The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the (...) paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use. (shrink)

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the (...) wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health. (shrink)

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate goals or (...) aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health, and the fact that empowered people might choose to live lives that risk reducing their health. (shrink)

It is an imperative within health care, medicine, and public health to restore, preserve, and enhance health. Therefore, it is important to determine what kinds of enhancement are increases in health and what kinds are not. Taking as its point of departure two conceptions of health, namely, “manifest health” and “fundamental health,” the paper discusses various means used to enhance ability and well-being, and if those means, such as wheelchairs, implants, medicines, stimulants, or narcotics, enhance health. The fact that some (...) means that enhance ability or well-being are not usually considered health enhancing, for example, narcotics, constitutes a problem. The paper ends with a discussion of some suggestions about how to distinguish between those enhancements that are health related and those that are not. One plausible idea holds that an enhancement is health related when the substance, or aid, increases ability or well-being, is integrated into the body, and does not harm the individual’s fundamental health. (shrink)

The discussion about theories of health has recently had an important new input through the work of Sridhar Venkatapuram. He proposes a combination of Lennart Nordenfelt's holistic theory of health and Martha Nussbaum's version of the capability approach. The aim of the present article is to discuss and evaluate this proposal. The article starts with a discussion of Nordenfelt's theory and evaluates Venkatapuram’ critique of it, that is, of its relativism, both regarding goals and environment, and of the subjectivist theory (...) of happiness used. Then the article explains why Nordenfelt's idea of a reasonable environment is not a problem for the theory, and it critiques Venkatapuram's own incorporation of the environment into the concept of health, suggesting that this makes the concept too wide. It contends, moreover, that Venkatapuram's alternative theory retains a problem inherent in Nordenfelt's theory, namely, that health is conceived of as a second-order ability. It is argued that health should, instead, be defined as first-order abilities. This means that health cannot be seen as a capability, and also that health cannot be seen as a meta-capability of the kind envisioned by Venkatapuram. It is, furthermore, argued that the theory lacks one crucial aspect of health, namely, subjective wellbeing. Finally, the article tries to illustrate how health, in the suggested alternative sense, as first-order abilities, fits into Nussbaum's capability theory, since health as an ‘actuality’ is part of all the ‘combined capabilities’ suggested by Nussbaum. (shrink)

There are great health disparities in the world today, both between countries and within them. This problem might be seen as related to the access to various kinds of capabilities. It is not fully clear, however, what the exact relation is between health and capabilities. Neither Amartya Sen nor Martha Nussbaum has explicitly formulated a theory of health to go with their theories of capabilities. This paper attempts to present a clarification of the conceptual relation between health and capabilities. Health, (...) it is argued, should be seen as a holistic multi-dimensional phenomenon, made up of basic abilities and subjective well-being, and of fundamental states and processes. Using this theory, the paper shows how health is related to Nussbaum’s ten capabilities. It is argued that health, in the senses described, is a necessary part of all ten capabilities. Moreover, some of the capabilities on Nussbaum’s list, such as thinking and imagining, and practical reasoning, refer to health. Finally, it is shown that even though health is part of all capabilities, health cannot itself primarily be seen as a capability. An acceptable degree of health is required as a functioning for any theory of human flourishing to be reasonable. (shrink)

Introduction: The concept of ” work ability” is central for many sciences, especially for those related to working life and to rehabilitation. It is one of the important concepts in legislation regulating sickness insurance. How the concept is defined therefore has important normative implications. The concept is, however, often not sufficiently well defined. Aim and Method: The objective of this paper is to clarify, through conceptual analysis, what the concept can and should mean, and to propose a useful definition for (...) scientific and practical work. Results: Several of the defining characteristics found in the literature are critically scrutinized and discussed, namely health, basic standard competence, occupational competence, occupational virtues, and motivation. These characteristics are related to the work tasks and the work environment. One conclusion is that we need two definitions of work ability, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice. Having work ability, in the first sense, means having the occupational competence, the health required for the competence, and the occupational virtues that are required for managing the work tasks, assuming that the tasks are reasonable and that the work environment is acceptable. In the second sense, having work ability is having the health, the basic standard competence and the relevant occupational virtues required for managing some kind of job, assuming that the work tasks are reasonable and that the work environment is acceptable. Conclusion: These definitions give us tools for understanding and discussing the complex, holistic and dynamic aspects of work ability, and they can lay the foundations for the creation of instruments for evaluating work ability, as well as help formulate strategies for rehabilitation. (shrink)

