In the final volume of his Homo Sacer series, The use of bodies, Agamben claims that for Foucault ethics never escapes the horizon of governmentality and therefore his conception of ethics is ‘strategic.’ In light of this criticism, motivated by Agamben’s Pauline conception of ‘use,’ we reassess the status and function of ethics in Foucault’s late lectures. We investigate how Foucault’s approach to ethics develops from his treatment of liberal governmentality and also how its methodological foundation is developed in an (...) interpretation of truth-telling in Sophocles’ Oedipus Rex. Our interpretation emphasizes the ambiguous status of ethics in Foucault’s late work: on the one hand, Agamben is right that Foucault assigns an irreducible strategic function to ethics thereby connecting it intrinsically to governmentality. On the other hand, Agamben overlooks how Foucault’s interpretation of Sophocles implies a conception of governmentality which emphasizes how ethical practices cannot be captured solely in strategic terms. Foucault’s ‘anarcheological’ approach thus articulates a dimension of ethics that remains, using Agamben’s own terms, ‘ungovernable’ and therefore also genuinely creative. Even so, Foucault’s approach to ethics remains in Agamben’s perspective on the deepest level faced with an antinomy that Agamben seeks to mediate with his Pauline conception of ‘inoperativity.’. (shrink)

Can rational arguments convince a person to change from a commitment to living an unvirtuous life into striving after virtue? Or can rationality, even in the best cases, only help preserve an alrea...

This book reassesses Gadamer's hermeneutics by bringing it into a dialogue with John McDowell's minimal empiricism. It employs the resources of McDowell's minimal empiricism to address the transcendental and ontological presuppositions for objective experience and understanding, while retaining Gadamer's emphasis on the historicity of understanding. By means of the dialogue with McDowell, the book develops a hermeneutical conception of objectivity and perceptual experience, which also entails reinterpretations of Gadamer's notions of tradition, practical wisdom and meaning. The book explores the philosophical (...) space beyond the analytic-Continental divide and demonstrates that hermeneutics is not limited to a reflection on understanding as it is practiced in the human sciences, but can be revived as a distinct and cogent philosophical approach with a transcendental and ontological dimension. Thaning's book is a richly detailed, well-argued and coherent presentation of a defensible, and potentially very important, philosophical position. It demonstrates an impressively deep understanding of the literature both from the phenomenological tradition and from the part of the analytical tradition, inspired by Wilfred Sellars, to which John McDowell belongs. Being a substantial philosophical achievement in its own right, the book raises far-reaching questions that will be of interest to a wide audience. Dr. Steven Crowell, Rice University, Houston (USA) Morten Thaning's book is an important contribution to the discourse of philosophical hermeneutics. Thaning extensively discusses a topic, which recent debates have touched upon, but which up to now has not been the subject matter of concentrated scholarly work: the relation between Gadamer's hermeneutics and McDowell's empiricism. With Thaning's interpretation Gadamer' work can be read anew as concerning the problem of hermeneutical objectivity. Prof. Dr. Günter Figal, University of Freiburg (Germany). (shrink)

Günter Figal's conception of epochē expresses a fundamental divergence from dominant interpretations of Husserlian phenomenology. The hermeneutical notion of objectivity employed by Figal is different from the notion as it is employed in generic forms of epistemology. He assumes that the questions which shape epistemology about the legitimate constraints on our understanding can be clarified though phenomenological descriptions of how we acknowledge the objectivity of the subject matter. Insofar as the objects of fine art already in Objectivity were conceived as (...) expressing a distinct kind of objectivity, Figal's aesthetics is developed in direct continuation of his hermeneutical philosophy. An audacious feature of Figal's aesthetic is the attempt to reinvigorate the classical discussion about how to distinguish between fundamental forms of art. Figal claims it is an indispensable task for a philosophical aesthetic to clarify why our always already practiced habit of categorizing works of art mirrors not just arbitrary conventions. (shrink)

