A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Background:To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.Methods:A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociologicals and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included.Ethical considerations:The review is conducted according to the Vancouver Protocol.Results:There are few studies that study ethical (...) challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good and inflicting harm. In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion.Conclusion:There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards (...) their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses. (shrink)

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each situation. (...) We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility. (shrink)

In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a (...) lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence. (shrink)

This article contends that an ethics of care has a particular moral ontology that makes it suitable to argue for the normative significance of relational responsibilities within professional health care. This ontology is relational. It means that moral choices always have to account for the web of relationships, the relational networks and responsibilities that are an essential part of particular moral circumstances. Given this ontology, the article investigates the conditions for health care professionals to be partial and to act on (...) the basis of particular responsibilities to their patients. We will argue that priorities could be partial in three ways: first, because there may be exceptional circumstances that allow for giving priority to one patient over another; second, because the integrity of the patient and a health care worker may be connected in special ways; and, finally, even if impartiality is essential, the institutional basis of health care must always give ample space for an ethically qualified individual and personal care for patients. Even if difficult priorities may be necessary, the conditions of institutional health care should always seek to create the prerequisites for nurses and doctors to administer proper care. (shrink)

Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.

In this article we elaborate on the concept of mature care, in which reciprocity is crucial. Emphasizing reciprocity challenges other comprehensions where care is understood as a one-sided activity, with either the carer or the cared for considered the main source of knowledge and sole motivation for caring. We aim to demonstrate the concept of mature care’s advantages with regard to conceptualizing the practice of care, such as in nursing. First, we present and discuss the concept of mature care, then (...) we apply the concept to two real life cases taken from the field of acute psychiatry. In the first example we demonstrate how mature care can grasp tacit reciprocal aspects in caring. In the other, we elucidate a difficulty related to the concept, namely the lack of reciprocity and interaction that affects some relationships. (shrink)

Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make (...) oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience. (shrink)

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the (...) notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry. (shrink)

BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with (...) key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

BackgroundNorway has extensive and detailed legal requirements and guidelines concerning involvement of next of kin during involuntary hospital treatment of seriously mentally ill patients. However, we have little knowledge about what happens in practice. This study explores NOK’s views and experiences of involvement during involuntary hospitalisation in Norway.MethodsWe performed qualitative interviews-focus groups and individual-with 36 adult NOK to adults and adolescents who had been involuntarily admitted once or several times. The semi-structured interview guide included questions on experiences with and views (...) on involvement during serious mental illness and coercion.ResultsMost of the NOK were heavily involved in the patient’s life and illness. Their conceptions of involvement during mental illness and coercion, included many important aspects adding to the traditional focus on substitute decision-making. The overall impression was, with a few exceptions, that the NOK had experienced lack of involvement or had negative experiences as NOK in their encounters with the health services. Not being seen and acknowledged as important caregivers and co sufferers were experienced as offensive and could add to their feelings of guilt. Lack of involvement had as a consequence that vital patient information which the NOK possessed was not shared with the patient’s therapists.ConclusionsDespite public initiatives to improve the involvement of NOK, the NOK in our study felt neglected, unappreciated and dismissed. The paper discusses possible reasons for the gap between public policies and practice which deserve more attention: 1. A strong and not always correct focus on legal matters. 2. Little emphasis on the role of NOK in professional ethics. 3. The organisation of health services and resource constraints. 4. A conservative culture regarding the role of next of kin in mental health care. Acknowledging these reasons may be helpful to understand deficient involvement of the NOK in voluntary mental health services. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

In this article, we present findings from a qualitative study examining how young women experience being long‐term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long‐term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative (...) methodological approach involving the analysis of interviews with 13 women, aged 16–29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long‐term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to (...) set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

May a couple have the aim of conceiving as their primary purpose in having marital relations? In this paper, I argue against the view of Alexander Pruss that it is wrong to do this since it treats human beings as fungible in their creation when their unique features are not known to their parents. I argue that Pruss cannot separate seeking reproduction as part of a marital vocation from seeking the unknown, unspecified child who is part of what makes for (...) success in this particular area. While neither spouse should treat the other as a mere tool for having a child, success in the shared goal of conceiving, as well as the goal itself and its pursuit, is very much part of the conjugal good. Existing human beings are morally irreplaceable in the sense that they must be individually valued and respected, but we may promote the lives of unknown existing people under a ‘catch all’ description—and may also deliberately conceive new people of some unknown, indeterminate kind. (shrink)

