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)

This article deals with science content “in the making” and in particular the role of the body in producing scientific phenomena. While accounts of scientists’ work have repeatedly demonstrated, how producing phenomena requires immense amounts of time and effort, involving tinkering and manual labor, this is a little empirically studied content in science education. Seeking to shed light on how the body is involved with materiality to produce physics phenomena, and in what terms this is learning physics content, the article (...) first examines how bodily tinkering is a necessary part of knowing physics through reviewing major accounts of science studies and research in science education. Secondly, drawing on phenomenology and pragmatist ideas, the article examines how students’ bodies need to be educated in the transactional process with material and artifacts to produce phenomena in the context of science learning in lower secondary physics education. Demonstrating that embodied phenomena production is an inescapable part of learning scientific inquiry, and that bodies are just as much a part of the subject physics as conceptual knowledge, we suggest that the education of students’ bodies needs to be made an explicit content. This is important not only for making tacit content accessible to all, but also for addressing epistemological understandings of what science and technology is about. (shrink)

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

New Jersey residents who tested their homes for radon and found more than four picocuries per liter were surveyed about their knowledge, emotions, attitudes, and intentions to take remedial action Respondents proved well informed, but radon levels were not highly correlated with any of the response variables. Overoptimism was more common than overreaction. The results suggest that active guidance is needed to ensure appropriate responses to environmental hazards, like radon, that require individual remediation. Simple information dissemination alone seems inadequate.

Constitutivist approaches to the normativity of rationality have recently come into vogue. Unlike their moral counterparts, however, they have not been confronted with the shmagency objection. In this paper, I challenge them with two versions of the objection based on recent developments in the debate surrounding the normativity of morality. These are shmagency as modal escapability, which is based on taking sophisticated shmagents to be able to modally escape various norms, and shmagency as underdetermination, which is based on taking constitutive (...) norms that allegedly have independent value to be underdetermined by that value. I consider three different kinds of constitutivist theories of the normativity of rationality: first-person-authority views, single-mental-state views, and systems-of-mental-states views. None of the three are able to deal with either of these shmagency objections. There are sophisticated shmagents who escape all these types of constitutivist principles of rationality, so they are modally escapable, and the value of rationality underdetermines all the views. Upshot: constitutivists about structural rationality ought to worry about shmagency. (shrink)

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the carer’s professional (...) role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context. (shrink)

This paper treats the problem of which type of units, individuals or whole societies, should be used when explaining societal phenomena. It is argued that factors operating at the individual level in principle form societies, and that societal phenomena therefore should ideally be explained at this level. However, it is also argued that many societal phenomena cannot in practice be analyzed at the individual level in a clear and strict way, but rather must be analyzed holistically, because it is not (...) known how they are related to individual factors due to the complexity of societies. For societies to be described and analyzed in a clear and strict way, they must as a rule be much simplified, and such simplification is often made easier by abandoning the individualistic perspective. If researchers still wish to describe a connection between individual factors and a societal phenomenon, they often must do so in vague terms. There are also other problems with the individualistic perspective that make it difficult to use. However, using the holistic perspective may be risky, as shown by two hypothetical examples. (shrink)

Student behavioural disengagement is a problem in many schools. This paper aims to explain why students’ behavioural disengagement occurs and reoccurs in Swedish classrooms in terms of two mechanisms. Mechanisms that explain student disengagement are tested quantitatively and illustrated qualitatively with primary data consisting of 74 video-recorded classroom lessons from three compulsory schools in Sweden. The regressions suggest that peer encouragement and the school subject curriculum are central for explaining student behavioural disengagement. Qualitative analysis decomposes how the mechanisms of peer (...) encouragement and school subject curriculum increase the risk of behavioural disengagement in real time using transcripts and images. In conclusion, this study shows how both mechanisms provide complementary explanations for students’ behavioural disengagement. (shrink)

The Swedish Jewish historian Hugo Valentin (1888–1963) founded the field of Swedish Jewish history in the 1920s. Valentin was also a prominent and public figure in Swedish Jewish affairs, as a writer, Zionist and refugee activist. This article focuses on Valentin’s analysis of antisemitism, from the 1920s to the early 1950s. It pays equal attention to the continuity and change of his writings on the topic, analysed in relation to such political contexts as the ‘Jewish question’, Zionism and anti-Nazi responses, (...) and advances within scholarly research on antisemitism. It shows that Valen­tin staked out a new approach to the topic of antisemitism, in which Jewish characteristics and the so-called Jewish question, while not completely absent, were placed within parentheses. Instead, he presented antisemitism and individual antisemites as problems in their own right, which, given Nazi German expansionism and the outbreak of the Second World War, seemed to be a greater and more urgent issue than whatever questions might have pertained to Jews and their place in modern society. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...) of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

Together with the Sophist, Plato’s Statesman is often taken to introduce and develop a new scientific form of theoretical inquiry, represented by the Eleatic visitor. This paper draws on recent scholarship on the Sophist and evaluates the reliability of this scientific approach when applied to political matters in the Statesman. It analyzes how the Eleatic visitor identifies and tries to mend two central mistakes in his own initial definition of the statesman and argues that the visitor’s treatment of three related (...) topics – eugenics, tyranny and law – makes his line of reasoning inconsistent. Relying on Plato’s dramatic use of similar forms of argumentation elsewhere, it suggests that the Statesman is not designed to defend the political significance of the visitor’s new form of scientific philosophy, but that its purpose instead is to test and to critically examine the consequences of this line of inquiry. (shrink)

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...) are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

The World Health Organization has published a global priority list of antibiotic-resistant bacteria to guide research and development of new antibiotics. Every pathogen on this list requires R&D activity, but some are more attractive for private sector investments, as evidenced by the current antibacterial pipeline. A “pipeline coordinator” is a governmental/non-profit organization that closely tracks the antibacterial pipeline and actively supports R&D across all priority pathogens employing new financing tools.

