he article combines Elinor Ostrom’s design principles for common-pool resources and human rights provisions, including subsequent clarifications and jurisprudence. It analyses whether stronger local self-governance, embedded in the natural resource dimension of peoples’ rights to self-determination is a recommendable approach. Two changes in understanding are noted. First, the universal approval of indigenous peoples’ right to self-determination as specified in the UN Declaration on the Rights of Indigenous Peoples. Second, the wide endorsement of the specific principle of free and prior informed (...) consent. As the exercise of peoples’ rights to self-determination is done on a collective level, it is important to have awareness of whether particularly affected and marginalized households and individuals are included or not included in the decision-making process. The article then reviews a range of new instruments adopted by the OECD and the UN for improved human rights awareness and compliance in the context of economic investments. The article finds that these instruments are still underutilized. Finally, the article identifies the role of human rights in bilateral investment treaties. It finds that there are less jurisdictional restrictions – as many treaties have a wide understanding of applicable law – than cognitive restrictions – as human rights competence is rarely sought when establishing tribunals mandated to solve investments disputes. (shrink)

Hans Morten Haugen offers an analysis of the intersection of intellectual property with health, traditional knowledge and biodiversity against a backdrop of established and emerging human rights. How those rights interface and who decides are among the most difficult issues in international intellectual property, and there is no doubt that there is room for fresh ideas on how to simultaneously achieve the goals of innovation, development and access. 0Also part of series: Library of Human Rights; 2.

Antallet sultne i verden har økt, selv om det kan diskuteres om det i dag er en høyere eller lavere andel som lider under sult enn for seks år siden – før matprisøkningen. Alle er uansett enige om at det samlet sett produseres nok mat i verden til at alle kan få dekket sine ernæringsbehov. Artikkelen viser at to hovedretninger i debatten om matproduksjon står mot hverandre. Den dominerende retningen fokuserer primært på matsikkerhet, forstått som økt matproduksjon og økt handel (...) med mat. Den andre retningen argumenterer for at interessene og rettighetene for de mest sårbare må ha forrang i politiske prioriteringer, og at de sårbare sikres best med en strategi basert på menneskerettigheter. Artikkelen drøfter landfordeling, økt bruk av genteknologi i landbruket og nedbygging av handelshindre for landbruksprodukter. Industrialisering av landbruket og liberalisering av handelen med landbruksvarer kan gi gode resultater på makronivå – på kort sikt. Dersom målet er å fremme situasjonen for de mest sårbare og samtidig møte klimautfordringene er løsningen en nedenfra-tilnærming, som til nå er blitt ignorert av de fleste stater.Nøkkelord: retten til mat, matsikkerhet, klima, Verdens handelsorganisasjon, FNs tusenårsmålEnglish summary: The struggle over food intake and food productionThe number of hungry persons in the world has increased – although it is debatable whether there is currently a higher or lower proportion of suffering from hunger than six years ago – before the food price increases. All agree that the overall production of food in the world is adequate for everyone's nutritional needs. The article demonstrates that there are two main approaches in the debate on food production. The dominant approach focuses primarily on food security, understood as increased food production and increased food trade. The other approach argues that the interests and rights of the most vulnerable must prevail, and that improvements for the vulnerable are best ensured with a strategy based on human rights. The article analyzes land distribution, increased use of genetic technology in agriculture and reduction of trade barriers for agricultural products. Industrialization of agriculture and the liberalization of trade in agricultural products can provide good results at the macro level – in the short term. If the goal is to promote the situation of the most vulnerable and at the same time addressing climate change, the solution is a bottom-up approach, which until now has been ignored by most states. (shrink)

