Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and (...) nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk. (shrink)

Among the thousands who arrive in Europe to seek asylum each year, a significant number are children traveling on their own. Like adults, they are fleeing from war and armed conflict situations, persecution, severe poverty, and deprivation. Some arrive because they have been trafficked and some are fleeing for reasons specifically related to their status as children. They need special attention, not only in terms of specialized care and assistance, but also in terms of the refugee status determination procedure. When (...) they arrive in a country of asylum they risk further violations of their rights. This paper intends to outline the rignts of these children under international law; to highlight key protection concerns facing them, particularly in the European context; to summarize ways of how a UN/ngo program has attempted to address these problems; and to make some specific recommendations. (shrink)

This book explores what science fiction can tell us about the human condition in a technological world, with the ethical dilemmas and consequences that this entails. This book is the result of the joint efforts of scholars and scientists from various disciplines. This interdisciplinary approach sets an example for those who, like us, have been busy assessing the ways in which fictional attempts to fathom the possibilities of science and technology speak to central concerns about what it means to be (...) human in a contemporary world of technology and which ethical dilemmas it brings along. One of the aims of this book is to demonstrate what can be achieved in approaching science fiction as a kind of imaginary laboratory for experimentation, where visions of human (or even post-human) life under various scientific, technological or natural conditions that differ from our own situation can be thought through and commented upon. Although a scholarly work, this book is also designed to be accessible to a general audience that has an interest in science fiction, as well as to a broader academic audience interested in ethical questions. (shrink)

How (Not) to Be Secular is what Jamie Smith calls "your hitchhiker's guide to the present" -- it is both a reading guide to Charles Taylor's monumental work A Secular Age and philosophical guidance on how we might learn to live in our times. Taylor's landmark book A Secular Age (2007) provides a monumental, incisive analysis of what it means to live in the post-Christian present -- a pluralist world of competing beliefs and growing unbelief. Jamie Smith's book is a (...) compact field guide to Taylor's insightful study of the secular, making that very significant but daunting work accessible to a wide array of readers. Even more, though, Smith's How (Not) to Be Secular is a practical philosophical guidebook, a kind of how-to manual on how to live in our secular age. It ultimately offers us an adventure in self-understanding and maps out a way to get our bearings in today's secular culture, no matter who "we" are -- whether believers or skeptics, devout or doubting, self-assured or puzzled and confused. This is a book for any thinking person to chew on. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

This mixed-methods study explores how high school students ( n=35) enrolled in a school with a high Latino/a population evaluate the trustworthiness of documents in two historical reasoning tasks: one about the Dust Bowl in the 1930s and the other about the experiences of Mexicans and Mexican Americans in the 1920s. Students indicated whether they trusted each document, provided a rationale for their trust (or distrust) of each document, and ranked the trustworthiness of the documents. We also interviewed 10 focal (...) students to explore students’ reasoning in more in-depth ways than the written responses allowed. We found that students tended to trust the secondary source documents more than the primary source documents because, as they argued, the secondary source documents contained more facts. In contrast, students were less likely to trust the primary source documents, particularly the songs, arguing that they were more opinion-based than factual. We also found that some students had an emotional response to the content of some of the documents, and in some cases, these emotional responses shaped how they viewed the documents’ trustworthiness. Additionally, students’ heritage may have played a role in some students’ trust justifications for some documents in the experiences of Mexicans and Mexican Americans task. We conclude with implications for curriculum and instruction. (shrink)

PurposeThis paper examines the influence of leader humility on knowledge sharing intention. Drawing on social exchange theory, we test the direct and indirect mechanisms to explain the influence leader humility has on knowledge sharing intention.Design/Methodology/ApproachA two-wave, time-lagged field study was conducted. We surveyed 252 professional employees from Australia.FindingsResults show a significant direct, positive association between leader humility and knowledge sharing intention. While leader humility had a direct, positive association with affective trust in supervisor and work engagement, it did not directly (...) impact on organizational citizenship behaviors directed toward the individual. There were three SET-related, serial mediators in the relationship between leader humility and knowledge sharing intention. These were affective trust, work engagement, and OCB-I.Research Limitations/ImplicationsFuture studies should collect multi-source data such as peers’ or supervisors’ ratings of the focal respondents’ work engagement, OCB-I, and knowledge sharing behaviors to augment single-source data. Future studies could adopt an affect theory of social exchange to further explore the relationships tested in this study.Originality/ValueThis study contributes to the affect SET and knowledge management literature on how leadership behaviors impact the intention to share knowledge. Our study highlights the preference of the willingness to share knowledge with their co-workers is mediated by affective trust in their immediate supervisors, work engagement, and OCB-I that are equally important as treating their subordinates with humility. (shrink)