The author's aim here is to philosophically analyze the notion of positive mental health. Defining characteristics of positive mental health are described, drawing on modern psychiatric, psychoanalytical, psychological, and philosophical literature. The author finds that it is impossible to draw decisive conclusions about what characteristics constitute positive mental health, and suggests a general theory of health. Lennart Nordenfelt's holistic theory of general health is chosen to guide the rest of the discussion. The author is affiliated with Malmo University, Sweden. This (...) book is based on his PhD thesis in the Department of Health and Society at Linkoping University. Annotation copyrighted by Book News Inc., Portland, OR. (shrink)

The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts are logically different, or if (...) they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promote health without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promoting health. Finally, most health promoting interventions target basic health, not manifest health, and often also thereby reduce future disease. (shrink)

Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms “health”, “quality of life” and “welfare” and showing what their conceptual relations are. Health-related quality of life has two central meanings: health-related well-being, (...) which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, “manipulating” the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment. (shrink)

It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which makes health promotion and disease (...) prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promote health without preventing disease, and vice versa, several kinds of public health interventions are discussed. The conclusion is that while health promotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time. (shrink)

Empowerment is a concept that has been much used and discussed for a number of years. However, it is not always explicitly clarified what its central meaning is. The present paper intends to clarify what empowerment means, and relate it to the goals of health promotion. The paper starts with the claim that health-related quality of life is the ultimate general goal for health promotion, and continues by briefly presenting definitions of some central concepts: “welfare” “health” and “quality of life”. (...) Several suggestions as to what empowerment is are then discussed: autonomy, freedom, knowledge, self-esteem, self-confidence, and control over health or life. One conclusion of this discussion is that empowerment can be seen as a complex goal which includes aspects of the three central concepts welfare, health and quality of life. To the extent that the empowerment goals aimed at are health-related, it is concluded that empowerment is a legitimate goal for health promotion. But empowerment is not only a goal, it can also be described as a process or as an approach. This process, or approach, in a fundamental way involves the participants in problem formulation, decision making and action, which means that the experts have to relinquish some of their control and power. (shrink)

When seeing immoral actions, criminal or not, we sometimes deem the people who perform them unhealthy. This is especially so if the actions are of a serious nature, e.g. involving murder, assault, or rape. We turn our moral evaluation into an evaluation about health and illness. This tendency is partly supported by some diagnoses found in the DMS-IV, such as Antisocial personality disorder, and the ICD-10, such as Dissocial personality disorder. The aim of the paper is to answer the question: (...) How analytically sound is the inclusion of morality into a theory of health? The holistic theory of Lennart Nordenfelt is used as a starting point, and it is used as an example of a theory where morality and health are conceptually distinct categories. Several versions of a pluralistic holistic theory are then discussed in order to see if, and if so, how, morality can be conceptually related to health. It is concluded that moral abilities (and dispositions) can be seen as being part of the individual’s health. It is harder to incorporate moral virtues and moral actions into such a theory. However, if immoral actions “cluster” in an individual, and are of a severe kind, causing serious harm to other people, it is more likely that the person, for those reasons only, be deemed unhealthy. (shrink)

The book under review offers a novel approach to politicizing the "animal issue." Drawing on liberal citizenship theory, the authors argue that key concepts of international justice such as "citizen," "denizen," and "sovereignty" may be mapped onto human-animal relations in order to protect individual animal rights as well as ecosystem integrity. The ambition is also to overcome some well-known problems of traditional animal rights theory in relation to ecological concerns. Yet the argument that ecosystems, like human states, ought to be (...) seen as sovereign communities entails problematic concept-stretching that may undermine the individual rights it was meant to protect. (shrink)

ArgumentEugenics and race played significant roles in Ukrainian interwar nationalism, yet remain largely unstudied. The Ukrainian nationalists’ understanding of the racial makeup of their imagined community was contradictory as they struggled to reconcile their desire for racial “purity” with the realities of significant variations between the populations inhabiting the enormous territories which they sought to include in their intended state project. The “turn to the right” over the 1930s placed an increased onus on race, and eugenics came to occupy an (...) increasingly prominent place in Ukrainian radical nationalism from around 1936. In 1941, the leading Ukrainian far-right organization, the OUN had developed a project for eugenic engineering, for their aborted state, declared in L’viv on June 30, 1941. Racial conceptualizations of the Ukrainian community figured prominently well into the Cold War era, gaining a new actuality and meaning in an émigré community dispersed across several countries. (shrink)

