Defined as patients who ‘lack decision-making capacity and a surrogate decision-maker’, the unrepresented present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical (...) error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient. (shrink)

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite (...) conception of a doctor’s energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care. (shrink)

Background Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. Methods An explorative qualitative (...) study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. Results The respondents’ ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. Conclusion This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research. (shrink)

Research ethics committees (RECs) have a crucial role in protecting children in research. However, studies on REC members’ perspectives on paediatric research are scarce. We conducted a qualitative study to explore Swedish scientific REC members’ perspectives on ethical aspects in applications involving children with severe health conditions. The REC members considered promoting participation, protecting children and regulatory adherence to be central aspects. The results underscored the importance of not neglecting ill children’s rights to adapted information and participation. REC members supported (...) a contextual and holistic approach to vulnerability and risk, which considers the child’s and parents’ psychological wellbeing and the child’s integrity, both short and long term. The ethical complexity of paediatric research requires continuous ethical competence development within RECs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Crisis of Authority From Holy Obedience to Bold Moral Imagination in European ChristianityKajsa AhlstrandIf we speak of a crisis of authority in Christianity we need to have some kind of common understanding of Christianity. The religion called Christianity is found in all inhabited continents and in a great variety of cultural forms. Two recent lists of countries with the greatest number of Christians show that the United States (...) is the country with the greatest number of Christians, followed by Brazil and Mexico.1 The Americas are on the top of the lists, but among the top ten we also find three Asian countries (China, India, and the Philippines), two African countries (Nigeria and the Democratic Republic of Congo), and four European countries (France, Russia, Germany, and Italy). (Australia is not on any of the lists since the total number of Australian citizens is smaller than the number of Christians in the top ten countries.) Although Christians live on all continents, it is a well-known fact that the majority of Christians now live in the Southern Hemisphere.When we talk about Christianity as an entity we have to be aware that there are enormous variations within Christianity with regard to cultural traditions, standard of living, level of education, and so on. A French Roman Catholic professor of theoretical physics may have very few convictions in common with a Pentecostal Nigerian peasant, although they both regard themselves as Christians.One way of looking at this diversity of values within Christianity is to go to the Inglehart-Welzel cultural map of the world.2 This map shows eight different “fields” of values located within a grid determined by two axes. The vertical axis goes from traditional to rational-secular values, the horizontal axis from survival values to self-expression values.The traditional values to secular-rational values dimension is described as “...the contrast between societies in which religion is very important and those in which it is not. [...] Societies near the traditional pole emphasize the importance of parent-child ties and deference to authority, along with absolute standards and traditional family values [...]. Societies with secular-rational values have the opposite preferences on all of these topics.” [End Page 49]The other dimension, survival values to self-expression values, is described thus: “Self-expression values give high priority to environmental protection, tolerance of diversity and rising demands for participation in decision making in economic and political life. These values also reflect mass polarization over tolerance of outgroups, including foreigners, gays and lesbians and gender equality. The shift from survival values to self-expression values also includes a shift in child-rearing values, from emphasis on hard work toward emphasis on imagination and tolerance as important values to teach a child.”When we apply this to the geographical dimensions of Christianity, we find that societies dominated by Christianity or in which there are significant numbers of Christians are found in every field of the map. This makes it difficult to speak of “Christian values” as if there were any values held by all or even a majority of Christians. Instead we find Christians in Africa who tend to embrace survival and traditional values—that is, religion is very important in their lives and they emphasize the importance of obedience to authority, especially within the family—whereas in the opposite diagonal corner (secular-rational values coupled with self-expression values) we find the Nordic countries, where, although the majority of the population belong to a church, religion plays a very limited role in day-to-day life and children are encouraged to rely on their empathy and imagination rather than to obey their parents and teachers.When we, in the following, move to the topic of a possible crisis of authority in Christianity, we have to remember that the suggested crisis is by no means a universal one. If we use Inglehart’s value map, the crisis of authority is located in the societies that score high on self-expression values, and if they also score high on secular-rational values the “crisis” is further aggravated. What the map does not show, however, is that there are individuals and groups within every... (shrink)

We give a new account of Björling’s contribution to uniform convergence in connection with Cauchy’s theorem on the continuity of an infinite series. Moreover, we give a complete translation from Swedish into English of Björling’s 1846 proof of the theorem. Our intention is also to discuss Björling’s convergence conditions in view of Grattan-Guinness’ distinction between history and heritage. In connection to Björling’s convergence theory we discuss the interpretation of Cauchy’s infinitesimals.