Tax havens and tax secrecy have risen to the top of the global policy agenda and may constitute the most important impediment for reducing inequalities. Moreover, complex corporate structures allow charging for services undertaken in various countries through one low-tax country. Transferring profits to low-tax jurisdictions will significantly reduce a multinational corporation’s overall tax burden. Individuals are assisted in opening shell corporations that officially own bank accounts where the real owner is not revealed. Reducing this practice of tax dodging has (...) proven to be difficult, despite substantial efforts by several international organizations and states over the last decade. It is too easy to be removed from the list of tax havens; mere membership in OECD’s Global Forum on Transparency and Exchange of Information for Tax Purposes qualifies. Tax dodgers add to global inequalities and severely weaken states’ capacity to undertake their task of creating a solid tax base, embedded in the principle that all actors are taxed according to the income generated in each country. A weak tax base will lead to less trust, more violence and more deaths. Keywords: country-by-country reporting, EU, OECD, tax avoidance, tax evasion, tax havens. (shrink)

No global professional codes for the natural science and technology professions exist. In light of how the application of new technology can affect individuals and communities, this discrepancy warrants greater scrutiny. This article analyzes the most relevant processes and seeks to explain why these processes have not resulted in global codes. Moreover, based on a human rights approach, the article gives recommendations on the future process and content of codes for science and technology professions. The relevance of human rights in (...) the realm of individual conduct is based on the fact that while human rights treaties primarily outline State obligations, individuals have responsibility for human rights promotion. Human rights principles have only recently been subject to interests from policy makers and academics, and must be better clarified. Human rights principles are found to be relevant, but are effective only if they are applied in conjunction with substantive human rights. (shrink)

The article analyses the three terms autonomy, dignity and vulnerability. The relevance and practical application of the terms is tested in two spheres. First, as guiding principles in the area of ethics of medicines and science. Second, as human rights principles, serving to guide the conduct of public policies for an effective realization of human rights. The article argues that all human beings have the same dignity, but that the autonomy—and therefore vulnerability—differs considerably. Simply said, with reduced autonomy comes increased (...) vulnerability, implying extra attention to the protective dimensions. The article finds that the three terms approach the protection of human beings in different ways and that all are relevant and applicable in both spheres, but that an isolated notion of autonomy and a ‘group-based’ notion of vulnerability are not adequate. (shrink)

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)

Norway’s liberal abortion law allows for abortion on social indications, yet access to screening for fetal abnormalities is restricted. Norwegian regulation of, and public discourse about prenatal screening and diagnosis has been exceptional. In this study, we wanted to investigate whether the exceptional regulation is mirrored in public attitudes. An electronic questionnaire with 11 propositions about prenatal screening and diagnosis was completed by 1617 Norwegian adults (response rate 8.5%). A majority of respondents supports increased access to prenatal screening with ultrasound (...) (60%) and/or full genome sequencing of fetal DNA (55%) available for all pregnant women. Significant minorities indicate, however, that a public offer of prenatal screening for all pregnant women would signal that people with Down syndrome are unwanted (46%) or could be criticized for contributing to a ‘sorting society’ (48%). Results indicate deeper ambivalences and a cultural sensitivity to the ethical challenges of prenatal screening and subsequent abortions. The specific diagnosis of Down syndrome and the fear of becoming a ‘sorting society’ which sorts human life due to diagnoses, appear to play prominent roles in citizen deliberations. The low response rate means that a non-response bias cannot be excluded, yet reasons why results are still likely to be of value are discussed. (shrink)

