Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

This is the first book-length study of the thought of Sri Chinmoy (1931-2007) and his teaching of a dynamic spirituality of integral transformation. A straightforward and unembroidered account of his philosophy, it allows Sri Chinmoy to speak for himself in his own words, in poetry as much as in prose.

This review begins with a detailed focus on the Turnaway Study, which addresses associations among early abortion, later abortion, and denied abortion relative to various outcomes including mental health indicators. The Turnaway Study was comprised of 516 women; however, an exact percentage of the population is not discernable due to missing information. Extrapolating from what is known reveals a likely low of 0.32% to a maximum of 3.18% of participants sampled from the available the pool. Motivation for conducting the Turnaway (...) Study, methodological deficiencies (sampling issues and others), and bias are specifically addressed. Despite serious departures from accepted scientific practices, journals in psychology and medicine have published dozens of articles generated from the study’s data. The high volume of one-sided publications has stifled dialogue on potential adverse psychological consequences of this common procedure. Following a critical analysis of the Turnaway Study, an overview of the strongest studies on abortion and mental health is offered. This comprehensive literature comprised of numerous large-scale studies from across the globe has been largely overlooked by scientists and the public, while the Turnaway Study dominates the media, information provided to women, and legal challenges involving abortion restrictions. In the final section of this article, literature reviews by professional organizations are considered, demonstrating that the biased science characterizing the Turnaway Study is aligned with a pervasive and systemic phenomenon wherein deriving reliable and valid results via careful attention to methodology and scrutiny by the scientific community have been supplanted by politics. (shrink)

This Article doDespite obvious differences in the Aristotelian and Stoic theories of responsibility, there is surprisingly a deeper structural similarity between the two. The most obvious difference is that Aristotle is (apparently) a libertarian and the Stoics are determinists. Aristotle holds adults responsible for all our "voluntary" actions, which are defined by two criteria: the "origin" or cause of the action must be "in us" and we must be aware of what we are doing. An "involuntary" action, for which we (...) are not responsible, is one that fails to meet either one of these two criteria. Aristotle is a libertarian insofar as he insists that all voluntary actions are "in our power" to perform or not. As determinists the Stoics cannot admit this sort of freedom, but they still consider the agent to be a vital link in the chain of events, so they redefine what is "in our power" as what comes about "through us." The terminology is different, but I argue that these actions, for which the Stoics hold us responsible, are in fact coextensive with Aristotle's voluntary actions. An "impression" is the first necessary condition for action, and is a sort of visual image of the object stimulating one to act. The right sort of impression activates the agent's "impulse," an internal movement of soul or mind, which is the direct cause of action. But impulse is always accompanied by "assent," which is the mind's affirming the truth of the proposition that we ought to go after the object stimulating our impulse. Thus, since assent is a necessary condition for action, we always act knowing what we are doing. This means that all actions caused by our own impulse and assent are by Aristotle's criteria voluntary, where impulse provides the internal origin of the action and assent provides the awareness of what is being done. I conclude that the Stoic and Aristotelian classes of what one is responsible for are coextensive, their criteria defining responsible actions are nearly identical, and the only substantial difference is that Aristotle claims such actions are in our power to do or not do while the Stoics say that such actions are necessitated (by our internal nature as well as external factors). es not have an abstract. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

This paper describes a strategy for getting students interested in ancient, especially Hellenistic, philosophy. While the works of Aristotle, the Stoics, the Skeptics, and the Epicureans may strike students as impossibly distant in time and thus far removed from their own personal concerns, students are always interested in the topics of free will and moral responsibility. Teaching the transition from Hellenic to Hellenistic philosophy through an emphasis on treatments of these topics engages students and makes feasible the teaching of an (...) understudied, extremely important period in Western philosophy. The author advocates focusing specifically on the debate between Aristotle and the Stoics on whether “being able to do otherwise” is a necessary condition for freedom. After presenting a detailed overview of the arguments that comprise this debate, the author offers suggestions on how this strategy might be augmented and on how to apply this strategy to courses which do not focus exclusively on ancient philosophy. (shrink)

This book is the recent addition to the Clarendon Later Ancient Philosophers series, and its greatest significance lies in its being the sole commentary on Against the Grammarians. It also provides the only English alternative to Bury’s 1949 translation in the Loeb edition. As such, it is a clear and readable translation, although, of course, there is no Greek text provided.

