improved with a more accurate prediction model. Breast cancer subtypes based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses are important prognostic factors with respect to the outcome of initial breast cancer therapy; the subtype defined by these parameters was also identified as an independent prognostic factor for outcomes in cases of metastatic breast cancer. However, the prognostic impact of breast cancer subtype with respect to end-stage disease remains unclear. In this retrospective observational study, we evaluated the relationship between survival time and associated clinicopathological factors, including breast cancer subtype, in order to develop a more accurate prognostic model for end-stage breast cancer patients. Methods: Seventy-three patients with end-stage breast cancer who were admitted to our hospice care unit from January 2014 to December 2018 were enrolled in the study. Patients in this unit were not provided with anticancer therapy but did receive highest-quality supportive care. The primary endpoint was survival time from the admission. Patient information, including age, PPI, disease-free interval (DFI), the number of treatments for the metastatic disease, metastatic site, and breast cancer subtypes were collected from medical records. Breast cancer subtypes included Luminal (Lum), Lum-HER2, HER2, and triple negative (TN) with respect to those that were HR+HER2−, HR+HER2−, HR−HER2+, and HR−HER2−, respectively. The study was approved by the ethical committee of the Oikawa Hospital (OHCT022). Results: The median survival time was 23 days (1-359 days). From the univariate analysis, PPI scores of less than six were associated with significantly shorter survival (14 days vs. 36.5 days, P = 0.001). Patients diagnosed with Lum-HER2 subtype, those who were older and were without liver metastasis, those with a shorter DFI, and those who underwent fewer treatments for metastatic disease showed a tendency toward a favorable prognosis, although these findings did not reach statistical significance. Multivariate logistic regression analysis revealed that a PPI score less than six (P = 0.001), Lum-HER2 subtype (P = 0.003), absence of liver metastasis (P = 0.001), and DFI lower than the median (33 months; P = 0.028) all contributed to longer survival time. Discussion & Conclusion: In addition to the PPI, breast cancer subtype can be used to provide more precise prognoses for end-stage breast cancer patients. Survival of patients diagnosed with the Lum-HER2 subtype was longer than that observed among those with any of the other subtypes who had not undergone any anticancer treatment for metastatic disease; these results suggest that anti-HER2 therapy may be associated with critical immunological modifications. Taken together, our results indicate that breast cancer subtype should be included to provide a more accurate prognostic model for end-stage breast cancer patients. Citation Format: Masahiro Oikawa, Yumika Setoguchi, Yasuko Enomoto, Kazuhumi Hisamatsu, Tetsuaki Inamitsu, Tatsuji Oikawa. The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-43.

Scientific reports suggest that women at risk for familial breast cancer may benefit from prophylactic mastectomy. However, few data are available about how women decide upon this clinical option, and in particular, what role an objective risk assessment plays in this. The purpose of the present study is to assess whether this objective risk information provided in genetic counselling affects the intention for prophylactic mastectomy. Additionally, the (mediating) effects of breast cancer worry and perceived risk are investigated. A total of 241 women completed a questionnaire before and after receiving information about their familial lifetime breast cancer risk in a genetic counselling session. Path analysis showed that the objective risk information had a corrective effect on perceived risk (β=0.38; P=0.0001), whereas the amount of breast cancer worry was not influenced by the counselling session. The objective risk information did not directly affect the intention for prophylactic mastectomy. The intention was influenced by perceived risk after counselling (β=0.23; P=0.002), and by the precounselling levels of perceived risk (β=0.27; P=0.00025) and breast cancer worry (β=0.32; P=0.0001), that is, higher levels of perceived risk and breast cancer worry imply a stronger intention for prophylactic mastectomy. A personal history of breast cancer did not directly influence the intention for prophylactic mastectomy, but affected women who had undergone a mastectomy as surgical treatment were more positively inclined to have a prophylactic mastectomy than women who had had breast-conserving therapy. The impact of objective risk information on the intention for prophylactic mastectomy is limited and is mediated by perceived risk. Important determinants of the intention for prophylactic mastectomy were precounselling levels of breast cancer worry and perceived risk, suggesting that genetic counselling is only one event in the entire process of decision making. Therefore, interventions aimed at improving decision making on prophylactic mastectomy should explicitly address precounselling factors, such as personal beliefs and the psychological impact of the family medical history.