In this paper we discuss visualizations in mathematics from a historical and didactical perspective. We consider historical debates from the 17th and 19th centuries regarding the role of intuition and visualizations in mathematics. We also consider the problem of what a visualization in mathematical learning can achieve. In an empirical study we investigate what mathematical conclusions university students made on the basis of a visualization. We emphasize that a visualization in mathematics should always be considered in its proper context.

Conflicts between labor unions and nongovernmental organizations often impede private labor regulatory attempts to protect worker rights at supplier factories. Based on a study of a failed private regulatory attempt for Swedish garment retailers, we contribute to existing research into union–NGO relations by demonstrating how conflict arises because unions and NGOs act upon different institutional logics. We also contribute to the institutional logics perspective by challenging the current emphasis on either coexistence or conflict among multiple logics, and showing the heterogeneity (...) in how multiple logics manifest on a local level, how this could shift over time, and suggesting an empirically derived typology of manifestations of multiple logics. (shrink)

According to Quine, Charles Parsons, Mark Steiner, and others, Russell’s logicist project is important because, if successful, it would show that mathematical theorems possess desirable epistemic properties often attributed to logical theorems, such as aprioricity, necessity, and certainty. Unfortunately, Russell never attributed such importance to logicism, and such a thesis contradicts Russell’s explicitly stated views on the relationship between logic and mathematics. This raises the question: what did Russell understand to be the philosophical importance of logicism? Building on recent work (...) by Andrew Irvine and Martin Godwyn, I argue that Russell thought a systematic reduction of mathematics increases the certainty of known mathematical theorems (even basic arithmetical facts) by showing mathematical knowledge to be coherently organized. The paper outlines Russell’s theory of coherence, and discusses its relevance to logicism and the certainty attributed to mathematics. (shrink)

In this paper we consider the major development of mathematical analysis during the mid-nineteenth century. On the basis of Jahnke’s (Hist Math 20(3):265–284, 1993 ) distinction between considering mathematics as an empirical science based on time and space and considering mathematics as a purely conceptual science we discuss the Swedish nineteenth century mathematician E.G. Björling’s general view of real- and complexvalued functions. We argue that Björling had a tendency to sometimes consider mathematical objects in a naturalistic way. One example is (...) how Björling interprets Cauchy’s definition of the logarithm function with respect to complex variables, which is investigated in the paper. Furthermore, in view of an article written by Björling (Kongl Vetens Akad Förh Stockholm 166–228, 1852 ) we consider Cauchy’s theorem on power series expansions of complex valued functions. We investigate Björling’s, Cauchy’s and the Belgian mathematician Lamarle’s different conditions for expanding a complex function of a complex variable in a power series. We argue that one reason why Cauchy’s theorem was controversial could be the ambiguities of fundamental concepts in analysis that existed during the mid-nineteenth century. This problem is demonstrated with examples from Björling, Cauchy and Lamarle. (shrink)

On the fundamental of Hindu philosophy with commentary in verse form.

In order for online communities to assemble and grow, some basic infrastructure is necessary that makes possible the aggregation of the collective action. There is a very intimate and complex relationship between the technological infrastructure and the social character of the community which uses it. Today, most infrastructure is provided by corporations and the contrast between community and corporate dynamics is becoming increasingly pronounced. But rather than address the issues, the corporations are actively obfuscating it. Wikiwashing refers to a strategy (...) of corporate infrastructure providers where practices associated to their role of profit seeking corporations that would be seen as unethical by the communities they enable are concealed by promoting a misleading image of themselves associated with the general values of wikis and Wikipedia . The empirical analysis is based on case studies and triangulation of several methods. (shrink)

How to achieve sustainable communities with decent work and economic growth without negative environmental impact, is at the heart of the United Nations Sustainable Development Goals and a top priority of many governments around the world. This article critically explores the role of government intervention for achieving sustainable local prosperity in frontier markets of developing countries, where such advancement is especially crucial. More specifically, we explore by an in-depth case study how multiple stakeholders cooperate to enhance local development and export (...) from firms in the leather and leather products industry in Ethiopia. From a multistakeholder engagement perspective, including representatives of local businesses, United Nations, Ministry of Trade and Industry, and other development partners, we analyze how government interventions have resulted in unintended outcomes despite their good intention. We contribute with a new understanding of why development initiatives in frontier markets struggle with stakeholder integration, caused by power asymmetry and lack of institutional trust which prevents the achievements of sustainable development goals. Contextualized implications for firms, government, and non-governmental actors on how to improve collaboration are provided, and policy implications are proposed. (shrink)

Keller & Miller's (K&M's) conclusion appears to be correct; namely, that common, harmful, heritable mental disorders are largely maintained at present frequencies by mutation-selection balance at many different loci. However, their “paradox” is questionable. (Published Online November 9 2006).