The aim of this study was to get a deeper understanding of student nurses’ experiences of personal caring ethics by reflection on caring encounters with patients in clinical practice, ethical caring ideals, ethical problems, and sources for inner strength that give courage to practice good caring. In all, 24 Scandinavian student nurses participated voluntarily in an interview study. The interviews were analyzed within a phenomenological–hermeneutical approach and revealed three themes. The students found themselves in two different states of vulnerability: one (...) in which they were overwhelmed by their vulnerability and began to suffer themselves and the other where their vulnerability became a source of development with focus on the patient. The students’ ethical caring ideals served as fixed reference points in their ethical development, but their ideals were at risk of decline. The students reflected on the barriers for performing ethical care and nurtured their ethical ideals by providing ethical care in secret. Caring in secret occurred also when student nurses did not experience a shared ethos. (shrink)

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

With the increase in the costs of providing education and concerns about financial responsibility, heightened consideration of accountability and results, elevated awareness of the range of teacher skills and student learning styles and needs, more focus is being placed on the promises offered by online software and educational technology. One of the most heavily marketed, exciting and controversial applications of edtech involves the varied educational programs to which different students are exposed based on how big data applications have evaluated their (...) likely learning profiles. Characterized most often as ‘personalized learning,’ these programs raise a number of ethical concerns especially when used at the K-12 level. This paper analyzes the range of these ethical concerns arguing that characterizing them under the general rubric of ‘privacy’ oversimplifies the concerns and makes it too easy for advocates to dismiss or minimize them. Six distinct ethical concerns are identified: information privacy; anonymity; surveillance; autonomy; non-discrimination; and ownership of information. Particular attention is paid to whether personalized learning programs raise concerns similar to those raised about educational tracking in the 1950s. The paper closes with discussion of three themes that are important to consider in ethical and policy discussions. (shrink)

The term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of people through migration. Much has also been (...) written on the global effects of environmental degradation, population growth, and economic disparities. In addition, the pace of scientific development has accelerated, with both negative and positive implications for global health. Concerns for national health transcend borders, with a need for shared human security and an enhanced role for international cooperation and development [2]. These issues have significant bioethical implications, and thus a renewed academic focus on the ethical dimensions of public health is needed. Future developments in science and health policy also require a firm grounding in bioethical principles. These core principles include beneficence; nonmaleficence ; respect for persons and human dignity ; and attention to equity and social justice. According to the World Health Organization [3], global ethical approaches should monitor and update ethical norms for research, as necessary; anticipate ethical implications of advances in science and technology for health; apply internationally accepted codes of ethics; ensure that agreed standards guide future work on the human genome; and ensure that quality in health systems and services is assessed and promoted. (shrink)

This is the first edited collection entirely dedicated to non-evidentialist epistemology or non-evidentialism—the controversial view that evidence is not required in order for doxastic attitudes to enjoy a positive epistemic status. Belief or acceptance can be epistemically justified, warranted, or rational without evidence. The volume is divided into three section: the first focuses on hinge epistemology, the second offers a critical reflection about evidentialist and non-evidentialist epistemologies, and the third explores extensions of non-evidentialism to the fields of social psychology, psychiatry, (...) and mathematics. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti. (shrink)

This is the introduction to Moretti, Luca and Nikolaj Pedersen (eds), Non-Evidentialist Epistemology. Brill. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti.

This collection of essays in honor of Prof. Stig Andur Pedersen's 60th Birthday spans over a broad scope of topics, ranging from mathematical modelling over realism in philosophy of science to an analysis of apology after medical mistakes. The unusually broad range is a fair but still inadequate reflection of the work of Stig Andur Pedersen, a philosopher and scientist whose range of interests, abilities and production is itself unusually broad.