Bilimsel faaliyetin ve bilimsel bilginin en temel özelliklerinden bir tanesi olarak karşımıza çıkan bilimsel nesnellik bilim felsefesi alanı içerisinde sıklıkla tartışılan bir konu olagelmiştir. Bu doğrultuda, bilimsel nesnelliğin temin edilmesine yönelik çeşitli görüşler ileri sürülmektedir. Genel olarak bilimsel nesnellik bilim insanlarının çalışmalarında olguları doğrudan yansıtması ya da bilim insanlarının çalışmalarını tarafsız bir bakış açısıyla tamamlaması olarak anlaşılmaktadır. Bu görüşlerin bilim felsefesi içerisindeki yansımaları sırasıyla olgulara bağlılık olarak nesnellik ve hiçbir yerden bakış olarak nesnellik isimleriyle olmuştur. Bu bakış açısı, kişisel çıkarların (...) ve değerlerin bilimsel çalışmalardan izole edilmesi sayesinde bilimsel nesnelliğin sağlanabileceğini kabul etmektedir. Diğer bir deyişle, bilimler değerlerden bağımsız olduğu takdirde nesnel olabilmektedirler. Bu görüşe karşı olarak, Helen Longino gibi bilim insanları ise değerleri bilimsel nesnelliğin bir gerekliliği olarak görmektedirler. Bu çalışmada, özellikle değerlerin göz ardı edilmesiyle bilimsel nesnelliğin gerçekleştirilmesinin mümkün olamayacağını vurgulan Helen Longino’nun “bağlamsal deneycilik” olarak bilinen görüşlerine yer verilmektedir. Buna göre Longino, bilimsel araştırmanın toplumsal yönlerini göz önünde bulundurarak değerden bağımsız ideali tamamen reddetmektedir. O değer yüklü bir bilimin hem bilgi kuramsal açıdan hem de nesnellik açısından güvenilir olabileceğini düşünmektedir. -/- Scientific objectivity, which is one of the most basic features of scientific activity and scientific knowledge, is a subject that is frequently discussed in the field of philosophy of science. In this direction, various views are put forward to ensure scientific objectivity. In general, scientific objectivity is understood as scientists reflecting the facts as they are in their studies or scientists completing their studies with an impartial point of view. The reflections of these views in the philosophy of science were respectively called objectivity as faithfulness to facts and objectivity as a view from nowhere. This perspective recognizes that scientific objectivity can be achieved by isolating personal interests and values from scientific studies. In other words, sciences can only be objective if they are value-free. Against this view, scientists such as Helen Longino see values as a necessity of scientific objectivity. In this study, Helen Longino's views known as "contextual empiricism" are included. Accordingly, it is emphasized that it is not possible to realize scientific objectivity by ignoring values. Longino completely rejects the value-free ideal, considering the social aspects of scientific research. She thinks that a value-laden science can be reliable both in terms of epistemology and objectivity. (shrink)

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer (...) their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

Mix & Stir', this book's aim is an endeavour to understand art as being a panhuman phenomenon of all times and cultures; to steer away from the persistent Eurocentric/Western-centric viewpoint towards a transcultural and transnational interconnected model of exchange and processes of interculturalization. Mix & Stir wants to expand this landscape by bringing to the fore new, recalcitrant, queer, idiosyncratic practices and discourses, theories and topics, methods and concerns that open up ways to approach art from a global perspective. Analogous (...) to a cookery book filled with recipes and instruction, Mix & Stir explores new outlooks on contemporary art from global perspectives. It intends to encourage studying art beyond national constraints, cultural dominances, and hierarchies: a voyage similar to that of culinary discovery. The book brings a variety of tastes and flavours to the table, and breaks new ground by allowing innovative, contrary, queer, idiosyncratic practices and discourses, theories and topics, methods, and concerns to access art in its global dimensions. Researchers, curators and artists with a special interest in this topical issue were invited to present, develop, outline, and contemplate compelling frames of reference, both theoretical and artistic, in order to arrive at a true 'world art studies'. Their contributions are structured in seven thematic fields: Undecidability and Spectatorship, Collectives, Circulations, Exhibitions, Artists at Work, Postcolonial Perspectives, and Deep Art History. The reader is invited to explore the vast supply of dishes, to taste and test the aromas and to feast. (shrink)

Background:Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection.Aim:The aim of this study was to gain a deeper understanding of how the ethics rounds (...) were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff.Research design:An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews.Participants and research context:A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed.Ethical considerations:The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards.Findings:The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work.Discussion:A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care.Conclusion:By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues. (shrink)

Progress -- Loss -- Return -- Amenability -- Citation tactics -- Affective subjects.

