Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

The "morning morality effect"-the alleged phenomenon that people are more likely to act in unethical ways in the afternoon when they are tired and have less self-control than in the morning-may well be expected to influence prehospital anaesthesiologist manning mobile emergency care units (MECUs). The working conditions of these units routinely entail fatigue, hunger, sleep deprivation and other physical or emotional conditions that might make prehospital units predisposed to exhibit the "morning morality effect". We investigated whether this is in fact (...) the case by looking at the distribution of patient transports to hospital with and without physician escort late at night at the end of the shift as a surrogate marker for changing thresholds in ethical behaviour. All missions over a period of 11 years in the MECU in Odense were reviewed. Physician-escorted transports to hospital were compared with non-physician-escorted transports during daytime, evening, and night-time (which correlates with time on the 24 h shifts). In total, 26,883 patients were transported to hospital following treatment by the MECU. Of these, 27.4% (26.9%-27.9%) were escorted to the hospital. The ratio of patient transports to hospital with and without physician escort during the three periods of the day did not differ (p = 1.00). We found no evidence of changes in admission patterns over the day. Thus, no evidence of the expected "morning morality effect" could be found in a prehospital physician-manned emergency care unit. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

Brogaard's non-indexical version of moral contextualism has two related problems. It is unable to account for the function of truth-governed assertoric moral discourse, since it leaves two (semantically clearheaded) disputants without any incentive to resolve seemingly contradictory moral claims. The moral contextualist could explain why people do feel such an incentive by ascribing false beliefs about the semantic workings of their own language. But, secondly, this leaves Brogaard's moral contextualism looking weaker than a Mackie-style invariantist error theory about morals. The (...) latter is equally non-objectivist, but less revisionist, since it takes the semantics of moral discourse at face value, and can also explain all of Brogaard's other linguistic evidence. (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)

Corporate social responsibility has become of great interest to both researchers and practitioners alike with much discussion on whether the costs outweigh the performance implications. CSR has become a firm strategic tool as firms recognize that the customer value proposition and CSR is integrated with the focus on how to differentiate the firm from the view of the customer. We utilized market orientation theory as our foundation for our research as it explains how organizations adapt to their customer environment to (...) develop competitive advantages. With the current customer focus on CSR, MO assists the field in identifying a possible firm differentiation. Our research found that firms that ranked high on CSR correlated positively to performance. We also found our theoretically developed constructs of firm customer orientation and firm market orientation correlated with the firm adopting CSR. The results also indicated that CSR positively mediates CO and MO to firm performance. As past research had mixed results over the direct relation of MO to performance, our research suggests that CSR may be the missing variable to explain the MO/performance relationship. (shrink)

Accounts of analogical inference are usually categorized into four broad groups: abductive, deductive, inductive and sui generis. The purpose of this paper is to defend a sui generis model of analogical inference. It focuses on the sui generis account, as developed by Juthe [2005, 2009, 2015, 2016] and Botting’s [2017] criticism of it. This paper uses the pragmadialectical theory of argumentation as the methodological framework for analyzing and reconstructing argumentation. The paper has two main points. First, that Juthe’s arguments against (...) a deductive interpretation of prima facie analogy argumentation remain unaffected by Botting’s criticism, which means that many of the reasons against deductive reformulation of analogy argumentation still stand. The additional argument, which Botting himself brings up, that a deductive interpretation cannot account for the cumulative effect of analogies, just provides further reason to reject deductivism. The second main point of this paper is that an inductive interpretation of analogical inference also fails. There are constitutional differences between inductive and analogical inference that cannot be bridged. The result is a firm defense of the sui generis view of analogical inference. (shrink)