Discussions of science and values in risk management have largely focused on how values enter into arguments about risks, that is, issues of acceptable risk. Instead this volume concentrates on how values enter into collecting, interpreting, communicating, and evaluating the evidence of risks, that is, issues of the acceptability of evidence of risk. By focusing on acceptable evidence, this volume avoids two barriers to progress. One barrier assumes that evidence of risk is largely a matter of objective scientific data and (...) therefore uncontroversial. The other assumes that evidence of risk, being "just" a matter of values, is not amenable to reasoned critique. Denying both extremes, this volume argues for a more constructive conclusion: understanding the interrelations of scientific and value issues enables a critical scrutiny of risk assessments and better public deliberation about social choices. The contributors, distinguished philosophers, policy analysts, and natural and social scientists, analyze environmental and medical controversies, and assumptions underlying views about risk assessment and the scientific and statistical models used in risk management. (shrink)

: The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, such (...) as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission. (shrink)

Current scientific research almost always requires collaboration among several (if not several hundred) specialized researchers. When scientists co-author a journal article, who deserves credit for discoveries or blame for errors? How should scientific institutions promote fruitful collaborations among scientists? In this book, leading philosophers of science address these critical questions.

Once upon a time, logic was the philosopher’s tool for analyzing scientific reasoning. Nowadays, probability and statistics have largely replaced logic, and their most popular application—Bayesianism—has replaced the qualitative deductive relationship between a hypothesis h and evidence e with a quantitative measure of h’s probability in light of e.

This text provides a critique of the subjective Bayesian view of statistical inference, and proposes the author's own error-statistical approach as an alternative framework for the epistemology of experiment. It seeks to address the needs of researchers who work with statistical analysis.

I begin with some elementary observations about assertion. In spite of recent criticisms of philosophers who have been too ready to take the subject-predicate indicative sentence as the standard form of assertion, there is no doubt that this form of sentence does represent something very fundamental about assertion. To put the matter in a rough-and-ready way: if we are to assert anything at all, it seems obvious that we must first draw our listener's attention to something that we propose to (...) talk about, and then, when we have secured his attention, go on to say something about that to which we have drawn attention. (shrink)

There is a wide gap, at any rate in the English-speaking world, between the people whose business it is to talk about the nature of poetry and those who are concerned with the critical analysis of language. Although both subjects are legitimate topics for philosophical discussion, there are few philosophers who combine a deep and effective interest in aesthetics with a concern in the problems of linguistic analysis. The analytical philosopher is only too ready to relegate poetry to the field (...) of “emotive” meaning; and, although “emotive” is a convenient term for marking off aspects of meaning with which the scientist is not concerned, it is also a means for keeping questions closed which ought to be opened. For it conceals the enormous differences which exist between various nonscientific uses of language. It does this behind an implicit suggestion that, since “emotions” are the province of the psychologist, any sort of inquiry into these uses of language will be merely a psychological inquiry. Poetry, of course, falls into this category of non-scientific uses of language, and a few psycho-analysts have accepted the commitment to discuss it; but on the whole its discussion is left to a very small band of aestheticians and a very large fraternity of literary critics. (shrink)

Of the many possible, and no doubt actual, forms of incoherence covered by my title, I shall be concerned with only one, and must begin by dismissing the others. The incoherence I shall speak of is not any alleged inconsistency between deterministic and indeterministic physical theories , such as between classical particle mechanics and quantum theory. It is an inconsistency internal to determinism. Not, that is, internal to any deterministic theory ; but to the general claims put forward by determinists—whether (...) scientists, philosophers, or laymen. Still another qualification—it is ‘hard’ determinism I shall be concerned with—‘hard’ in the sense in which William James distinguished between hard and soft determinism. Soft determinism James himself ridiculed as glaringly incoherent, and in any case I shall not be specially concerned with determinism as regards human conduct—with the problem of free will and responsibility. (shrink)

It is fashionable nowadays to discredit the theory of the general will, and an attempt to rehabilitate it is not likely to receive much sympathy. Nevertheless, I propose to give some reasons for adopting a more lenient attitude towards the theory, and to indicate some possible lines along which a rehabilitation might be conducted.

