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)

In this paper, the aim is to study how the work organization in one specific company for one specific trade has changed over time and with these changes, the presence and absence of alienation of employees in this trade. Blauner’s U-shaped alienation development trend has been a reference in discussions on alienation. It displays a connection between the degree of alienation and technological development. The findings from this study verify the trend and the connection in the case company. However, although (...) the development trend may look similar to that of Blauner’s model, it is differently founded. Where previous studies highlight the production system, including technology, as crucial to the presence of alienation, this study documents that external conditions outside or partly outside the company’s control—such as digital information availability, product complexity, and quality requirements—will determine the presence of alienation. Thus, researchers should adjust the content of the concept of alienation accordingly. (shrink)

ABSTRACTRoy Bhaskar's concrete utopianism assumes that a key role for intellectuals, given the current precarious situation of humanity, is the envisaging of alternative possible futures, coherently grounded in the deep structure of what already exists, which includes what people already know and have. Without this grounding, people will not be able to make a persuasive case for change. With this grounding, and by combining the realism of the intellect with the optimism of the will, they may be able to usher (...) in a future of which the youthful Marx said ‘the world has long since dreamed’. This paper is both motivated by Bhaskar's position, and takes it as its starting point. I therefore begin by presenting three scenarios for the world's future, which I take to be real possibilities. I consider which of these possibilities would be worth striving for, and in so doing, I introduce a strategy that I take to be a means to that end. Specifically, this strategy involves harmonizing interventions with critical realist eco-philosophical ambitions. I argue that such interventions should therefore have an interdisciplinary framework, be dedicated to an ethics of dialogue and care, and be directed by dialectical change and learning. (shrink)

Trust has become an important aspect of evaluating the relationship between lay public and technology implementation. Experiences have shown that a focus on trust provides a richer understanding of reasons for backlashes of technology in society than a mere focus of public understanding of risks and science communication. Therefore, trust is also widely used as a key concept for understanding and predicting trust or distrust in emerging technologies. But whereas trust broadens the scope for understanding established technologies with well-defined questions (...) and controversies, it easily fails to do so with emerging technologies, where there are no shared questions, a lack of public familiarity with the technology in question, and a restricted understanding amongst social researchers as to where distrust is likely to arise and how and under which form the technology will actually be implemented. Rather contrary, ‘trust’ might sometimes even direct social research into fixed structures that makes it even more difficult for social research to provide socially robust knowledge. This article therefore suggests that if trust is to maintain its important role in evaluating emerging technologies, the approach has to be widened and initially focus not on people’s motivations for trust, but rather the object of trust it self, as to predicting how and where distrust might appear, how the object is established as an object of trust, and how it is established in relation with the public. (shrink)

Harald Grimen: Hva er tillit. Universitetsforlaget, 2009. 151 sider.

The potential of mitigating the spreading rate and consequences of the coronavirus disease 2019 currently depends on adherence to sanitary protocols. The current study aimed to investigate the role of fatalism and comparative optimism for adherence to COVID-19 protocols. We also tested whether these factors are directly associated with adherence or associated through attitudinal mediation. The results were based on a web survey conducted among university students in Tehran, Iran. The respondents completed a multidimensional measure of fatalism and measures of (...) comparative optimism, attitudes toward COVID-19 health measures, and adherence. The estimated structural equation model explained approximately 40% of the total variance in attitudes toward COVID-19 protocols and adherence. As expected, high internality was associated with stronger adherence, whereas luck was associated with weaker adherence. Comparative optimism was more strongly associated with adherence than fatalism, and somewhat unexpectedly comparative optimism was associated with stronger adherence. Analyses of direct and indirect effects suggested that fatalism was mainly mediated through attitudes, whereas comparative optimism had both direct and mediated effects. The findings are discussed in relation to the role of these social psychological factors for COVID-19 mitigation. (shrink)

Reflections on an Interview with Jan Masschelein.