This chapter considers the ways in which whiteness as a skin color and ideology becomes a dominant level that sets the background against which all things, people and relations appear. Drawing on Merleau-Ponty's phenomenology, it takes up a series of films by Bruce Nauman and Marlon Riggs to consider ways in which this level is phenomenally challenged providing insights into the embodiment of racialization.

Helen Steward argues that determinism is incompatible with agency itself--not only the special human variety of agency, but also powers which can be accorded to animal agents. She offers a distinctive, non-dualistic version of libertarianism, rooted in a conception of what biological forms of organisation might make possible in the way of freedom.

In this article I explore the contemporary relationship of theology to philosophy through the call for a `renewed philosophy of being' by Pope John Paul II. I argue that in fact three understandings of being appear in this call: the first, phenomenological, appears as the bringing to description of the situation of contemporary nihilism, exemplified by Nietzsche both in his published works and his Nachlaß; the second, metaphysical, can be understood as the moralistic voice taken up by contemporary theologians in (...) addressing philosophy. This voice, I argue, is the voicing of the subjectivity of the (Cartesian) subject, and can be understood as the unfolding of the being-historical of the subject, explained in Martin Heidegger's use of the term `history of being' or Seinsgeschichte . This voice arises out of the `modernity' of the eighteenth century up to the present: it is a voice of extreme nihilism, but expressing itself as an imperative — not what `is', but what `should be'. This voice is also to be found in John Paul II. The third understanding is a possibility only arising out of the extreme nihilism encountered in the first two understandings of being. This understanding makes possible the genuine asking of the `question of being', the Seinsfrage, also laid out by Heidegger. As such, the question of being, when genuinely asked, alters the human comportment to God. Inasmuch as being presses in on man through a lack, an emptiness, that reasserts the fundamental orientation toward the future that unfolds from out of the being of beings, so the region of concealment and the withdrawal of the nihilating of the nothing, which is the region proper to divinity, can be understood and seen all over again. (shrink)

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician—nurse collaboration, lack of (...) confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed. (shrink)

Helen Longino seeks to break the current deadlock in the ongoing wars between philosophers of science and sociologists of science--academic battles founded on disagreement about the role of social forces in constructing scientific knowledge. While many philosophers of science downplay social forces, claiming that scientific knowledge is best considered as a product of cognitive processes, sociologists tend to argue that numerous noncognitive factors influence what scientists learn, how they package it, and how readily it is accepted. Underlying this disagreement, however, (...) is a common assumption that social forces are a source of bias and irrationality. Longino challenges this assumption, arguing that social interaction actually assists us in securing firm, rationally based knowledge. This important insight allows her to develop a durable and novel account of scientific knowledge that integrates the social and cognitive. Longino begins with a detailed discussion of a wide range of contemporary thinkers who write on scientific knowledge, clarifying the philosophical points at issue. She then critically analyzes the dichotomous understanding of the rational and the social that characterizes both sides of the science studies stalemate and the social account that she sees as necessary for an epistemology of science that includes the full spectrum of cognitive processes. Throughout, her account is responsive both to the normative uses of the term knowledge and to the social conditions in which scientific knowledge is produced. Building on ideas first advanced in her influential book Science as Social Knowledge, Longino brings her account into dialogue with current work in social epistemology and science studies and shows how her critical social approach can help solve a variety of stubborn problems. While the book focuses on epistemological concerns related to the sociality of inquiry, Longino also takes up its implications for scientific pluralism. The social approach, she concludes, best allows us to retain a meaningful concept of knowledge in the face of theoretical plurality and uncertainty. (shrink)