This article aims to reconstruct the normative distinction between sophistry and dialectics developed in Plato’s treatment of sophistry. We begin by describing Plato’s notion of sophistry as a knack of persuasion that succeeds by masquerading itself as truth-oriented and by providing gratification for its listeners. We then argue that the stringency of Plato’s arguments becomes clear by using his definition of sophistry as a guideline for the interpretation of the dialogues Protagoras and Gorgias. Together, these dialogues provide a well-structured argument (...) that questions the usefulness of sophistic practice, despite its effectiveness in attaining power within the Athenian democratic institutions. Plato’s fundamental critique of sophistry differs from certain misleading prejudices against sophistry, also found in Plato’s writings and challenged by historical research. The critique is therefore of lasting relevance not only to the understanding of Plato’s philosophical agenda but also to the interpretation of »the sophists«. We end by suggesting that Plato’s normative distinction between sophistry and dialectics is also of relevance for our contemporary conception of democratic discursive culture and its legitimacy. (shrink)

This essay argues that what makes Michel Foucault’s oeuvre not only stand apart but also cohere is an assiduous philosophical practice taking the form of an ongoing yet concrete self-modification in the medium of thought. Part I gives an account of three essential aspects of Foucault’s conception of philosophical activity. Beginning with his famous characterization of philosophy in terms of ascēsis, it moves on to articulate his characterization of philosophical practice as a distinct form of meditation, differing from both Cartesian (...) meditation and Hegelian meditation, as it aims to stand vigil for the day to come and operates as a preface to transgression. Part II begins the articulation of crucial traits left implicit in this understanding of philosophy by turning to Foucault’s in-depth investigation of philosophy in Antiquity during his lectures at the Collège de France in the 1980s. First, it develops how philosophy here begins to constitute and distinguish itself by establishing itself as an activity that has a privileged relationship to truth and truth-telling as an unremitting, existentially determining challenge for the philosopher. Further, it instantiates how Platonism elaborates the need for a sustained ‘auto-ascetic’ ethical non-compliant differentiation as the condition of possibility for accessing and stating truth, and then describes how the assertion of an ethical differentiation and attitude in Cynicism takes the form of an insistent combat for another world in this world. Finally, it underlines how the ethical-practical philosophical work upon oneself in Antiquity is developed in an ongoing critical and political exchange with others. Part III indicates how ethical differentiation according to Foucault remains an essential precondition for the practice of philosophy and is further developed in the modern age. This is particularly perspicuous in Kant’s determination of the Enlightenment, in the attitude of modernity exemplified by Baudelaire, and in the history of revolt since the beginning of early Modernity. On this background, Part IV develops how philosophy as an ongoing meditative practice of self-modification leads to an affirmative critique, confirming the virtuality of this world in order to investigate the potentiality in the examined. In this manner, the essay presents Foucault’s philosophical practice as well as an outline of the history of ideas of a seemingly alternate, yet still agenda-setting conception of philosophical practice today. (shrink)

This essay argues that what makes Michel Foucault’s oeuvre not only stand apart but also cohere is an assiduous philosophical practice taking the form of an ongoing yet concrete self-modification in the medium of thought. Part I gives an account of three essential aspects of Foucault’s conception of philosophical activity. Beginning with his famous characterization of philosophy in terms of ascēsis, it moves on to articulate his characterization of philosophical practice as a distinct form of meditation, differing from both Cartesian (...) meditation and Hegelian meditation, as it aims to stand vigil for the day to come and operates as a preface to transgression. Part II begins the articulation of crucial traits left implicit in this understanding of philosophy by turning to Foucault’s in-depth investigation of philosophy in Antiquity during his lectures at the Collège de France in the 1980s. First, it develops how philosophy here begins to constitute and distinguish itself by establishing itself as an activity that has a privileged relationship to truth and truth-telling as an unremitting, existentially determining challenge for the philosopher. Further, it instantiates how Platonism elaborates the need for a sustained ‘auto-ascetic’ ethical non-compliant differentiation as the condition of possibility for accessing and stating truth, and then describes how the assertion of an ethical differentiation and attitude in Cynicism takes the form of an insistent combat for another world in this world. Finally, it underlines how the ethical-practical philosophical work upon oneself in Antiquity is developed in an ongoing critical and political exchange with others. Part III indicates how ethical differentiation according to Foucault remains an essential precondition for the practice of philosophy and is further developed in the modern age. This is particularly perspicuous in Kant’s determination of the Enlightenment, in the attitude of modernity exemplified by Baudelaire, and in the history of revolt since the beginning of early Modernity. On this background, Part IV develops how philosophy as an ongoing meditative practice of self-modification leads to an affirmative critique, confirming the virtuality of this world in order to investigate the potentiality in the examined. In this manner, the essay presents Foucault’s philosophical practice as well as an outline of the history of ideas of a seemingly alternate, yet still agenda-setting conception of philosophical practice today. (shrink)