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and (...) nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

Among the thousands who arrive in Europe to seek asylum each year, a significant number are children traveling on their own. Like adults, they are fleeing from war and armed conflict situations, persecution, severe poverty, and deprivation. Some arrive because they have been trafficked and some are fleeing for reasons specifically related to their status as children. They need special attention, not only in terms of specialized care and assistance, but also in terms of the refugee status determination procedure. When (...) they arrive in a country of asylum they risk further violations of their rights. This paper intends to outline the rignts of these children under international law; to highlight key protection concerns facing them, particularly in the European context; to summarize ways of how a UN/ngo program has attempted to address these problems; and to make some specific recommendations. (shrink)

Hilary Kornblith argues that many traditional philosophical accounts involve problematic views of reflection (understood as second-order mental states). According to Kornblith, reflection does not add reliability, which makes it unfit to underlie a separate form of knowledge. We show that a broader understanding of reflection, encompassing Type 2 processes, working memory, and episodic long-term memory, can provide philosophy with elucidating input that a restricted view misses. We further argue that reflection in fact often does add reliability, through generalizability, flexibility, and (...) creativity that is helpful in newly encountered situations, even if the restricted sense of both reflection and knowledge is accepted. And so, a division of knowledge into one reflexive (animal) form and one reflective form remains a plausible, and possibly fruitful, option. (shrink)

Reinforcement learning systems usually assume that a value function is defined over all states that can immediately give the value of a particular state or action. These values are used by a selection mechanism to decide which action to take. In contrast, when humans and animals make decisions, they collect evidence for different alternatives over time and take action only when sufficient evidence has been accumulated. We have previously developed a model of memory processing that includes semantic, episodic and working (...) memory in a comprehensive architecture. Here, we describe how this memory mechanism can support decision making when the alternatives cannot be evaluated based on immediate sensory information alone. Instead we first imagine, and then evaluate a possible future that will result from choosing one of the alternatives. Here we present an extended model that can be used as a model for decision making that depends on accumulating evidence over time, whether that information comes from the sequential attention to different sensory properties or from internal simulation of the consequences of making a particular choice. We show how the new model explains both simple immediate choices, choices that depend on multiple sensory factors and complicated selections between alternatives that require forward looking simulations based on episodic and semantic memory structures. In this framework, vicarious trial and error is explained as an internal simulation that accumulates evidence for a particular choice. We argue that a system like this forms the “missing link” between more traditional ideas of semantic and episodic memory, and the associative nature of reinforcement learning. (shrink)

This book explores what science fiction can tell us about the human condition in a technological world, with the ethical dilemmas and consequences that this entails. This book is the result of the joint efforts of scholars and scientists from various disciplines. This interdisciplinary approach sets an example for those who, like us, have been busy assessing the ways in which fictional attempts to fathom the possibilities of science and technology speak to central concerns about what it means to be (...) human in a contemporary world of technology and which ethical dilemmas it brings along. One of the aims of this book is to demonstrate what can be achieved in approaching science fiction as a kind of imaginary laboratory for experimentation, where visions of human (or even post-human) life under various scientific, technological or natural conditions that differ from our own situation can be thought through and commented upon. Although a scholarly work, this book is also designed to be accessible to a general audience that has an interest in science fiction, as well as to a broader academic audience interested in ethical questions. (shrink)

This mixed-methods study explores how high school students ( n=35) enrolled in a school with a high Latino/a population evaluate the trustworthiness of documents in two historical reasoning tasks: one about the Dust Bowl in the 1930s and the other about the experiences of Mexicans and Mexican Americans in the 1920s. Students indicated whether they trusted each document, provided a rationale for their trust (or distrust) of each document, and ranked the trustworthiness of the documents. We also interviewed 10 focal (...) students to explore students’ reasoning in more in-depth ways than the written responses allowed. We found that students tended to trust the secondary source documents more than the primary source documents because, as they argued, the secondary source documents contained more facts. In contrast, students were less likely to trust the primary source documents, particularly the songs, arguing that they were more opinion-based than factual. We also found that some students had an emotional response to the content of some of the documents, and in some cases, these emotional responses shaped how they viewed the documents’ trustworthiness. Additionally, students’ heritage may have played a role in some students’ trust justifications for some documents in the experiences of Mexicans and Mexican Americans task. We conclude with implications for curriculum and instruction. (shrink)