Das Altern ist nicht nur eine biologische, sondern auch eine kulturelle Tatsache. Als Objekt der Verhandlungen zwischen Wissensdiskursen erscheint Alter als ein ebenso heterogenes wie problematisches Phanomen, das von Werturteilen und Weltanschauungen bestimmt wird. Des Weiteren sind Alter und Medizin in der offentlichen Meinung moderner Gesellschaften eng miteinander verbunden. Das interdisziplinare Forschungsprojekt "Kulturelle Variationen und Reprasentationen des Alters" geht von einem erweiterten, die geistes-, sozial- und medizinwissenschaftlichen Diskurse integrierenden Konzept von Alterskulturen und Potentialen des Alters aus. Dies bedeutet, Alter als (...) Gegenstand des Wissens und als Konzept zu begreifen. Alterskonzepte, das heisst Vorstellungen, Wertungen und, Bilder des Alters, sind Deutungsmuster fur elementare Bedurfnisse an der Schnittstelle von individuellem und kollektivem Leben. Mit Beitragen von David Blane und Gopalakrishnan Netuveli, Johannes Siegrist und Morten Wahrendorf, Peter Rusterholz, Anouk Janssen, Hiltrud Westermann-Angerhausen, Stefanie Knoll, Jean-Claude Schmitt, Gerd Gockenjan, Giovanna Pinna, Hans-Georg Pott, Monika Gomille, Miriam Seidler, Pat Thane, Simone Moses, Heiner Fangerau und Jorg Vogele, Anja Schonlau, Thomas Kupper". (shrink)

In this paper I offer a normative account of development expertise. Although extending expertise beyond the traditional development experts to include local stakeholders, this normative account aims to delimit legitimate forms of expertise. I label this normative view third wave development expertise. Third wave expertise is distinguished from both the technocratic and the social constructivist views of development expertise. In particular, I discuss the notions of contributory and interactional expertise. Contributory expertise denotes the extent to which a group of agents (...) possesses knowledge which can make a significant contribution to development decision-making, while interactional expertise denotes the extent to which they are able to communicate this knowledge meaningfully. While local stakeholders may possess contributory expertise in matters of their own development, they may lack interactional expertise to communicate this knowledge. Resolving this issue, I argue, requires a mediator who can interact with and between external experts and local stakeholders. (shrink)

Two of the Scandinavian countries, Sweden and Finland have recently joined the European Communities. Together with a third Scandinavian country, Denmark, which joined the Communities two decades ago it seems likely that Scandinavian views and attitudes will make a great impact on the future work of the European Communities — including the on-going harmonisation in the field of corporate social responsibility.This article provides an examination of the Scandinavian view on the five best known models for achieving corporate social responsibility and (...) it shows the likely impact of the admittance of the Scandinavian countries on the future work in the European Communities with regard to corporate social responsibility. (shrink)