Breast cancer is the most common cancer worldwide. The occurrence of breast cancer is associated with many risk factors, including genetic and hereditary predisposition. Breast cancers are highly heterogeneous. Treatment strategies for breast cancer vary by molecular features, including activation of human epidermal growth factor receptor 2 (HER2), hormonal receptors (estrogen receptor [ER] and progesterone receptor [PR]), gene mutations (e.g., mutations of breast cancer 1/2 [BRCA1/2] and phosphatidylinositol‐4,5‐bisphosphate 3‐kinase catalytic subunit alpha [PIK3CA]) and markers of the immune microenvironment (e.g., tumor‐infiltrating lymphocyte [TIL] and programmed death‐ligand 1 [PD‐L1]). Early‐stage breast cancer is considered curable, for which local‐regional therapies (surgery and radiotherapy) are the cornerstone, with systemic therapy given before or after surgery when necessary. Preoperative or neoadjuvant therapy, including targeted drugs or immune checkpoint inhibitors, has become the standard of care for most early‐stage HER2‐positive and triple‐negative breast cancer, followed by risk‐adapted post‐surgical strategies. For ER‐positive early breast cancer, endocrine therapy for 5‐10 years is essential. Advanced breast cancer with distant metastases is currently considered incurable. Systemic therapies in this setting include endocrine therapy with targeted agents, such as CDK4/6 inhibitors and phosphoinositide 3‐kinase (PI3K) inhibitors for hormone receptor‐positive disease, anti‐HER2 targeted therapy for HER2‐positive disease, poly(ADP‐ribose) polymerase inhibitors for BRCA1/2 mutation carriers and immunotherapy currently for part of triple‐negative disease. Innovation technologies of precision medicine may guide individualized treatment escalation or de‐escalation in the future. In this review, we summarized the latest scientific information and discussed the future perspectives on breast cancer.

The term mammographies signifies both the technology of imaging by which most Western women learn that they have contracted breast cancer and the documentary imperative that drives their written and visual mappings of the breast cancer experience. Key to this explanation and the development of the book is the concept of the post-millennial shift in breast cancer narratives. The book investigates the change in narratives (and subsequent tensions) around breast cancer before and after 2000. These narratives are constructed through DeShazer's analysis of the written and photographic diaries, blogs and newspaper serialisations of breast cancer memoirists. The book as whole can be described as being literary critical, feminist and interdisciplinary. In terms of the representation of breast cancer, one of the primary tensions that the author deals with is between the buoyant pink and the elegiac anti-pink iconography, and between the visceral and sanitised representations of breast cancer. Similarly, throughout the book, remembering those who have died from the condition is preferred to the discourse on cancer survivors as heroes. The use of warlike metaphors for beating cancer is also confronted. The book is both highly absorbing and very readable. I covered 30 pages with hardly a pause in reading, a clear sign that the author is very experienced and competent. The publication is also a good introduction to the literary category and medical narrative known as autothanatography. An autothanatography gives a written account of a person's journey with a terminal illness and constitutes the terminal counterpart to writing about ones' own life in an autobiography. The second chapter entitled ‘Breast cancer narratives as feminist theory’ contrasts two diagnostic trends in breast cancer: the familial (genetic) and the environmental (carcinogenic). The narrative of inevitability, of being part of a lineage of breast cancer suffers, is intertwined with the issue that many substances in our environment (such as our food, cosmetics and the air we breathe) contain carcinogens and cancer caused by such means is preventable. The later theme constitutes an intersection between breast cancer and green and anti-capitalist theories, something which Audre Lorde (one of the autothanatographers in the book) terms Cancer Inc. Many sections of the book analyse the queering of breast cancer narratives, citing authors who challenge the dominant heterosexism of the social representation of breast cancer as well as the manner in which treatment schemes are designed almost solely for heterosexual women. All this, DeShazer argues, is part of the post-millennial shift away from traditionally feminine depictions of breast cancer. Chapter six, ‘Cancer narratives and the ethics of commemoration’ helps to shift the analysis from the literary to a visual perspective and introduces the concept of photo-diaries of breast cancer patients such as those by Charlee Brodsky, as depicted on the book cover. This is connected in part with Susan Sontag's (1979) ideas of photos as memento mori, and Sontag's work features prominently in this book. Chapter six also touches on the carnivalesque nature of mammographies, the posthumous issues of consent and the ethics of breast cancer. Indeed, Roland Barthes’ concepts of punctum and stadium are also invoked at various points in the text as a means of theorising the medical narrative. Furthermore, the photographic diaries of breast cancer patients help the reader to engage with the dichotomy between public grief and private illness by showing images of breast cancer patients that would only be witnessed in a closed family circle, highlighting the pre-millennial tendency to avoid graphic representations of post-mastectomy bodies. The penultimate chapter ‘Bodies, witness, mourning: reading breast cancer autothanatography’ addresses the ethics of the posthumous publication of diaries and photographs. The chapter casts light upon the tensions between family members, for example. DeShazer suggests that one must address questions such as who has rights to the material (diaries and images) left by the deceased and whether there is a moral obligation to publish the departed person's work in the same narrative (feminist, queer, for instance) that it was written. This chapter is a poignant reminder that memory outlasts the physical form of a person, as do the perceived obligations that come with remaining true to a loved ones' legacy. For those interested in medical narratives, medical semiotics, photographic diaries, the ethics of posthumous publication and feminist and anti-capitalist literature, I highly recommend this thought-provoking publication. For those who are not, I recommend it still as it functions as a wonderful introduction into autothanatography and all the other topics touched on above.