Hilary Kornblith argues that many traditional philosophical accounts involve problematic views of reflection. According to Kornblith, reflection does not add reliability, which makes it unfit to underlie a separate form of knowledge. We show that a broader understanding of reflection, encompassing Type 2 processes, working memory, and episodic long-term memory, can provide philosophy with elucidating input that a restricted view misses. We further argue that reflection in fact often does add reliability, through generalizability, flexibility, and creativity that is helpful in (...) newly encountered situations, even if the restricted sense of both reflection and knowledge is accepted. And so, a division of knowledge into one reflexive form and one reflective form remains a plausible, and possibly fruitful, option. (shrink)

The generality problem is commonly considered to be a critical difficulty for reliabilism. In this paper, we present a dynamical perspective on the problem in the spirit of naturalized epistemology. According to this outlook, it is worth investigating how token belief-forming processes instantiate specific types in the biological agent’s cognitive architecture and background experience, consisting in the process of attractor-guided neural activation. While our discussion of the generality problem assigns “scientific types” to token processes, it represents a unified account in (...) the sense that it incorporates contextual and common sense features emphasized by other authors. (shrink)

This work describes the nano field in Norway as currently emerging in the dynamics between two forms of nano research activities described along a centre-periphery axis. 1) There are strategic research initiatives committed to redeem the envisioned potential of the field by means of social and material reorganisation of existing research activities. This activity is seen as central as it is one of our premises that the standard circulating nano vision implies such a work of reorganisation. The fact that nano (...) is often taken as a paradigmatic example of the shift from Mode-1 to Mode-2 research, supports this assumption. 2) In parallel to this activity, a wide variety of research projects pursuing nano strategies are being funded. We regard such research activity as peripheral in so far as the activity is not marked by being committed to the circulating nano vision, as may often be the case. In the process of reorganising, this article argues, the research activity at the periphery provides a crucial arena for discussing and validating what is to be achieved through the work of reorganisation that takes place at the centre. Our analysis is informed by two Norwegian cases. We examine a major nano research initiative at a Norwegian university as a centre and a research project utilising nanoparticles in fish vaccines as a periphery. (shrink)

Innovation plays a central role in economic development, at regional and national level. The paper takes a practical approach to innovation and the support of entrepreneurship, based on experience of facilitating two contrasting networks of enterprises. Action research is seen as having a central role, but with different approaches according to the innovation process concerned, and the part of the process.

ABSTRACTPatric Baert suggests that ‘encountering difference’, as we might when immersing ourselves in new cultural settings, allows us to redescribe and reconceptualise ourselves, our culture and our surroundings. By so doing, individuals can learn to see themselves, their own culture and their own presuppositions from a different point of view. They can then contrast their interpretations with alternative forms of life; and this is a requirement both for learning about themselves and coming to understand others. There is evidence that such (...) learning can reduce animosity towards others and encourage reciprocity. In this paper, I discuss the possibility that such an approach could also be useful if applied to the more-than-human world, as an antidote to nature’s exploitation by humans. I therefore argue that we need to ‘encounter difference’ with nature’s forms, which will allow us to learn from it. The meaning and implications of such ‘encountering difference’ will be developed in relation to Bhaskar’s philosophy of metaReality. (shrink)

Incremental change and innovation are often regarded as two separate concepts, with some interconnections. Based on two practical cases that emphasize respectively incremental change and innovation, the article discusses whether a division between these concepts can be maintained. Action research is seen as having a central role, offering an integral working method in industrial networks.