A common view of politics is that it is reducible to applied ethics. If politics, in a classic phrase, is about “who gets what, when, and how,” then the task of normative political theory would simply be to tell us who is morally entitled to get whatever the “what” is in that statement.This view, however, can easily reduce politics to a dizzying vortex of actions to assess from an ethical perspective. And while the task of moral philosophy may be precisely (...) to articulate principles by which to pass such judgment, the focus of political theory lies elsewhere.To study and assess politics means attending to the institutional frameworks and structural conditions that enable or constrain human action to begin with. The question for normative political theory, in other words, is whether the organizational structure of a given society—embodied in its decision-making procedures, its distribution of power, and its defining patterns of production, reproduction, and distribution—is defensible or not.This question of justice in the institutional makeup of society has not been entirely ignored in animal rights literature. Animal advocates have always been clear about the massive societal ramifications of dismantling the speciesist order. Likewise, rights theorists and activists have often proposed concrete legal measures for improving the protection of animals, be it by piecemeal welfare reform in animal agriculture, by the abolition of specific practices in biomedical research, or by seeking the equivalent of human rights for select species like great apes or dolphins. The field has also seen fierce debate among animal advocates about the appropriate strategies for engaging with the state and the legal system.Nonetheless, most discussions have been about what it means to treat individual animals with respect, and not about what is required of a political order aspiring to just treatment of all species. In fact, it is only in the last decade that the issue of political justice has taken up a place at the center of animal ethics.Though the field is still developing, we may take it as a sign of maturity that it can now sport its first “short introduction” book: Alasdair Cochrane's Should Animals Have Political Rights? (2020). Its appearing as part of the Polity Press series Political Theory Today further attests to the book's timeliness.The starting point of Cochrane's book—and of political animal studies in general—is that political relations between humans and other animals are not optional but inevitable. Other animals live among us, and the way we organize our societies has a massive impact on the lives of other sentient animals both inside and outside the borders of our human communities. Assuming that these creatures possess intrinsic value as experiencing individuals with morally relevant interests, the question seems inescapable: What kind of polity can accommodate for the multispecies character of our communities and embody justice for all sentients? Cochrane's answer is largely the same as the one he offered in his previous book, Sentientist Politics: A Theory of Global Inter-Species Justice (Oxford University Press, 2018), where he laid out his full vision of a postnational and species-neutral “cosmozoopolis.”The present book is much more concentrated and written as an accessible introduction for readers new to the field. Over seven short chapters, Cochrane reconstructs his argument for an interspecies democracy by assessing a series of arguments and propositions drawn from previous literature on the topic.The first notion to be scrutinized is the popular idea that animal welfare legislation is enough to secure respect for animals. Here, Cochrane acknowledges that welfarism goes some way toward safeguarding animal interests, but he also stresses that its historical record has been disheartening. Welfarism protects animals only insofar as their protection coincides with human interests, and this is far from enough to ensure respect for the animals’ intrinsic value.The second line of argument tries to push beyond welfarism by claiming constitutional protection for animals. By this move, reformers hope to place animal interests on an equal footing with human interests and prevent the overriding of the former in the name of human entitlements (to property, artistic expression, freedom of science, and so forth). Looking at real-world cases, however, Cochrane finds that these constitutional provisions tend to be sidelined when they come into conflict with the interests of big agribusiness.Noting that more than constitutional protection is needed, Cochrane turns to a third set of arguments about legal personhood for animals. Winning personhood for animals would certainly constitute a radical step toward equalizing the interests of different species. Nonetheless, Cochrane argues that personhood alone would be insufficient. Intrinsic value, to him, cannot be fully respected unless animals win the political right to have their interests factor into society's articulation of the public good. As sentient beings, we can all make a claim on the political communities we are part of to not only recognize us as members but furnish us with the means to live well.The fourth and final step for Cochrane is to argue that democratic representation for animals is necessary for realizing these political membership rights. Without representation, he contends, political rights risk being watered down, leaving animals with much less than they are entitled to as sentient beings. Cochrane critically discusses several different models for how this representation could be organized. While he is partial to a system where specially trained human representatives are tasked with voicing the animals’ interests in the legislative process, he leaves many of the practicalities open for future experimentation.Readers familiar with the field of political animal studies will find little new in Should Animals Have Political Rights? For students new to the field, however, Cochrane's book does an excellent job introducing the main issues in a very accessible format. Students of “regular” political science will also benefit from the book's fresh challenge to the discipline's understanding of “the political” as well as its important insights into the relationship between individual and political rights. (shrink)