There is among many moral philosophers today a renewed emphasis on the connection between reason and morality, and an attempt to exhibit moral behaviour as characteristically rational. What is original in Mr. Kneale's extremely interesting paper is the following-up of a suggestion that certain words like “right,” “wrong,” “ought,” are used in the same way both by lawyers and by moralists; this leads to a logical rehabilitation of the somewhat unpopular concept of the moral law, which in turn argues objectivity (...) and rationality in morals, and makes it possible “to distinguish between good and bad moralists in much the same way as we can distinguish between good and bad lawyers.” The legal pattern is essentially the same as the moral pattern. (shrink)

Over the past two decades, several consistent procedures have been designed to infer causal conclusions from observational data. We prove that if the true causal network might be an arbitrary, linear Gaussian network or a discrete Bayes network, then every unambiguous causal conclusion produced by a consistent method from non-experimental data is subject to reversal as the sample size increases any finite number of times. That result, called the causal flipping theorem, extends prior results to the effect that causal discovery (...) cannot be reliable on a given sample size. We argue that since repeated flipping of causal conclusions is unavoidable in principle for consistent methods, the best possible discovery methods are consistent methods that retract their earlier conclusions no more than necessary. A series of simulations of various methods across a wide range of sample sizes illustrates concretely both the theorem and the principle of comparing methods in terms of retractions. (shrink)

Although physician‐assisted death can be a great benefit both to those who are terminally ill and those who are not, the risks for patients in these two categories are quite different. For now it is reasonable to make the benefit available only for those near death, and to await better evidence about the risks before making it more broadly available.

Suicide is devastating. It is an assault on our ideas of what living is about. In Contemplating Suicide Gavin Fairbairn takes fresh look at suicidal self harm. His view is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse, intended to do so. It emphasises the intentions that the person had in acting, rather than the consequences that follow from those actions. Much of the book (...) is devoted to an attempt to construct a natural history of suicidal self harm and to examine some of the ethical issues that it raises. Fairbairn sets his philosophical reflections against a background of practical experience in the caring professions and uses a storytelling approach in offering a critique of the current language of self harm along with some new ways of thinking. Among other things he offers cogent reasons for abandoning the mindless use of terms such as attempted suicide and parasuicide , and introduces a number of new terms including cosmic roulette , which he uses to describe a family of human acts in which people gamble with their lives. By elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions currently inhabit, Fairbairn has contributed to the development of understanding in this area. Among other things a richer model and vocabulary may reduce the likelihood that those who come into contact with suicidal self harm, will believe that familiarity with the physical facts of the matter - the actions of the suicider and the presence or absence of a corpse - is always sufficient to justify a definite conclusion about the nature of the self harming act. (shrink)

In the latter half of the twentieth century, philosophers of science have argued (implicitly and explicitly) that epistemically rational individuals might compose epistemically irrational groups and that, conversely, epistemically rational groups might be composed of epistemically irrational individuals. We call the conjunction of these two claims the Independence Thesis, as they together imply that methodological prescriptions for scientific communities and those for individual scientists might be logically independent of one another. We develop a formal model of scientific inquiry, define four (...) criteria for individual and group epistemic rationality, and then prove that the four definitions diverge, in the sense that individuals will be judged rational when groups are not and vice versa. We conclude by explaining implications of the inconsistency thesis for (i) descriptive history and sociology of science and (ii) normative prescriptions for scientific communities. (shrink)

Jim Joyce argues for two amendments to probabilism. The first is the doctrine that credences are rational, or not, in virtue of their accuracy or “closeness to the truth” (1998). The second is a shift from a numerically precise model of belief to an imprecise model represented by a set of probability functions (2010). We argue that both amendments cannot be satisfied simultaneously. To do so, we employ a (slightly-generalized) impossibility theorem of Seidenfeld, Schervish, and Kadane (2012), who show that (...) there is no strictly proper scoring rule for imprecise probabilities. -/- The question then is what should give way. Joyce, who is well aware of this no-go result, thinks that a quantifiability constraint on epistemic accuracy should be relaxed to accommodate imprecision. We argue instead that another Joycean assumption — called strict immodesty— should be rejected, and we prove a representation theorem that characterizes all “mildly” immodest measures of inaccuracy. (shrink)

Philosophers of science have long been concerned with the question of what a given scientific theory tells us about the contents of the world, but relatively little attention has been paid to how we set out to build theories and to the relevance of pre-theoretical methodology on a theory’s interpretation. In the traditional view, the form and content of a mature theory can be separated from any tentative ontological assumptions that went into its development. For this reason, the target of (...) interpretation is taken to be the mature theory and nothing more. On this view, positions on ontology emerge only once a theory is to hand, not as part of the process of theory building. Serious attention to theory creation suggests this is too simple. In particular, data collection and experimentation are influenced both by theory and by assumptions about the entities thought to be the target of study. Initial reasoning about possible ontologies has an influence on the choice of theoretical variables as well as on the judgments of the methodology appropriate to investigate them. (shrink)