Corporate sustainability is an important strategy and value orientation for marketing, but scarce research addresses the organizational drivers and barriers to including it in companies’ marketing strategies and processes. The purpose of this study is to determine levels of commitment to corporate sustainability in marketing, processes associated with sustainability marketing commitment, drivers of sustainability marketing at the functional level of marketing, and its organizational context. Using survey data from 269 managers in marketing, covering a broad range of industries in Sweden (...) and Denmark, we took a structural modelling approach to examine construct relationships, mediation, and moderation effects. Overall, the findings show that marketing capabilities associated with the innovation of new products, services, and business models constitute a strong driver to leverage sustainability marketing commitment. In conjunction with insights into processes related to the enactment of sustainability marketing, this result indicates that companies’ marketing departments have a propensity to drive corporate sustainability. The study provides substance to the idea of aligning substantive marketing capabilities closer to dynamic capabilities. Accordingly, the study reveals that reliance on market orientation alone does not lead to greater sustainability commitment. (shrink)

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational (...) and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference. (shrink)

Der Ubergang von der Ideenwelt des Veda zu derjenigen der Upanisaden wird in der Regel als Beginn der indischen Philosophie angesehen. Lars Gohler zeigt in seiner Monographie zur fruhen Philosophie in Indien, dass es neben den Upanisaden hingegen noch eine weitere Traditionslinie in der Entstehung der indischen Philosophie gegeben hat: Sie fuhrt von der Opferritualistik des Veda zu der ihr nachfolgenden Ritualwissenschaft und Hermeneutik der Mimamsa. Ein Grossteil der Begriffe der indischen Philosophie, die ursprunglich aus dem Bereich der Opferritualistik (...) stammen, wurden in der Mimamsa von ihrem engeren rituellen Gebrauch gelost und erhielten eine philosophische Dimension. Ebenso haben die Diskurslogik, Sprachphilosophie und Hermeneutik der Mimamsa in methodischer Hinsicht wichtige Ausgangspunkte fur die klassische Philosophie Indiens dargestellt. Gohler beleuchtet in seiner Studie detailliert diese weitgehend unbekannte Traditionslinie und zeigt ihren entscheidenden Einfluss auf die Entwicklung der indischen Philosophie auf. (shrink)

We are living in a world which is severely crisis-ridden and faces some major challenges. The fact that we are currently facing a genuine global pandemic brings about even more uncertainty. The social and political institutions, which emerged and consolidated during the 20th century, and which created stability, have become fragile. The young generation born in the 1990s and onwards have experienced 9/11 and the ‘war against terrorism’, the financial crisis of 2008, changes to climate, environmental degradation, and most recently (...) the COVID-19 pandemic. The generation born between 1960 and 1990 have had the same experiences along with severe economic crises in the 1970s and 1980s and the Cold War. Some of these challenges are in different ways intertwined with capitalism and its crises, while others are linked to the rapid development of new technologies, in particular innovations within communication and information technologies. This introduction lists the most important grand challenges facing the world as they have emerged more recently. The five articles following this introduction address some of these challenges, with particular attention to the problems of capitalism and democracy and the relation between these two areas. Most authors agree that climate change and the destruction of the environment are the biggest and most pertinent problems to address, but it is their stance that we can only meet these challenges if democracy is functioning well. (shrink)

Limiting intensive care is paid increasing attention. In the echoing call for physicians’ ethical self‐restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, (...) but only draw conclusions from defined premises, the premises may or may not be true. Their intertwined descriptive and normative evidence is endorsed in an academic and political discourse. There will necessarily be various demands for rationality in prudent decisions between physicians, their patients and society. These demands are formulated dialogically through critical questions and justified answers. A good argument is the convincing one that, finally and ideally, leads to the absence of open objections. Thus, in the end the rightness of a given decision does not depend on axiomatic moral principles, but is comparative and conditional, as it is given in an omnilateral argument. Neither is it the democratic process of shared decision making that we should evaluate, but rather the argumentative state itself, when we judge the morality of health politics and clinical practice. (shrink)

This is a set of three volumes containing edited versions of papers and commentaries presented in invited symposium sessions of the Eighth World Congress of the Econometric Society. The papers summarize and interpret recent key developments and discuss future directions in a wide range of topics in economics and econometrics. The papers cover both theory and applications. Written by leading specialists in their fields, these volumes provide a unique survey of progress in the discipline.

This is the first of three volumes containing edited versions of papers and commentaries presented in invited symposium sessions of the Eighth World Congress of the Econometric Society. The papers summarize and interpret recent key developments and discuss future directions in a wide range of topics in economics and econometrics. The papers cover both theory and applications. Written by leading specialists in their fields these volumes provide a unique survey of progress in the discipline.