Abstract:It is a common belief that obesity is wholly or partially a question of personal choice and personal responsibility. It is also widely assumed that when individuals are responsible for some unfortunate state of affairs, society bears no burden to compensate them. This article focuses on two conceptualizations of responsibility: backward-looking and forward-looking conceptualizations. When ascertaining responsibility in a backward-looking sense, one has to determine how that state of affairs came into being or where the agent stood in relation to (...) it. In contrast, a forward-looking conceptualization of responsibility puts aside questions of the past and holds a person responsible by reference to some desirable future state of affairs and will typically mean that he or she is subjected to criticism, censure, or other negative appraisals or that he or she is heldcost-responsible in some form, for example, in terms of demanded compensation, loss of privileges, or similar. One example of this view is the debate as to whether the obese should be denied, wholly or partially, free and equal access to healthcare,notbecause they are somehow personally responsible in the backward-looking sense but simply because holding the obese responsible will have positive consequences. Taking these two conceptions of responsibility into account, the authors turn their analysis toward examining the relevant moral considerations to be taken into account when public policies regarding obesity rely on such a conception of responsibility. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ossian and the Invention of Textual HistoryKristine Louise HaugenIt is now controversial to call James Macpherson a forger or the poems of Ossian a hoax. 1 Encouraged by Derick Thomson’s 1952 demonstration that Macpherson’s Ossian indeed echoes authentic Gaelic verse, 2 a group of critics has undertaken to “rehabilitate” Macpherson, not least through a new critical edition of Ossian’s poems and related texts. 3 The edition makes it easier (...) than before to encounter Ossian directly:Morna, thou fairest of women, daughter of Cormac-Carbre? [sic] why in the circle of stones, in the cave of the rock, alone? The stream murmureth hoarsely. The blast groaneth in the aged tree. The lake is troubled before thee.... But thou art like snow on the heath. Thy hair like a thin cloud of gold on the top of Cromleach.... Thy arms, as two white pillars in the hall of Fingal. 4The authentic source of this passage seems to be the eighteenth-century commonplace that the savage and uneducated delight in figurative language, especially similes and metaphors—a commonplace enunciated often in the writings [End Page 309] of Hugh Blair, a literary critic deeply interested in Macpherson’s Ossianic productions. 5 As Harold Weinbrot and others suggest, the Ossian poems were celebrated largely because they confirmed readers’ most picturesque preconceptions about the “infancy of mankind.” 6There was room for disagreement. Many influential litterati were convinced of the poems’ antiquity, among them Goethe, Herder, Cesarotti, and a host of Scottish intellectuals. 7 But there were also detractors, mainly English—for example, Dr. Johnson and Edward Gibbon—although David Hume soon joined the skeptics, and the Scotsman Malcolm Laing issued the most crushing attack in the exchange several decades after Ossian’s first appearance in 1760. 8 The Ossian poems served a potent mixture of scholarly and political concerns, of which some were new but some were venerable. With a subtle but important shift in balance, the same mixture underlay the willingness of the most prominent eighteenth-century critics to discredit problematic texts and textual myths, even at the cost of an apparent reduction in historical knowledge. 9 For all parties Macpherson’s Ossian invited not only aesthetic delectation, but sustained thought about the relationship between early poetry and history and the value of early texts for reconstructing the past. [End Page 310]The question of British origins had preoccupied seventeenth-century antiquaries for a number of reasons, including Polydore Vergil’s unflattering Anglica Historia (first published 1546). 10 In the campaign to establish respectable national roots the Celtic druids had quickly become a kind of favorite example; they were presented early and often as heroes of British culture. The druids and their associates the bards had been described in their French setting by classical authors; William Camden, John Selden, and others transferred them easily to Celtic Britain. It was then straightforward to suggest further that the British Celts were the first discoverers of writing and philosophy, or at least discoverers concurrent with the ancient Hebrews, or both, this theory having been elaborated for the French Celts through Annius of Viterbo’s historical forgeries of 1498 and Annius’s French partisans. 11In fact this theory placed England at a disadvantage as Scotland, Ireland, and Wales had the more convincing joint claim to Celtic ancestry. Individual claims for Scotland and Ireland were frequently heard as well. The text most relevant to Ossian was the deist John Toland’s 1726 history of the druids, in which Toland both satirized the eighteenth-century clergy and argued that the ancient Celts of France and Scotland were colonists from Ireland—the original home of druidism, learning, and Toland. 12 In Toland’s version the theory made much of certain unpublished Irish manuscripts, supposedly dating from Cicero’s day and written in the “native” Irish alphabet. St. Patrick had burned hundreds of druidical religious books when he arrived in Ireland—proof that the Celts had a written language—but the bardic histories, couched in rugged verse, had escaped the evangelist’s flames. 13 Clearly, any respectable reply would need to draw on ancient manuscripts too.Even for readers unfamiliar with Toland, Macpherson’s texts... (shrink)

It is widely assumed that human learning and the structure of human languages are intimately related. This relationship is frequently suggested to derive from a language-specific biological endowment, which encodes universal, but communicatively arbitrary, principles of language structure (a Universal Grammar or UG). How might such a UG have evolved? We argue that UG could not have arisen either by biological adaptation or non-adaptationist genetic processes, resulting in a logical problem of language evolution. Specifically, as the processes of language change (...) are much more rapid than processes of genetic change, language constitutes a both over time and across different human populations, and, hence, cannot provide a stable environment to which language genes could have adapted. We conclude that a biologically determined UG is not evolutionarily viable. Instead, the original motivation for UG arises because language has been shaped to fit the human brain, rather than vice versa. Following Darwin, we view language itself as a complex and interdependent which evolves under selectional pressures from human learning and processing mechanisms. That is, languages themselves are shaped by severe selectional pressure from each generation of language users and learners. This suggests that apparently arbitrary aspects of linguistic structure may result from general learning and processing biases deriving from the structure of thought processes, perceptuo-motor factors, cognitive limitations, and pragmatics. (shrink)