What is philosophy of mathematics and what is it about? The most popular answer, I suppose, to this question would be that philosophers should provide a justification for our presently most cherished mathematical theories and for the most important tool to develop such theories, namely logico-mathematical proof. In fact, it does cover a large part of the activity of philosophers that think about mathematics. Discussions about the merits and faults of classical logic versus one or other ‘deviant’ logics as the (...) logical basis for mathematical theories, ranging from intuitionist over modal logic to paraconsistent logic, typically belong to this area, as do debates about the natural-number concept, its ‘nature’, its properties, especially its uniqueness, and so on. No doubt sociologists of knowledge could explain why philosophers of mathematics came to select these particular problems and deal with them the way they do. What it does imply, however, is that the question is meaningful whether different kinds of philosophies of mathematics are possible, and—why not?—perhaps even desirable. To a certain extent, the answer is trivial: look at what, e.g., phenomenologists have to say about mathematics and you must notice it does not fit into the scheme sketched above.1 Rather, the question should be whether there are forms that, on the one hand, reinterpret the whole enterprise, and, on the other hand, somehow remain related to the work of ‘mainstream’ philosophers of mathematics today.The book under review here does precisely that. Let me be a bit more precise. The general proposal, present throughout all the contributions, is that even at a first, superficial, glance at what mathematicians do when they do mathematics, it is far more complex than ‘just thinking about and …. (shrink)

In the past three decades a number of narrative self-concepts have appeared in the philosophical literature. A central question posed in recent literature concerns the embodiment of the narrative self. Though one of the best-known narrative self-concepts is a non-embodied one, namely Dennett’s self as ‘a center of narrative gravity’, others argue that the narrative self should include a role for embodiment. Several arguments have been made in support of the latter claim, but these can be summarized in two main (...) points. Firstly, a logical one: without taking the body into account Dennett’s theory becomes self-refuting. Secondly, a more practical/phenomenological point: a disembodied self-concept overlooks how personal the body is, and as such should be considered part of the self. In this paper I endorse these criticisms of non-embodied narrative self-concepts, but I argue that the relationship between the narrative self and the body is far from sufficiently fleshed out. I claim that the narrative self and the body are much more interwoven than the above criticisms suggest. What I aim to show in this paper is that the relationship between the body and the narrative self is interactive rather than unidirectional: not only does our body shape our narrative self, but our narrative self also shapes our body. The upshot of this is a better conception of the self is as a dynamic interaction between its various aspects. (shrink)

The relative merits and demerits of historically prominent views such as the correspondence theory, coherentism, pragmatism, verificationism, and instrumentalism have been subject to much attention in the truth literature and have fueled the long-lived debate over which of these views is the most plausible one. While diverging in their specific philosophical commitments, adherents of these historically prominent views agree in at least one fundamental respect. They are all alethic monists. They all endorse the thesis that there is only one property (...) in virtue of which propositions can be true, and so, in this sense, take truth to be one. The truth pluralist, on the other hand, rejects this idea. There are several properties in virtue of which propositions can be true. The literature on truth pluralism has been growing steadily for the past twenty years. This volume, however, is the first of its kind—the first collection of papers focused specifically on pluralism about truth. Part I is dedicated to the development, investigation, and critical discussion of different forms of pluralism. An additional reason to look at truth pluralism with interest is the significant connections it bears to other debates in the truth literature—the debates concerning traditional theories of truth and the deflationism/inflationism divide being cases in hand. Parts II and III of the volume connect truth pluralism to these two debates. (shrink)

The book is an introductory exposition of the development of the physical and astronomical notions of the universe. It covers the period from Greek antiquity to the Copernican revolution and the Renaissance, half of the text being devoted to medieval science within both the Aristotelian and the Archimedean traditions. The book is intended for a general audience interested in intellectual and scientific developments, but should also be useful as a guide to further studies. Thus it has an extensive bibliography classifying (...) much of the secondary literature on the subject, and also a sixty page 'dictionary' of all the scientists and philosophers mentioned in the text. This contains references to printed editions of the sources and to a selection of books and periodicals. (shrink)

In this wide-ranging interview Priscilla Alderson discusses how she came to research parental and childhood consent and became a sociologist and how, late in her career, she became convenor of the critical realism group started by Roy Bhaskar at the Institute for Education in London. She discusses aspects of her seminal research over the years on multiple subjects, such as the rights of children, and reflects on what critical realism has added to her social research.