BACKGROUND Breast cancer is one of the most frequent causes of mortality among women’s population. Early diagnosis is critical for successful treatment, but underscreening is frequent. Novel screening methods that are more convenient, such as thermography, are being developed. They could help a wider group of screeners and they could contribute to better compliance with screening and thus to a decline in breast cancer mortality. OBJECTIVE The study aims to explore the screeners’ preferences for the screening process, specifically for a novel screening that utilizes artificial intelligence (AI) and thermal imaging. Furthermore, we explore a better understanding of the barriers and facilitators associated with participation in breast cancer screening by currently used mammography. METHODS One online focus group with experts and five focus groups with potential screeners on thermography were carried out. Potential screeners were recruited through an online survey (n=228) focused on addressing barriers and motivations related to screening. Survey data were analyzed using SPSS software. Findings from the focus groups were examined by two researchers utilizing open, axial, and selective coding in MAXQDA software. RESULTS The information obtained in the focus groups showed that small changes during the procedure (tailored adjustments, such as film or music during the procedure, dimmed light) were appreciated, especially by women without any mammography screening experience. Furthermore, the non-invasiveness of the procedure was seen positively by all participants. Among other important factors that influence the perception of the procedure and can therefore affect the decision whether to go or not, was the way they were treated by medical staff and waiting hours. For certain women, how the interaction goes between them, and the clinicians is more important than the technology itself. Results from the online survey complemented these insights on motivation and barriers. Personal belief in breast cancer prevention was the most indicated motivator for women with mammography experience (44%, n=154), followed by an invitation from a screening program (29%, n=154). Barriers indicated by women without experience were mainly: no recommendation from a doctor (53%, n=74), no warning signals (36%, n=74) or no problem related to breasts (28%, n=74) followed by being too young for mammography (23%, n=74). CONCLUSIONS Even though the thermography was perceived mainly positively, rather than the technique itself, women prioritized how they were treated by medical staff. This includes detailed information in understandable language, empathetic communication and adjustments that fit personal preferences. As we also saw in the results from the survey, doctors play the leading role in the decision to go to the screening, so their change in the approach can encourage greater participation in breast cancer screening initiatives.

Background: Trastuzumab deruxtecan (T-DXd) is an anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugate. T-DXd has shown great efficacy in HER2-positive breast cancer, hence receiving approval in Japan in March 2020. In Japan, all-patient postmarketing surveillance (PMS) is underway to evaluate the risk of interstitial lung disease/pneumonitis (ILD/p) in patients with breast cancer treated with T-DXd. Due to the limited generalizability of results from clinical trials, there is a need for more information about ILD/p in a real-world setting. Herein we present an interim analysis of the large-scale all-patient PMS. Methods: This is an observational, multicenter, all-patient PMS (jRCT1080225197) with an observation period of 18 months that enrolled all patients treated with T-DXd for recurrent/advanced HER2-positive breast cancer. Patients who initiated T-DXd treatment between May 2020 (launch date of T-DXd) and May 2021 were included in the interim analysis to ensure the observation period of 6 months from the initial treatment of T-DXd. This interim analysis is based on safety data from the first 6 months of 1204 patients. Data collected includes baseline characteristics and information on ILD/p. All potential ILD/p (identified based on the AE terms) reported by physicians were adjudicated by an independent ILD adjudication committee. The incidence of ILD/p was calculated from adjudicated drug-related ILD/p. Results: The interim analysis set included 1204 patients with median age of 60 years. Three of the 1204 patients (0.2%) received T-DXd as a first-line treatment, 30 (2.5%) as second-line, 1159 (96.3%) as third- line or later treatment. At baseline, 105 (8.7%) of patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) 2 or greater, 8 (0.7%) had severe renal impairment (15≤ creatinine clearance (CLcr) < 30 mL/min), 4 (0.3%) had end-stage renal disease (CLcr < 15 mL/min), 5 (0.4%) had severe liver impairment (total bilirubin >4.5 mg/dL), and 32 (2.7%) had comorbid ILD/radiation pneumonitis. Those were defined as exclusion criteria in clinical trials of T-DXd. The median dose at the start of administration of T-DXd was 5.4 mg/kg (range:2.7-5.4). During the first 6 months from the initial treatment, T-DXd was discontinued in 403 (33.5%) of the 1204 patients. The most common reasons for discontinuation were disease progression in 232 (57.6%) of the discontinued 403 patients followed by ILD/p in 97 (24.1%) of the 403 patients. In the first 6 months, the incidence of all grade, grade ≥3, and grade 5 ILD/p were 8.2% (n=99), 1.7% (n=20) and 0.4% (n=5), respectively. The incidence of ILD/p stratified by baseline characteristics identified as potential risk factors of drug-related ILD/p is shown in Table. Conclusion: This is the first report demonstrating real-world experience with T-DXd in Japan. The interim analysis revealed useful information including patient and treatment profiles of T-DXd and the incidence of ILD/p during the first 6 months from the initial treatment in a real-world setting in Japan. The final analysis of the ongoing PMS is warranted for further evaluation. Incidence of interstitial lung disease/pneumonitis by patient baseline characteristics XX XX ILD/p: interstitial lung disease/pneumonitis, 95% CI: 95% confidence interval, CLCr: creatinine clearance using the Cockcroft-Gault equation * includes ILD/p, pulmonary fibrosis, radiation pneumonitis, chronic obstructive pulmonary disease, emphysema, and Asthma (Source: Powell CA, Modi S, Iwata H, et al. Pooled analysis of drug-related interstitial lung disease and/or pneumonitis in nine trastuzumab deruxtecan monotherapy studies. ESMO Open 2022;7(4):100554) Citation Format: Junji Tsurutani, Hideki Mizutani, Ayumi Tanabe. Real-world experience with trastuzumab deruxtecan in patients with breast cancer: 6 month-interim analysis of an all-patient postmarketing surveillance in Japan [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-17-07.