Maxim Fetissenko (2011) argues that the animal rights movement needs a new rhetorical strategy focusing on human health benefits and environmental preservation rather than on moral argumentation. Against this, I claim that the movement has not overused but rather has downplayed moral argumentation. Instead of promoting its real agenda, the movement has often diminished the issue of animal oppression and implicated itself in the reproduction of speciesism. If our goal is to abolish speciesist oppression, we should work consistently to make (...) alternative identities and values available to people rather than opting for illusory shortcuts that do not disturb the speciesist social order. (shrink)

The two notions of “globalization” and “knowledge society” are often assumed to be relatively neutral descriptions of contemporary social and cultural developments, although they are embedded in discourses on power and domination. In this paper the argument is made that both these notions can be understood as expressions of an ideology of neo-colonialism and that they assume an ethnocentric or Eurocentric bias rather than being neutral descriptions of the “natural” unfolding of social and political changes. The thesis of the “knowledge (...) society”, in particular, needs to be demythologized as a vehicle for the rebirth of nations and regions in the context of increasing global challenges. A critical perspective such as this is a desired complement to the otherwise glossy versions of the future of “knowledge work” and “creative work” based on a doctrine of “fundamentalism of education”. The critical understanding of contemporary regimes for knowledge, learning and education on the international scene provide a necessary counterpoint to the dominating political and educational discourses advocating the advent of “knowledge society”. (shrink)

In this article, a number of future energy visions, especially those basing the energy systems on hydrogen, are discussed. Some often missing comparisons between alternatives, from a sustainability perspective, are identified and then performed for energy storage, energy transportation, and energy use in vehicles. It is shown that it is important to be aware of the losses implied by production, packaging, distribution, storage, and end-use of hydrogen when suggesting a “hydrogen economy.” It is also shown that for stationary electric energy (...) storage, fuel cell electrolyzers could be feasible. Zero-tailpipeemission vehicles are compared. The battery electric vehicle has the highest electrical efficiency, but other requirements imply that plug-in hybrids or fuel cell hybrids might be a better option in some types of vehicles. Finally, a simplified example is applied to the overall results and used to discuss the needs and nature of an energy system based on intermittent energy sources. (shrink)

Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale includes items that cover overconsumption, actions (...) that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior. (shrink)

The scope of this paper is to conceptualise a data-based research framework for the role of creative networks in cultural exchange. Participation in culture measured as audience per 1000 residents and expenditures on culture-related activities were analysed in relation to such territorial assets as accessibility to creative infrastructure, the economic status of residents, the governance networks of civil society, and cultural capital. The results indicate how accessibility, governance networks, and cultural capital contribute to participation measured via audience indicators while a (...) low poverty rate has explanatory value with respect to expenditures on culture. (shrink)

Recent research highlights the positive effects of organizational CSR engagement on employee outcomes, such as job and life satisfaction, performance, and trust. We argue that the current debate fails to recognize the potential risks associated with CSR. In this study, we focus on the risk of work addiction. We hypothesize that CSR has per se a positive effect on employees and can be classified as a resource. However, we also suggest the existence of an array of unintended negative effects of (...) CSR. Since CSR positively influences an employee’s organizational identification, as well as his or her perception of engaging in meaningful work, which in turn motivates them to work harder while neglecting other spheres of their lives such as private relationships or health, CSR indirectly increases work addiction. Accordingly, organizational identification and work meaningfulness both act as buffering variables in the relationship, thus suppressing the negative effect of CSR on work addiction, which weakens the positive role of CSR in the workplace. Drawing on a sample of 565 Swiss employees taken from the 2017 Swiss Public Value Atlas dataset, our results provide support for our rationale. Our results also provide evidence that the positive indirect effects of organizational CSR engagement on work addiction, via organizational identification and work meaningfulness, become even stronger when employees care for the welfare of the wider public. Implications for research and practice are discussed. (shrink)

BackgroundHealthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethical questions related to editorial integrity.MethodsWe conducted a descriptive cross-sectional study of all medical advertisements published in the Journal of the Danish Medical Association in 2015. Drugs advertised 6 times or more were compared (...) with older comparators: comparative evidence of added benefit; Defined Daily Dose cost; regulatory safety announcements; and completed and ongoing post-marketing studies 3 years after advertising.ResultsWe found 158 medical advertisements for 35 prescription drugs published in 24 issues during 2015, with a median of 7 advertisements per issue. Four drug groups and 5 single drugs were advertised 6 times or more, for a total of 10 indications, and we made 14 comparisons with older treatments. We found: ‘no added benefit’ in 4 of 14 comparisons, ‘uncertain benefits’ in 7, and ‘no evidence’ in 3 comparisons. In no comparison did we find evidence of ‘substantial added benefit’ for the new drug; advertised drugs were 2 to 196 times more expensive per Defined Daily Dose; 11 safety announcements for five advertised drugs were issued compared to one announcement for one comparator drug; 20 post-marketing studies were requested for the advertised drugs versus 10 studies for the comparator drugs, and 7 studies assessed both an advertised and a comparator drug at 3 year follow-up.Conclusions and relevanceIn this cross-sectional study of medical advertisements published in the Journal of the Danish Medical Association during 2015, the most advertised drugs did not have documented substantial added benefits over older treatments, whereas they were substantially more expensive. From January 2021, the Journal of the Danish Medical Association no longer publishes medical advertisements. (shrink)

Voor de taalgebruiker spreekt taal vanzelf, maar de taalonderzoeker staat voor raadsels. Woordvormen lijken in niets op hun betekenis. En taalconstructies lijken onlogisch in elkaar te zitten. Toch kunnen we in een enkele zin onze bedoelingen tot in de subtielste nuances duidelijk maken. We hebben geen toegang tot het bewustzijn van de Ander maar kunnen desondanks gedachten met elkaar uitwisselen. We kunnen de werkelijkheid met elkaar bespreken en fictieve werelden met elkaar delen alsof ze toch ergens buiten onszelf bestaan. De (...) taalgebruiker heeft er allemaal geen moeite mee. In De magie van taal brengt Net Koene stap voor stap in kaart wat zich in ons hoofd afspeelt wanneer we naar de Ander luisteren. Ze isoleert taalvormen, woorden, constructies, toonhoogte- en ritmekenmerken die we als informatief herkennen in wat de Ander zegt. Ze laat zien hoe al die vormen systematisch hun eigen bijdrage leveren aan onze voorstelling van waar de Ander het over heeft. De auteur toont deze processen vanuit een denkbeeldig alwetend perspectief, in dit boek Omega genoemd. Binnen dit theoretische kader legt ze per hypothese verband tussen wat in het bewustzijn opkomt en de machinerie van het brein: hoe vormt de wereld van onze zintuigen zich, hoe komt ons voorstellingsvermogen tot stand, hoe transformeert de zintuiglijke wereld in een bespreekbare wereld? En vooral: hoe werkt het dat we de inhoud van ons bewustzijn op dat van de Ander kunnen afstemmen? (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that (...) promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

This article offers a discussion of the connection between technology and values and, specifically, I take a closer look at ethically sound design. In order to bring the discussion into a concrete context, the theory of Value Sensitive Design (VSD) will be the focus point. To illustrate my argument concerning design ethics, the discussion involves a case study of an augmented window, designed by the VSD Research Lab, which has turned out to be a potentially surveillance-enabling technology. I call attention (...) to a “positivist problem” that has to do with the connection between the design context and the use context, which VSD seems to presuppose, and I argue that it is necessary to clearly distinguish between the two, since the designers’ intentions do not always correspond with the users’ practice; in fact, the relation between design and use is very complex and principally unpredictable. Thus, a design theory must accept that foresight is limited to anticipation rather than prediction. To overcome the positivist problem, I suggest a phenomenological approach to technology inspired by Don Ihde’s concept of multistability. This argument, which is general in nature and thus applies to any theory of design ethics, is intended as a constructive criticism, which can hopefully contribute to the further development of design ethics. (shrink)

The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity (...) to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector. (shrink)