Here is a well-known thought about truth: Truth consists in correspondence with reality. A sentence is true just in case what it says corresponds with how the world is. Theories of truth that incorporate this thought are naturally regarded as robust or “heavyweight”. Truth is to be understood in a realist fashion. The world decides what is true and what is not. A recent incarnation of the correspondence view is found in truth-maker theories, whose adherents maintain that truths are true (...) in virtue of there being something – a truth-maker – in the world that makes them so.2. (shrink)

This article reviews practitioners’ evaluations of in-hospital ethics seminars. A qualitative study included 11 innovative in-hospital ethics seminars, preceded and followed by interviews with most participants. The settings were obstetric, neonatal and haematology units in a teaching hospital and a district general hospital in England. Fifty-six health service staff in obstetric, neonatal, haematology, and related community and management services participated; 12 attended two seminars, giving a total of 68 attendances and 59 follow-up evaluation interviews. The 11 seminars facilitated by an (...) ethicist addressed the key local concerns of staff about the social and ethical consequences of advances in genetics and their impact on professional policies and practice. Seminar agendas were drawn from prior interviews with 70 staff members. During evaluation interviews, participants commented on general aspects that they had enjoyed, how the sessions could be improved, timing, the mix of participants, the quality of the facilitation, whether sessions should be more challenging, after-effects of sessions, and interest in attending seminars and contacting the ethicist in future. Participants valued the increased interprofessional understanding and coherent discussion of many pressing issues that addressed important though seldom discussed ethical questions. The seminars worked well in the different hospitals and specialties. (shrink)

We use the construct of the “other” to explore how hate operates rhetorically within the virtual conclave of Stormfront, credited as the first hate Web site. Through the Internet, white supremacists create a rhetorical vision that resonates with those who feel marginalized by contemporary political, social, and economic forces. However, as compared to previous studies of on-line white supremacist rhetoric, we show that Stormfront discourse appears less virulent and more palatable to the naive reader. We suggest that Stormfront provides a (...) “cyber transition” between traditional hate speech and “reasonable racism,” a tempered discourse that emphasizes pseudo-rational discussions of race, and subsequently may cast a wider net in attracting audiences. (shrink)

Sustainability challenges typically occur across sectoral boundaries, calling the state, market, and civil society to action. Although consensus exists on the merits of cross-sector collaboration, our understanding of whether and how it can create value for various, collaborating stakeholders is still limited. This special issue focuses on how new combined knowledge on cross-sector collaboration and business models for sustainability can inform the academic and practitioner debates about sustainability challenges and solutions. We discuss how cross-sector collaboration can play an important role (...) for the transition to new and potentially sustainability-driven business models given that value creation, delivery, and capture of organizations are intimately related to the collaborative ties with their stakeholders. Sustainable alternatives to conventional business models tend to adopt a more holistic perspective of business by broadening the spectrum of solutions and stakeholders and, when aligned with cross-sector collaboration, can contribute new ways of addressing the wicked sustainability problems humanity faces. (shrink)

Coming from a prosperous London Quaker family, the author Priscilla Wakefield wrote educational books for children, and one work for adults, Reflections on the Present Condition of the Female Sex, also reissued in this series. This 1796 book on botany, a science which 'contributes to health of body and cheerfulness of disposition' but is difficult to study because of its Latin nomenclature and the cost of textbooks, offers a simple introduction for children through the medium of letters between sisters, (...) as 'Felicia' shares with 'Constance' her growing understanding of plant science. Felicia's governess is a follower of Linnaeus, whose classificatory system is described as 'the one universally adopted', and by the twenty-eighth and final letter, Felicia is describing the class Cryptogamia. This illustrated account in simple language gives an insight into the level of education thought appropriate for young girls at the end of the eighteenth century. (shrink)

