Background Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. Aim To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time. Method Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014). Results Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' (...) lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. Conclusion A substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...) tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

The debate on responsibility for health takes place within political philosophy and in policy setting. It is increasingly relevant in the context of rationing scarce resources as a substantial, and growing, proportion of diseases in high-income countries is attributable to lifestyle. Until now, empirical studies of medical professionals' attitudes towards personal responsibility for health as a component of prioritisation have been lacking. This paper explores to what extent Norwegian physicians find personal responsibility for health relevant in prioritisation and what type (...) of risk behaviour they consider relevant in such decisions. The proportion who agree that it should count varies from 17.1% to 26.9%. Higher age and being male is positively correlated with acceptance. The doctors are more willing to consider substance use in priority setting decisions than choices on food and exercise. The findings reveal that a sizeable proportion have beliefs that conflict with the norms stated in the Norwegian Patient Act. It may be possible that the implementation of legal regulations can be hindered by the opposing attitudes among doctors. A further debate on the role personal responsibility should play in priority setting seems warranted. However, given the deep controversies about the concept of health responsibility and its application, it would be wise to proceed with caution.Design Nationally representative cross-sectional study. Setting Panel-data. Participants 1072 respondents, response rate 65%. (shrink)

The commentary brings up two topics. The first concerns whether and how a patient’s socioeconomic status should count in clinical care. We provide a brief summary of Puschel and colleagues’ view and discuss it in relation to other accounts. We share their conclusion; considering SES in clinical care can be justified from a fairness perspective. Yet, we question the claim that this is a new perspective, and argue that the reason for the claim of novelty is an insufficient use of (...) references. This leads to the second topic, which is a discussion of citation practices in philosophical/ethics papers. We describe common deviations from academic standards, and suggest how unfortunate practices can be reduced. (shrink)

Meanings of living at home on a ventilator Nine adults were interviewed in order to illuminate the meanings of being dependent on a ventilator and living at home. The data were analysed using a phenomenological‐hermeneutic method inspired by the philosophy of Ricoeur. Five main themes emerged through the analysis: experiencing home as a safe and comfortable space from which to reach out, experiencing the body as being frail, brave and resilient, striving to live in the present, surrendering oneself to and (...) trusting others, and experiencing technology as a burden and a relief to the lived body. Meanings of being home on a ventilator were interpreted as maintaining autonomy and persistence in interaction with the ventilator and other human beings and being able to rise above yourself and your personal boundaries in order to live a good life. These meanings indicate that aesthetic and ethical values impact on the lived body. They are bound up with experiencing a vital force and interdependency, bringing safety and courage into daily life. (shrink)

In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...) prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsibility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prognostic justifications for deprioritization. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

I will begin with a brief presentation of C & H’s arguments against nonindexical contextualism, temporalism, and relativism. I will then offer a general argument against the monadic truth package. Finally, I will offer arguments in favor of nonindexical contextualism and temporalism.

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative (...) analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)

1. Ḥeleḳ ʻaśarah maʼamarot -- 2. Ḥeleḳ ʻAśeret ha-dibrot -- 3. Ḥeleḳ Torah shebi-khetav -- 4. Ḥeleḳ torah shebe-ʻal peh. ʻAśarah hilulim. Ṿaṿe ha-ʻamudim.

1. Ḥeleḳ ʻaśarah maʼamarot -- 2. Ḥeleḳ ʻAśeret ha-dibrot -- 3. Ḥeleḳ Torah shebi-khetav -- 4. Ḥeleḳ torah shebe-ʻal peh. ʻAśarah hilulim. Ṿaṿe ha-ʻamudim.

Kerekh 1. Toldot ha-adam, as̀arah maʼamarot.

Does a factive conception of knowability figure in ordinary use? There is some reason to think so. ‘Knowable’ and related terms such as ‘discoverable’, ‘observable’, and ‘verifiable’ all seem to operate factively in ordinary discourse. Consider the following example, a dialog between colleagues A and B: A: We could be discovered. B: Discovered doing what? A: Someone might discover that we're having an affair. B: But we are not having an affair! A: I didn’t say that we were. A’s remarks (...) sound contradictory. In this context the factivity of ‘someone might discover that’ explains this fact. So there is some reason to believe that knowability and related modalities are factive in ordinary use. For factive treatments of knowability in the context of epistemic theories of truth, compare Tennant (2000: 829) and Wright (2001: 59-60, n. 17). (shrink)