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

This paper argues that intelligence can be approximated by the ability to produce accurate predictions. It is further argued that general intelligence can be approximated by context dependent predictive abilities combined with the ability to use working memory to abstract away contextual information. The flexibility associated with general intelligence can be understood as the ability to use selective attention to focus on specific aspects of sensory impressions to identify patterns, which can then be used to predict events in novel situations (...) and environments. The argumentation synthesizes Godfrey-Smith’s environmental complexity theory, adding the notion of niche broadness as well as changes concerning the view of cognition and control, and Hohwy’s predictive mind theory, making explicit the significance of accuracy as a composite of trueness and precision where the nervous system acts as a distributed controller motivating actions that keep the body in homeostasis. (shrink)

This paper argues that intelligence can be approximated by the ability to produce accurate predictions. It is further argued that general intelligence can be approximated by context dependent predictive abilities combined with the ability to use working memory to abstract away contextual information. The flexibility associated with general intelligence can be understood as the ability to use selective attention to focus on specific aspects of sensory impressions to identify patterns, which can then be used to predict events in novel situations (...) and environments. The argumentation synthesizes Godfrey-Smith’s environmental complexity theory, adding the notion of niche broadness as well as changes concerning the view of cognition and control, and Hohwy’s predictive mind theory, making explicit the significance of accuracy as a composite of trueness and precision where the nervous system acts as a distributed controller motivating actions that keep the body in homeostasis. (shrink)

Numerous species use different forms of communication in order to successfully interact in their respective environment. This article seeks to elucidate limitations of the classical conduit metaphor by investigating communication from the perspectives of biology and artificial neural networks. First, communication is a biological natural phenomenon, found to be fruitfully grounded in an organism’s embodied structures and memory system, where specific abilities are tied to procedural, semantic, and episodic long-term memory as well as to working memory. Second, the account explicates (...) differences between non-verbal and verbal communication and shows how artificial neural networks can communicate by means of ontologically non-committal modelling. This approach enables new perspectives of communication to emerge regarding both sender and receiver. It is further shown that communication features gradient properties that are plausibly divided into a reflexive and a reflective form, parallel to knowledge and reflection. (shrink)

PurposeThis paper examines the influence of leader humility on knowledge sharing intention. Drawing on social exchange theory, we test the direct and indirect mechanisms to explain the influence leader humility has on knowledge sharing intention.Design/Methodology/ApproachA two-wave, time-lagged field study was conducted. We surveyed 252 professional employees from Australia.FindingsResults show a significant direct, positive association between leader humility and knowledge sharing intention. While leader humility had a direct, positive association with affective trust in supervisor and work engagement, it did not directly (...) impact on organizational citizenship behaviors directed toward the individual. There were three SET-related, serial mediators in the relationship between leader humility and knowledge sharing intention. These were affective trust, work engagement, and OCB-I.Research Limitations/ImplicationsFuture studies should collect multi-source data such as peers’ or supervisors’ ratings of the focal respondents’ work engagement, OCB-I, and knowledge sharing behaviors to augment single-source data. Future studies could adopt an affect theory of social exchange to further explore the relationships tested in this study.Originality/ValueThis study contributes to the affect SET and knowledge management literature on how leadership behaviors impact the intention to share knowledge. Our study highlights the preference of the willingness to share knowledge with their co-workers is mediated by affective trust in their immediate supervisors, work engagement, and OCB-I that are equally important as treating their subordinates with humility. (shrink)

Social enterprises in the microfinance industry need to adhere to both financial and social demands. Critics argue that there is a mission drift away from the social mission, and this has motivated the introduction of social rating agencies to strengthen the business ethics of microfinance institutions. Using a global dataset of 204 socially rated MFIs from 58 countries, we assess the factors that drive the social performance ratings of MFIs. Overall our results show that social ratings of MFIs are significantly (...) related to financial performance, greater outreach especially in rural areas, well-defined social objectives, staff commitment, service quality and an enhanced customer service. We observe that various rating agencies attach different importance to each of the social indicators. The public policy implication is that social rating agencies need to become more transparent, to reduce the information asymmetries between heterogenous socially motivated investors and the focal MFI. (shrink)