Carleton B. Christensen, Self and World: From Analytic Philosophy to Phenomenology Content Type Journal Article DOI 10.1007/s10743-010-9078-2 Authors Morten S. Thaning, Department of Philosophy, Politics, and Management, Copenhagen Business School, Solbjerg Plads 3, 2000 Frederiksberg, Denmark Journal Husserl Studies Online ISSN 1572-8501 Print ISSN 0167-9848 Journal Volume Volume 26 Journal Issue Volume 26, Number 3.

McDowell recently renounced the assumption that the content of any knowledgeable, perceptual judgement must be included in the content of the knowledge grounding experience. We argue that McDowell’s introduction of a new category of non-inferential, perceptual knowledge is incompatible with the main line of argument in favour of conceptualism as presented in Mind and World [McDowell, John. 1996. Mind and World. 2nd ed. Cambridge, MA: Harvard University Press]. We reconstruct the original line of argument and show that it rests on (...) the assumption that a specific model of justification, the Comparison Model, must apply to all cases of non-inferential, perceptual knowledge. We then show that the Comparison Model cannot be applied to McDowell’s new category of non-inferential, perceptual knowledge. As a consequence, McDowell is in need of an alternative model of justification and an alternative argument for conceptualism. We propose such an alternative model of justification based on McDowell’s reading of Sellars, but argue that the model only serves to make the need for an alternative motivation for conceptualism more urgent. (shrink)

How does perception provide reasons for our empirical judgements? This volume offers a set of new essays which in different ways address this fundamental question, and investigate the implications for our understanding of perceptual experience.

Marya Schechtman's narrative self-constitution view relies on an account of reality as self-evident that eclipses the interpretive labor required to fix the content of intelligibility. As a result, her view illegitimately limits what counts as identity-conferring narrative and problematically excludes many with psychiatric disabilities from the category of full personhood. Plantikow cautions personal identity theorists against this move and offers an alternative approach to engaging in and conceptualizing narrative construction.

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)

Introduction -- Running away from revenge -- Just deserts -- The emotions of revenge -- The science of mad -- Why we punish? -- Other cultures and revenge -- When self-help is permissible -- Release revenge.

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)

Marya Schechtman’s narrative self-constitution view relies on an account of reality as self-evident that eclipses the interpretive labor required to fix the content of intelligibility. As a result, her view illegitimately limits what counts as identity-conferring narrative and problematically excludes many with psychiatric disabilities from the category of full personhood. Plantikow cautions personal identity theorists against this move and offers an alternative approach to engaging in and conceptualizing narrative construction.

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)

This landmark volume brings together the work of the world's leading researchers in sublimated perception. This compilation marks a fundamental shift in the current study of subliminal effects: No longer in question is the notion that perception without awareness occurs. Now, the emphasis is on elucidating the parameters of subliminal effects and understanding the conditions under which stimuli perceived without awareness significantly influence affect, cognition, and behavior. PERCEPTION WITHOUT AWARENESS firmly establishes subliminal perception within the mainstream of psychological science. Well (...) represented here are the two main research branches that have emerged: One directly investigates the nature of subliminal effects; the other uses subliminal techniques as tools for investigating psychological phenomena such as hypnosis, dreaming, repression, social judgment and inference, psychopathology, and symptom formation. Broadly grouped into three main sections, the contributed chapters explore * The cognitive perspective--including implicit memory and implicit perception, the measurement of unconscious perceptual processes, and methods for revealing unconscious processes * The clinical perspective--exploring the cognitive and dynamic aspects of subliminal perception, memory, and consciousness; direct recovery of subliminal stimuli; and validation of subliminal psychodynamic activation * The social perspective--discussing subliminal mere-exposure effects, affect and social perception, and the role of subliminality in social psychology Timely and thought-provoking, PERCEPTION WITHOUT AWARENESS is sure to be of enormous interest to all psychoanalytic clinicians and scholars, as well as cognitive, clinical, and social psychologists whose work touches upon issues relating to psychopathology, perception, cognition, and memory. (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)

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)

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.

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.

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)

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)

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)

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)