Most of what is known about psychosocial adjustment to cancer comes from studies of women with early stage cancer, mainly breast cancer. The findings suggest that for women in an intimate relationship, support from their partner is an important predictor of their adjustment. Randomised Control Trials (RCTs) of couple-based interventions show they are efficacious for improving couples' adjustment to breast and gynaecological cancers, particularly for reduction of sexual problems. The most common cancer in men worldwide is prostate cancer. It is unclear whether results from intervention research targeting female cancers generalises to men with prostate cancers, and their partners, or to people with advanced stage disease. There has been no published RCT of a couple-based intervention for men with cancer, few interventions involving patients with advanced disease, and none specifically designed for men with advanced stage prostate cancer. While men and women find the same types of partner support behaviours helpful generally, they do show disparity in their coping and preferences for support in some situations, particularly health related challenges. It is also difficult to engage men in coping interventions, perhaps because the programs do not address their needs. Further, while people facing advanced or terminal cancer may derive benefit from some aspects of interventions for early stage disease, they are also likely to have additional needs, such as managing unfinished business, changes in roles, and increases in carer burden that these programs do not address. This literature review describes the nature of advanced stage prostate cancer and the psychosocial challenges that diagnosis and treatments pose for men and their partners. The efficacy of interventions involving men with advanced stage disease is reviewed, and the implications of these findings for assessment and intervention of couples coping with advanced stage prostate cancer is discussed.

The global population is progressively aging, to the extent that over 1.5 billion people worldwide will be aged 65 years or more by 2050, and the prevalence of end-stage renal disease in the elderly will remain high in forthcoming years. Since older patients typically suffer from several comorbidities, the above issue poses a hefty financial burden on healthcare systems. Although current guidelines might be useful for older individuals with fewer comorbidities and no significant disability, a tailored therapeutic approach is often essential in individuals with severe comorbidities, short life expectancy or poor treatment compliance. In such patients, rather than aggressively pursuing different therapeutic targets, physicians should strive to enhance quality of life by treating comorbidity-related symptoms and addressing common geriatric syndromes, including cognitive impairment, depression, incontinence, falls and polypharmacy, and the decision about starting dialysis should be guided not only by medical reasons, but also by patients‘ personal beliefs and preferences.

There is a widely accepted consensus that religious education, together with all other school subjects, should contribute to the goals of education for sustainable development. As a result, theoretical models have been developed to profile what the specific contributions of religious education might be. However, the question whether religious education can achieve the intended goals has not yet been researched in more detail. More fundamentally, to be able to formulate realistic goals involves the clarification of students’ predispositions. In the light of these questions, the author focuses on an ecological sustainability dilemma, the so-called poplar dilemma, and asks how students react to this conflictive situation and what roles religious orientations play in their responses. Analysis of the responses of a sample of more than 1100, 14- to 16-year-old students at secondary schools in Germany and Austria led to the conclusion that over-reaching, action-changing environmental sustainability goals are probably beyond the reach of religious education as a single subject. Nevertheless, it becomes clear that ecological issues are regarded by many as religious and spiritual questions and can therefore be addressed in a focused way through religious education. The idea of religious stewardship, which implies taking responsibility and addresses both religious and non-religious students, could be particularly promising. Religious education could develop a characteristic profile as an area in which translation between different motivations for engaging in religious stewardship occurs, and where commitments to taking responsibility are sought.