Constitutivism explains norms in terms of their being constitutive of agency, actions, or certain propositional attitudes. However, the shmagency objection says that if we can be shmagents – like agents, minus the norm-explaining features of agency – we can avoid the norms, so the explanation fails. This paper extends this objection, arguing that constitutivists about practical norms suffer from it despite their recent attempts to solve it. The standard response to the objection is that it is self-defeating for agents to (...) become shmagents. I agree, but the response ignores the possibility of shmagents who consider whether to be agents while already standing outside agency. Another response says that we ought to be agents because agency is, in some sense, normatively valuable, and if so, we can explain norms in terms of this valuable form of agency. But then the norms that our constitutions are supposed to explain are underdetermined because it is unclear how much we ought to care about this value. I conclude that the shmagency objection has yet to be answered. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...) (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined (...) or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications. (shrink)

In recent discussions of the Humean Theory of Motivation (HTM), several authors – not to mention other philosophers around the proverbial water cooler – have appealed to the simplicity of the theory to defend it. But the argument from simplicity has rarely been explicated or received much critical attention – until now. I begin by reconstructing the argument and then argue that it suffers from a number of problems. Most importantly, first, I argue that HTM is unlikely to be simpler (...) than even close competing theories, and second, it is unlikely that a plausible version of the theory will be very simple. Moreover, I argue that a convincing case for HTM is likely to have to show that it is more virtuous than defenders have done so far. (shrink)

In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What (...) this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)

Realists about group agency, according to whom corporate agents may have mental states and perform actions over and above those of their individual members, think that individual agents may switch between participating in individual and corporate agency. My aim is, however, to argue that the inescapability of individual agency spells out a difficulty for this kind of switching – and, therefore, for realism about corporate agency. To do so, I develop Korsgaard's notion of plight inescapability. On my take, it suggests (...) that individual agents are continuously faced with fully exercising their own individual agency (absent external limits at the time of its exercise). But then individual agents may not switch to acting as members of corporate agents, in the sense of taking on irreducible mental states that differ from their own. As it nevertheless is possible to participate fully in the action of a corporate entity, this incompatibility between individual and corporate mental states suggests a challenge for group agent realism. (shrink)

Why be moral? According to constitutivism, there are features constitutive of agency, actual or ideal, the properties of which explain why moral norms are normative for us. I aim to investigate whether this idea is plausible. I start off critically. After defining constitutivism and outlining its attractions and problems (chapter 1), I discuss the theories of various features of agency that are supposed to ground morality according to the leading constitutivists in the literature. I find these theories wanting. They are (...) based on implausible assumptions about agency (chapter 2), and they fail to make sense of moral (and other) norms because the so-called shmagency objection, according to which we can shirk from our normative commitments by being ‘shmagents’ rather than agents, appears in new ways for them (chapter 3). Then I get more constructive. I defend a two-tiered form of constitutivism. The first tier captures practical rationality, and the second tier captures reasons for action. Starting with the first tier, I defend a Humean theory of agency (chapter 4) and add a principle of instrumental rationality to it (chapter 5). Appendices A and B supplement these chapters with replies to criticisms of the Humean picture. In chapters 6 and 7, I put this conception of agency to work to reach the second tier of the view. I start by defending a form of reasons internalism which treats practical reasons as grounded in the desires of ideal agents (chapter 6). Then I extend this theory to moral reasons, arguing – unexpectedly for a Humean – that we have universally prescriptive reasons to cooperate with other cooperative agents to satisfy our other respective desires (chapter 7). Hence, the constitutive features of ideal agency ground a morality of cooperation. I conclude by summarizing the case for constitutivism (chapter 8). (shrink)

Researchers have recently provided proof of concept for uterus transplantation, giving rise to a discussion about priority setting. This article analyses whether absolute uterine‐factor infertility (AUFI), the main indication for uterus transplantation, gives rise to a healthcare need and the extent to which such a need places justified claims on public funding in a needs‐based welfare system. It is argued that, regardless of the concept of health to which one subscribes, there is a healthcare need for uterus transplantation in women (...) with AUFI. The provision of alternative ways of addressing this need, such as surrogacy and adoption, reduces its severity. Hence, where such alternatives are publicly funded, uterus transplantation is unlikely to become cost‐effective. However, where surrogacy and adoption are not publicly funded, uterus transplantation should be given a similar priority level to other assisted reproductive technologies. In these circumstances, public funding for uterus transplants may well be justified, particularly in well‐funded healthcare system with relatively generous cost‐effectiveness thresholds. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)