‘Language and End Time’ is a translation of Sections I, IV and V of ‘Sprache und Endzeit’, a substantial essay by Günther Anders that was published in eight instalments in the Austrian journal FORVM from 1989 to 1991. The original essay was planned for inclusion in the third volume of The Obsolescence of Human Beings. ‘Language and End Time’ builds on the diagnosis of ‘our blindness toward the apocalypse’ that was advanced in the first volume of The Obsolescence in (...) 1956. The essay asks if there is a language that is capable of making us fully comprehend the looming ‘man-made apocalypse’. In response to this, it offers a critique of philosophical jargon and of the putatively ‘objective’ language of science, which are both dismissed as unsuitable. Sections I, IV and V introduce this core problematic. The selection of this text for inclusion in this special journal issue responds to present-day realities that inscribe Anders’s reflections on nuclear science and the nuclear situation into new contexts. The critique that ‘Language and End Time’ advances resonates with the way in which the decisions of a few companies and individuals are shaping the future of life on earth. At the same time, the wider stakes of Anders’s turn against the language employed by scientists are newly laid bare by the realities and politics of climate change and fake news. In this new context, the language of science is all too readily dismissed as if it were a mere idiom that can be ignored without consequence. It is against the backdrop of a future that is, if anything, more uncertain than at the time of Anders’s writing, that the essay’s reflections on popularisation, the limits of language and the nature of truth gain added significance. (shrink)

Inference has long been a concern in epistemology, as an essential means by which we extend our knowledge and test our beliefs. Inference is also a key notion in influential psychological or philosophical accounts of mental capacities, from perception via utterance comprehension to problem-solving. Consciousness, on the other hand, has arguably been the defining interest of philosophy of mind over recent decades. Comparatively little attention, however, has been devoted to the significance of consciousness for the proper understanding of the nature (...) and role of inference. It is commonly suggested that inference may be either conscious or unconscious. Yet how unified are these various supposed instances of inference? Does either enjoy explanatory priority in relation to the other? In what ways or senses, can an inference be conscious, or fail to be conscious, and how does this matter? This book brings together original essays from established scholars and emerging theorists that illustrate how several current debates in epistemology, philosophy of psychology, and philosophy of mind can benefit from reflections on these and related questions about the significance of consciousness for inference. Contributors include: Kirk Ludwig and Wade Munroe; Michael Rescorla; Federico Bongiorno and Lisa Bortolotti; Berit Brogaard; Nicholas Allott; Jake Quilty-Dunn and Eric Mandelbaum; Corine Besson; Anders Nes; David Henderson, Terry Horgan, and Matjaž Potrč; Elijah Chudnoff; and Ram Neta. (shrink)

There are several strategies to promote health in individuals and populations. Two general approaches to health promotion are behavior change and empowerment. The aim of this article is to present those two kinds of strategies, and show that the behavior-change approach has some moral problems, problems that the empowerment approach (on the whole) is better at handling. Two distinct ‘ideal types’ of these practices are presented and scrutinized. Behavior change interventions use various kinds of theories to target people’s behavior, which (...) they do through information, persuasion, coercion and manipulation. Empowerment is a collaborative method where those ‘facilitated’ participate in the change process. Some ethical problems with the behavior-change model are that it does not sufficiently respect the right to autonomy of the individuals involved and risks reducing their ability for autonomy, and that it risks increasing health inequalities. Empowerment, on the other hand, respects the participant’s right to autonomy, tends to increase the ability for autonomy, as well as increasing other coping skills, and is likely to reduce inequalities. A drawback with this approach is that it often takes longer to realize. (shrink)

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year educational (...) programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability. (shrink)

Following decades of neglect, the work of the German Jewish philosopher, literary author, cultural critic, and poet Günther Anders (1902–1992) is gaining increasing recognition in the English-speaking world. This translation of “Résistance heute” (Resistance Today) makes one of Anders’s most programmatic and polemical short texts available. Published at the height of his anti-nuclear activism, “Resistance Today” is the written version of a speech Anders delivered in November 1962 upon acceptance of the northwest Italian city of Omegna’s Resistance (...) Prize (other notable recipients included Jean-Paul Sartre and Frantz Fanon). It first appeared in print in the West German left-wing journal Das Argument in November 1963. Clearly written for the occasion, the text condenses (and often further radicalizes) key premises about the end of history, the amoral character of work, and the continuity between Nazi totalitarianism, the nuclear age and the world of consumerism that are developed in great nuance across a range of books that Anders had recently published. Key co-ordinates include: Die Antiquiertheit des Menschen 1 (The Obsolescence of Human Beings 1, 1956), his groundbreaking critique of technology; Der Mann auf der Brücke (The Man on the Bridge, 1959), a philosophical travel diary occasioned by Anders’s 1958 visit to Japan and his participation at the World Conference Against Atomic and Hydrogen Bombs in Tokyo; Burning Conscience (1961), a correspondence with the American reconnaissance pilot Claude Eatherly, who scouted the target area before the Enola Gay went on to drop the atom bomb on Hiroshima. It seems likely that Burning Conscience, which turned into an international bestseller, occasioned the award of the prize. (shrink)