Memory is fleeting. New material rapidly obliterates previous material. How, then, can the brain deal successfully with the continual deluge of linguistic input? We argue that, to deal with this “Now-or-Never” bottleneck, the brain must compress and recode linguistic input as rapidly as possible. This observation has strong implications for the nature of language processing: (1) the language system must “eagerly” recode and compress linguistic input; (2) as the bottleneck recurs at each new representational level, the language system must build (...) a multilevel linguistic representation; and (3) the language system must deploy all available information predictively to ensure that local linguistic ambiguities are dealt with “Right-First-Time”; once the original input is lost, there is no way for the language system to recover. This is “Chunk-and-Pass” processing. Similarly, language learning must also occur in the here and now, which implies that language acquisition is learning to process, rather than inducing, a grammar. Moreover, this perspective provides a cognitive foundation for grammaticalization and other aspects of language change. Chunk-and-Pass processing also helps explain a variety of core properties of language, including its multilevel representational structure and duality of patterning. This approach promises to create a direct relationship between psycholinguistics and linguistic theory. More generally, we outline a framework within which to integrate often disconnected inquiries into language processing, language acquisition, and language change and evolution. (shrink)

Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignity make room for a moderate and normatively richer position on the moral permissibility of AD. I do not think that we have seen the full potential of the said conceptions and interpretations. I try in this article to contribute my part. First, I briefly recapitulate some (...) of the paradoxical ways in which dignity is typically invoked in the debate and try to clear up some of the obvious confusions. Then, I go on to explore a particular Kantian line of thought in some recent works on dignity and AD that seems to pave the way for a moderate position with a more principled foundation than the usual compromise positions. (shrink)

In this review article, Christiansen provides a historical perspective on the two research traditions, implicit learning and statistical learning, thus nicely setting the scene for this special issue of Topics in Cognitive Science. In this “tale of two literatures”, he first traces the history of both literatures before sketching a framework that provides a basis for understanding implicit learning and statistical learning as a unified phenomenon.

Journal of Social Philosophy, EarlyView.

How may clinical ethics committees inspire ethical reflection among healthcare professionals? How may they deal with organizational ethics issues? In recent years, Norwegian CECs have attempted different activites that stretch or go beyond the standard trio of education, consultation, and policy work. We studied the novel activities of Norwegian CECs by examining annual reports and interviewing CEC members. Through qualitative analysis we identified nine categories of novel CEC activities, which we describe by way of examples. In light of the findings, (...) we argue that some novel working methods may be well suited to promote ethical reflection among clinicians, and that the CEC may be a suitable venue for discussing issues of organizational ethics. (shrink)

A central task for clinical ethics consultants and committees (CEC) is providing analysis of, and advice on, prospective or retrospective clinical cases. However, several kinds of biases may threaten the integrity, relevance or quality of the CEC's deliberation. Bias should be identified and, if possible, reduced or counteracted. This paper provides a systematic classification of kinds of bias that may be present in a CEC's case deliberation. Six kinds of bias are discussed, with examples, as to their significance and risk (...) factors. Possible remedies are suggested. The potential for bias is greater when the case deliberation is performed by an individual ethics consultant than when an entire clinical ethics committee is involved. (shrink)

Controversies arise over abortion, assisted dying and conscientious objection in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main (...) “driver” for support for assisted dying and opposition to conscientious objection. This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority. (shrink)

Blindsight is classically defined as residual visual capacity, e.g., to detect and identify visual stimuli, in the total absence of perceptual awareness following lesions to V1. However, whereas most experiments have investigated what blindsight patients can and cannot do, the literature contains several, often contradictory, remarks about remaining visual experience. This review examines closer these remarks as well as experiments that directly approach the nature of possibly spared visual experiences in blindsight.