In this critical comment, we argue that nondemocratic, but decent regimes fail to constitute legitimate governance under Applbaum’s free group agency account. To make this case, we first introduce the three principles of liberty, equality and agency that Applbaum takes to flow directly from his free agency conception of legitimacy. Against this backdrop, we discuss Applbaum’s claim that a nondemocratic regime along the lines of a Rawlsian decent consultation hierarchy could meet the threshold of legitimacy. Contrary to this suggestion, we (...) argue that nondemocratic, but decent regimes cannot claim legitimacy under Applbaum’s account because they are constitutively inegalitarian, thus failing to adequately grant citizens the equal normative power without which legitimacy is unattainable under the free group agency account. (shrink)

The views of parents and staff about physical and symbolic space and its effects on ethical clinical practice are reported. Researchers observed four neonatal intensive care units (NICUs) in southern England, and interviewed 40 senior staff and the parents of 80 babies. The adults' concerns include: how space affects the sharing of information and responsibility for the babies; respect and welcoming policies; access, freedom of movement and accessibility of staff; family friendly space and privacy; aesthetic values; and 'baby-led' space. The (...) paper concludes that abstract principles of respect for autonomy and attitudes towards the baby's biological and personal space take on practical embodied meanings in clinical spaces and practices. NICU design and aesthetics convey powerful ethical messages of welcome or exclusion that endorse or undermine partnerships between staff and parents. Helping premature and impaired babies to reach their space at the centre of their family involves sensitive management. (shrink)

El artículo analiza el desarrollo de la interseccionalidad como concepto presente en el proceso de juzgar con perspectiva de género, en particular, su impacto en la jurisprudencia de la Corte Interamericana de Derechos Humanos (Corte IDH). La metodología utilizada es cualitativa, principalmente, revisión de sentencias de la Corte IDH. De las 13 sentencias seleccionadas en el período 2015-2022 se concluye que la Corte IDH ha incorporado progresivamente la perspectiva interseccional y la ha usada como categoría analítica para estudiar, entender y (...) hacer frente a las discriminaciones que constituyen una forma agravada de discriminación y barreras de acceso a la justicia. (shrink)

In this article, I critically assess Hélène Landemore's new model of Open Democracy, asking whether it requires of citizens to blindly defer to the decisions of the mini-public. To address this question, I, first, discuss three institutional mechanisms in Open Democracy, all of which can be read to grant citizens democratic control. I argue that neither the capacity to authorize the selection mechanism (random sortition), nor the lottocratic conception of political equality, nor the self-selection mechanisms of Landemore's model deliver the (...) form of control that would insulate Open Democracy from the charge of blind deference. I then discuss the direct democracy mechanisms that Landemore incorporates into her model. Although these devices grant citizens control and, by extension, offer the resources for repudiating the charge of blind deference, they also, I argue, subvert the logic of Landemore's lottocratic model, rendering Open Democracy predictably unstable. Given the deliberative asymmetries between the mini-public and the citizenry, a high frequency of bottom-up challenges is to be expected that would throw the whole system into jeopardy. Thus, the challenge for lottocrats is to show how democratic control can be achieved in a lottocratic system without undermining the benefits of the legislature by lot. (shrink)

Vann McGee claims that open-ended schemas are more innocuous than ordinary second-order quantification, particularly in terms of ontological commitment. We argue that this is not the case.

The following short contributions add to the debate on transplantation: one describes the distress of a woman recently widowed when asked for the organs of her dead husband for transplantation, and the other the eagerness with which a boy awaits the death of a potential kidney donor - not a heartless emotion but the longing for a new lease of life.