Since the publication of David Lewis’ Counterfactuals, the standard line on subjunctive conditionals with impossible antecedents (or counterpossibles) has been that they are vacuously true. That is, a conditional of the form ‘If p were the case, q would be the case’ is trivially true whenever the antecedent, p, is impossible. The primary justification is that Lewis’ semantics best approximates the English subjunctive conditional, and that a vacuous treatment of counterpossibles is a consequence of that very elegant theory. Another justification (...) derives from the classical lore than if an impossibility were true, then anything goes. In this paper we defend non-vacuism, the view that counterpossibles are sometimes non-vacuously true and sometimes non-vacuously false. We do so while retaining a Lewisian semantics, which is to say, the approach we favor does not require us to abandon classical logic or a similarity semantics. It does however require us to countenance impossible worlds. An impossible worlds treatment of counterpossibles is suggested (but not defended) by Lewis (Counterfactuals. Blackwell, Oxford, 1973), and developed by Nolan (Notre Dame J Formal Logic 38:325–527, 1997), Kment (Mind 115:261–310, 2006a: Philos Perspect 20:237–302, 2006b), and Vander Laan (In: Jackson F, Priest G (eds) Lewisian themes. Oxford University Press, Oxford, 2004). We follow this tradition, and develop an account of comparative similarity for impossible worlds. (shrink)

I argue that David Lewis is too quick to deny the presentist the right to employ span operators. There is no reason why the presentist could not help herself to both primitive tensed slice operators and primitive span operators. She would then have another device available to eliminate ambiguities and explain why sentences with embedded contradictions may nevertheless be true.

The aim of this chapter is to shed new light on the question of what newly sighted subjects are capable of seeing on the basis of previous experience with mind- independent, external objects and their properties through touch alone. This question is also known as "Molyneux’s question." Much of the empirically driven debate surrounding this question has been centered on the nature of the representational content of the subjects' visual experiences. It has generally been assumed that the meaning of "seeing" (...) deployed in these disputes is more or less clear and unproblematic, and therefore requires no analysis or clarification. In this chapter, we wish to challenge this assumption. We argue that getting clear on the meaning of "seeing" is the only feasible way to determine whether the empirical attempts to answer Molyneux’s question accurately capture what newly sighted subjects are in fact capable of seeing. Specifically, we show that the dominant interpretations of the empirical results from a recent study (Held et al., 2011) fail to take into account that seeing can be not only purely visual but also epistemic in that it requires background knowledge (such as what an object with a particular viewpoint-independent shape looks like from a particular perspective). (shrink)

Relativism offers a nifty way of accommodating most of our intuitions about epistemic modals, predicates of personal taste, color expressions, future contingents, and conditionals. But in spite of its manifest merits relativism is squarely at odds with epistemic value monism: the view that truth is the highest epistemic goal. I will call the argument from relativism to epistemic value pluralism the trivial argument for epistemic value pluralism. After formulating the argument, I will look at three possible ways to refute it. (...) I will then argue that two of these are unsuccessful, and defend the third, which involves denying that there are any genuinely relative truths. (shrink)

Memory has eluded a unified philosophical analysis for millennia because memory isn’t a single type of mental state. On a standard classification, procedural memory is memory of how to do things, semantic memory is memory of facts or fact-like propositions and episodic memory is memory of events in which you partook. Autobiographical memory is memory of what happened in your past in real-life cases. Empirical studies suggest that autobiographical memory is a construction of pieces of past experiences. This points to (...) a view of memory according to which we have no direct awareness of what happened in the past and hence no internal justification of what we seem to remember happened. Here I argue that a version of phenomenal dogmatism, the view that seemings can justify higher-order mental states immediately and fully in the absence of defeaters, is plausible for memories and that it bypasses a common route from a constructionist view of memory to skepticism about the past. (shrink)

The article provides the state of the art on the debate about whether the logical form of ‘look’ statements commits us to any particular theory of perceptual experience. The debate began with Frank Jackson’s (1977) argument that ‘look’ statements commit us to a sense-datum theory of perception. Thinkers from different camps have since then offered various rejoinders to Jackson’s argument. Others have provided novel arguments from considerations of the semantics of ‘look’ to particular theories of perception. The article closes with (...) an argument of this sort for a representational theory of perceptual experience. (shrink)