Nähere Informationen zu diesem Buch erhalten Sie direkt vom Verlag / For further information about this title please contact Mohr Siebeck.

Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physician–patient relationship is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physician–patient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of his argument (...) yet build on his genuine insights. In our analysis, Wyller’s critique of bedside rationing is instructive both for harbouring some very common misconceptions that must be exposed and refuted, but also for offering important words of caution. In particular, bedside rationing must be performed in ways that do not harm the physician–patient relationship. Read irenically, Wyller’s critique is a reminder of what must not be lost in our painful endeavour to update the ethics of medicine to encompass the unavoidability of rationing. (shrink)

Patients in nursing homes sometimes give accounts of episodes in which they feel their autonomy and/or self-respect are violated as a result of the care they receive from nursing staff. In these ethically difficult care situations nurses use strategies such as negotiation, explanation and, in some cases, restraint. This study investigates how nurses apply these strategies to resolve ethical dilemmas in such a way that patients experience respect rather than violation. Critical issues that will be discussed include the definition of (...) ethically difficult care situations in nursing homes and the identification of strategies for resolving such situations. Examples of the use of three strategies are presented. The use of negotiation, restraint and explanation are discussed in order to ensure respect for patients’ autonomy and thus to optimize health care outcomes. (shrink)

This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The importance of moral integrity for individuals and society, including its special role in health care, is advocated. Criteria for evaluating the acceptability of claims to conscientious objection are outlined. The (...) precise content of the criteria is dictated by the two main interests that are at stake in the dilemma of conscientious objection: the patient's interests and the health professional's moral integrity. Alternative criteria proposed by other authors are challenged. The bold claim is made that conscientious objection should be recognised by society as acceptable whenever the five main criteria of the proposed set are met. (shrink)

Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Descriptions of activities involving priority setting in annual reports from Norwegian CECs were studied and categorized through qualitative content analysis. Three hundred thirty-nine reports from 38 CECs were studied. (...) We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests. (shrink)

Background Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Method Descriptions of activities involving priority setting in annual reports from Norwegian CECs were studied and categorized through qualitative content analysis. Results Three hundred thirty-nine reports from 38 (...) CECs were studied. We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. Discussion In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. Conclusions The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

Many philosophers and medical scientists assume thatdisease categories or entities used to classify concrete cases ofdisease, are often defined by disease mechanisms or causalprocesses. Others suggest that diseases should always be definedin this manner. This paper discusses these standpoints criticallyand concludes that they are untenable, not only when `diseasemechanism' refers to an objective mechanism, but also when`mechanism' refers to a pragmatically demarcated part of thetotal ``objective'' causal structure of diseases. As an alternativeto principles that use the concept of disease mechanism (...) oranalogous concepts, a pragmatic approach is suggested anddescribed. This approach has been suggested before, but inproblematic or inadequate versions. This paper proposes a versioncompiled of two ``pragmatic principles'' and shows that they aremuch more adequate than the principle of disease mechanism. Withreference to a case study of a still ongoing internationaldiscussion of various candidates for a classification system formalignant lymphomas, including REAL (Revised European–AmericanClassification of Lymphoid Neoplasms) in which the concept ofdisease mechanism or analogous concepts plays a very small part,it is shown just how pivotal these two pragmatic principles canbe in actual discussions of definitions of diseases. Finally, itis pointed out that with regard to modern philosophy of languageit may, at least in some cases, be problematic to distinguishbetween the two pragmatic principles as they stand. (shrink)

ABSTRACTStories pervade sport. In elite spectator sport, stories play out in packed stadiums while being broadcast simultaneously to immense TV audiences. These stories, which present controversial...

By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The (...) objector's moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such ‘situation-based’ conscientious refusals explicitly. (shrink)