This is the second of three volumes containing edited versions of papers and commentaries presented in invited symposium sessions of the Eighth World Congress of the Econometric Society. The papers summarize and interpret key developments and discuss future directions in a wide range of topics in economics and econometrics. The papers cover both theory and applications. Written by leading specialists in their fields, these volumes provide a unique survey of progress in the discipline.

This is the third of three volumes containing edited versions of papers and commentaries presented in invited symposium sessions of the Eighth World Congress of the Econometric Society. The papers summarize and interpret recent developments and discuss future directions in a wide range of topics in economics and econometrics. The papers cover both theory and applications. Written by leading specialists in their fields, these volumes provide a unique survey of progress in the discipline.

There is an emerging consensus that retrieval practice is a powerful way to enhance long-term retention and to reduce achievement gaps in school settings. Less is known whether retrieval practice benefits performance in individuals with low intrinsic motivation to spend time and effort on a given task, as measured by self-reported need for cognition. Here, we examined retrieval practice in relation to individual differences in NFC by combining behavioral and functional magnetic resonance imaging data. Using a within-subject design, upper-secondary school (...) students learned a language-based material, with half of the items by means of retrieval practice with feedback and half by study only. One week later, the students were tested on the word-pairs either in the classroom, or in a fMRI scanner. In both settings, a retrieval practice effect was observed across different levels of NFC. Relatedly, comparable fMRI effects were seen in both NFC subgroups. Taken together, our findings provide behavioral and brain-imaging evidence that retrieval practice is effective also for individuals with lower levels of NFC, which is of direct relevance for educational practice. (shrink)

This volume offers an original and innovative collection of fresh approaches to the investigation of the idea of taste. It is divided into three sections: the concept of taste; taste and culture; and gustatory taste. The papers in all three parts deal with the way that aesthetics interpenetrates discussions of food, political conflict, art appreciation, aesthetic judgement, and education. These are fresh, never-before published contributions from a range of scholars, using the most recent literature in their areas of expertise. There (...) is no other book available that collects the latest research in this field, and, as such, it represents a key contribution to recent aesthetic, and more broadly philosophical, interest in matters of taste. (shrink)

The authors offer a clear, succinct and basic introduction to set theory and formal logic for linguists.

The brain networks underlying human multiple-cue judgment, the judgment of a continuous criterion based on multiple cues, have been examined in a few recent studies, and the ventral precuneus has been found to be a key region. Specifically, activation differences in ventral precuneus (as measured with functional magnetic resonance imaging, fMRI) has been linked to an exemplar-based judgment process, where judgments are based on memory for previous similar cases. What aspects of exemplar-based judgment ventral precuneus supports is however poorly understood. (...) Ventral precuneus is a brain region important for various episodic memory processes, where increased engagement of this region together with the ventromedial prefrontal cortex (vmPFC) and the medial temporal lobes (MTL) during learning have been linked to retrieval success. Several alternatives are plausible, for example that reduced brain activity in ventral precuneus during learning to make exemplar-based judgments could reflect reduced needs for visuo-spatial attention as a function of learning to master the task. The present study used fMRI during a multiple-cue judgment task to gain novel neurocognitive evidence informative for the link between learning-related activity changes in ventral precuneus and exemplar-based judgment. Participants (N = 27) spontaneously learned to make judgments during fMRI, in a multiple-cue judgment task specifically designed to induce exemplar-based processing. Contrasting brain activity during late learning to early learning indeed revealed higher activity in ventral precuneus, the bilateral MTL and the vmPFC. Activity in the ventral precuneus and the vmPFC was found to parametrically increase between each judgment event, and activity levels in the ventral precuneus predicted performance after learning. These results are interpreted such that the ventral precuneus supports the aspects of exemplar-based processes that are related to episodic memory, tentatively by building and retrieving memory representations for judgment. (shrink)

ABSTRACTThe concept of need is often proposed as providing an additional or alternative criterion to cost‐effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the (...) relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis ; the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others. (shrink)