There is no abstract for this chapter. The following is a summary. -/- We distinguish between, explicit, inadvertent, and habitual racist actions. We argue that while inadvertent bigots and habitual racists are inclined to (sincerely) deny that they committed a racially motivated action, they have different reasons for their denial. Inadvertent bigots are denying it because, however deeply they search, they are not going to find any such motive. Habitual racists, by contrast, may hold explicit egalitarian attitudes but they are (...) nonetheless implicitly racially motivated. There is thus an implicit stressful conflict between their covert racist intentions and their overt egalitarian attitudes. While they aren’t aware of the source of this distress, cognitive dissonance theory predicts that they nevertheless will engage in dissonance-reducing strategies. Specifically, we argue that habitual racists will be inclined to confabulate a description of the action in non-racial terms. (shrink)

I. Non-Trivial Counterpossibles On Lewis’ account, a subjunctive of the form ‘if it were the case that p, it would be the case that q’ (represented as ‘p → q’) is to be given the following rough meta-linguistic truth-conditions1.

The nature of the colors—what they are like, whether they are instantiated by objects or are projected by our minds, whether their nature is revealed to us in color perception, and whether there could be alien colors (e.g. reddish-green)—has been one of the central topics in philosophy for centuries. This entry focuses on the contemporary philosophical debate about the nature of the colors.

The question of whether blindsight is a form of unconscious perception continues to spark fierce debate in philosophy and psychology. One side of the debate holds that while the visual information categorized in blindsight is not access-conscious, it is nonetheless a form of perception, albeit a form of unconscious perception. The opposition, by contrast, holds that blindsight is just a form of degraded conscious perception that makes the categorized information harder to access because it is degraded. In this chapter, we (...) address the opposition’s arguments for thinking that blindsight is a form of degraded conscious vision and then argue that the residual awareness found in blindsight is a form of non-perceptual awareness. To back this claim, we examine the residual visual abilities to detect and discriminate colour found in some blindsight patients and show that residual consciousness in blindsight is indirect and lacks the phenomenal character characteristic of conscious vision. (shrink)

It may seem that when you have an emotional response to a perceived object or event that makes it seem to you that the perceived source of the emotion possesses some evaluative property, then you thereby have prima facie, immediate justification for believing that the object or event possesses the evaluative property. Call this view ‘dogmatism about emotional justification’. We defend a view of the structure of emotional awareness according to which the objects of emotional awareness are derived from other (...) experiences such as bodily sensation, inner awareness, sensory perception, memory, and imagination. On this basis, we argue that dogmatism about emotional justification is an untenable position, regardless of whether the special feature of an immediate justifier that makes it an immediate justifier is its presentational phenomenology or its evidence insensitivity. (shrink)

Descriptions are phrases of the form ‘an F’, ‘the F’, ‘Fs’ and ‘the Fs’. They can be indefinite (e.g., ‘an F’ and ‘Fs’), definite (e.g. ‘the F’ and ‘the Fs’), singular (e.g., ‘an F’, ‘the F’) and plural (e.g., ‘the Fs’, ‘Fs’). In English plural indefinite descriptions lack an article and are for that reason also known as ‘bare plurals’.

Abstract Ernest Sosa has argued that the relevant alternatives theory of knowledge has yet to overcome serious difficulties. The most serious difficulty is that of providing criteria for when a rival alternative to a claim is relevant. Without such criteria, the theory is ad hoc. I argue that most other externalist theories of knowledge, including Sosa's own, fall victim to this criticism. At the end of the paper I make a suggestion as to why Sosa's objection might not be as (...) damaging as it at first seems. (shrink)

The paper starts out by distinguishing two closely related hypotheses about extended cognition. According to the strong hypothesis, there are no intrinsic representations in the brain. This is a version of the extended-mind view defended by Andy Clark and Richard Menary. On the weak hypothesis, there are intrinsic representations in the brain but some types of cognition, knowledge or memory are constituted by particular types of external devices or environmental factors that extend beyond the skull and perhaps beyond the skin. (...) This type of view was defended, for example, by Andy Clark and David Chalmers. After drawing this distinction and clarifying the notions of causal influence and constitution, I defend the second weaker hypothesis with respect to procedural knowledge and knowledge of action and show why this sort of view supports what we might call a ‘situationist-friendly virtue epistemology’. (shrink)

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)