For some time we have seen a shift away from direct marketing, a core feature and dominant exchange form in the alternative food world, towards a greater role for intermediation. Yet, we still need to better understand to what extent and in what ways new mediated Alternative Food Networks represent an evolution of or departure from core tenets of alternative food systems. This paper focuses on AFNs with new intermediaries that connect small-scale producers with urban end-consumers. Based on original research (...) in Frankfurt, Berlin, and Calgary, we analyze three different types of mediated AFNs: one driven by consumers, one by an external intermediary, and one by producers. Our cases include non-capitalist, capitalist, and alternative capitalist economic practices as identified by Gibson-Graham. Conceptually, we base our analysis on the three-pillar-model of alternative agri-food systems, which we further refine. Besides comparing our cases with each other, for heuristic purposes we also compare them with an ideal-type model that adheres to core tenets of alterity in all three pillars. Our empirical analysis shows that intermediary organizations can bring important benefits and that mediated AFNs are in principle able to hold true to the core tenets of alternative agri-food systems. However, it is very important to develop models of democratic control and ownership as well as economic arrangements in which created value is fairly shared. Only then can the potentials of new mediated models be realized while the pitfalls of the conventional systems they seek to replace be avoided. (shrink)

Helen Steward puts forward a radical critique of the foundations of contemporary philosophy of mind, arguing that it relies too heavily on insecure assumptions about the sorts of things there are in the mind--events, processes, and states. She offers a fresh investigation of these three categories, clarifying the distinctions between them, and argues that the category of state has been very widely and seriously misunderstood.

In _Considering Emma Goldman_ Clare Hemmings examines the significance of the anarchist activist and thinker for contemporary feminist politics. Rather than attempting to resolve the tensions and problems that Goldman's thinking about race, gender, and sexuality pose for feminist thought, Hemmings embraces them, finding them to be helpful in formulating a new queer feminist praxis. Mining three overlapping archives—Goldman's own writings, her historical and theoretical legacy, and an imaginative archive that responds creatively to gaps in those archives —Hemmings shows how (...) serious engagement with Goldman's political ambivalences opens up larger questions surrounding feminist historiography, affect, fantasy, and knowledge production. Moreover, she explores her personal affinity for Goldman to illuminate the role that affective investment plays in shaping feminist storytelling. By considering Goldman in all her contradictions and complexity, Hemmings presents a queer feminist response to the ambivalences that also saturate contemporary queer feminist race theories. (shrink)

This volume will be the starting point for future discussion and research.

Im Gegensatz zum drei Jahre jüngeren Schelling, dem er sein Leben lang verbunden blieb, wird Steffens nach seinem Tod nahezu vergessen; in der landläufigen Überlieferung hat er als der Überbringer der Romantik nach Dänemark überlebt. Erst mit Beginn des 21. Jahrhunderts wird er als Naturforscher, als Philosoph und Universitätsreformer wiederentdeckt, nicht zuletzt auch im Diskurs-Zusammenhang um das Anthropozän. Steffens-Forscherinnen und Forscher aus Norwegen, Dänemark und Deutschland setzen sich mit dem romantischen Denken der Zeit, mit den Aspekten der nationalen Wiedergeburt in (...) Kultur, Politik und Wissenschaft auseinander, mit Naturgeschichte und Kunst: Marit Bergner, Marie-Theres Federhofer, Bernd Henningsen, Lore Hühn, Daniel Fulda, Norman Kasper, Jesper Lundsfryd Rasmussen, Jessika Piechocki, Anna Lena Sandberg und Elisabeth Décultot. (shrink)

Most people believe that it is sometimes morally permissible for a person to use force to defend herself or others against harm. In Defensive Killing, Helen Frowe offers a detailed exploration of when and why the use of such force is permissible. She begins by considering the use of force between individuals, investigating both the circumstances under which an attacker forfeits her right not to be harmed, and the distinct question of when it is all-things-considered permissible to use force against (...) an attacker. Frowe then extends this enquiry to war, defending the view that we should judge the ethics of killing in war by the moral rules that govern killing between individuals. She argues that this requires us to significantly revise our understanding of the moral status of non-combatants in war. Non-combatants who intentionally contribute to an unjust war forfeit their rights not to be harmed, such that they are morally liable to attack by combatants fighting a just war. (shrink)