Practical deliberation often involves conditional judgements about what will (likely) happen if certain alternatives are pursued. It is widely assumed that the conditionals useful in deliberation are counterfactual or subjunctive conditionals. Against this, I argue that the conditionals of deliberation are indicatives. Key to the argument is an account of the relation between 'straightforward' future-directed conditionals like ' If the house is not painted, it will soon look quite shabby' and * "w e r e ' ' e d F (...) D C s like ' If the house were not to be painted, it would soon look quite shabby': an account on which both of these types of FDCs are grouped with the indicatives for semantic treatment and on which, while conditionals of both types are properly used in means/ends deliberations, those of the ' were'ed-up variety are especially well suited for that purpose. (shrink)

This article explores the enduring mysteries of consciousness and the afterlife, two enigmatic topics that have fascinated humanity for ages. Despite extensive scientific efforts, the existence of an afterlife remains unproven, and understanding consciousness remains a significant challenge. The research introduces innovative hypotheses through simple thought experiments with empirical evidence and robust theoretical foundations. It delves into the complexities of consciousness, its relationship with the brain, and the need for interdisciplinary approaches encompassing physics, psychology, and philosophy. Boldly contemplating the probability (...) of a continuous consciousness after death, the study argues that existing evidence strongly supports this idea. Beyond theoretical implications, it envisions practical outcomes, suggesting that insights into these mysteries could enhance human well-being and contribute to a more harmonious world. In summary, this article embarks on a quest to shed light on age-old questions about consciousness and the afterlife. Through fresh methodologies, it aims to provide new perspectives that could reshape our understanding of existence and inspire intellectuals to positive individual and societal advancements. -/- . (shrink)

are ambiguous. In the mouth of someone who cannot remember whether it was Michael, or rather someone else, who was top scorer, can express the epistemic possibility that Michael led the league in scoring. But from someone who knows that Michael did not even play last season, but is wondering what would have happened if he had, means something quite different. Now where it has this quite different meaning, may still turn out to be the expression of some epistemic possibility. (...) Perhaps where does not express the epistemic possibility of ‘Michael led the league in scoring’, it expresses the epistemic possibility of ‘Michael would have led the league in scoring’. Analysis of this ‘would have’ statement, together with an exploration of the suspicion that the ‘might have’ statement is ambiguous between these two epistemic possibilities, will have to await another occasion. The important point for present purposes is that is ambiguous between an expression of the epistemic possibility of ‘Michael led the league in scoring’ and some quite different reading. (shrink)

What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of (...) responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered—namely, clinicians’ willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians’ need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. (shrink)

It is only when mixing two or more pure substances along a reversible path that the entropy of the mixing can be made physically manifest. It is not, in this case, a mere mathematical artifact. This mixing requires a process of successive stages. In any finite number of stages, the external manifestation of the entropy change, as a definite and measurable quantity of heat, isa fully continuous function of the relevant variables. It is only at an infinite and unattainable limit (...) thata non-uniform convergence occurs. And this occurs when considered in terms of the number of stages together with a distinguishability parameter appropriate to the particular device which is used to achieve reversibility. These considerations, which are of technological interest to chemical engineers, resolve a paradox derived in chemical theory called Gibbs'' Paradox. (shrink)

This study examines high school students’ responses to a public policy discussion on the topic of Internet privacy. Specifically, students discussed the question of whether search engines and social media sites should be permitted to monitor, track, and share users’ personal data or whether such practices violate personal privacy. We observed discussions of the topic in four high school classrooms in 2015–2016, prior to the presidential election in 2016. We first explain why the topic failed to work as a controversial (...) public issue with high schoolers. We then explain their responses to the issue. We found (1) students displayed a surprising trust in Facebook and Google; (2) students framed the issue of Internet Privacy as a conflict in values and a set of trade-offs; and (3) students tended to put more weight on personal responsibility than implications for democracy in their assessment of the (acknowledged) erosion of privacy as a result of social media and Internet search engines. We conclude with implications for social studies education and teacher education. (shrink)

University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; (...) and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes. (shrink)

The widespread potential for somatic fusion among different conspecific multicellular individuals suggests that such fusion is adaptive. However, because recognition of non‐kin (allorecognition) usually leads to a rejection response, successful somatic fusion is limited to close kin. This is consistent with kin‐selection theory, which predicts that the potential cost of fusion and the potential for somatic parasitism decrease with increasing relatedness. Paradoxically, however, Crozier1 found that, in the short term, positive‐frequency‐dependent selection eliminates the required genetic polymorphism at allorecognition loci. The (...) ‘Crozier paradox’ may be solved if allorecognition is based on extrinsically balanced polymorphisms, for example at immune loci. Alternatively, the assumption of most models that self fusion is mutually beneficial is wrong. If fusion is on average harmful, selection will promote unconditional rejection. However, we propose that fusion within individuals is beneficial, selecting for the ability to fuse, but fusion between individuals on average costly, selecting for non‐self recognition (rather than non‐kin recognition). We discuss experimental data on fungi that are consistent with this hypothesis. BioEssays 30:1193–1203, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

I examine two challenges that collaborative research raises for science. First, collaborative research threatens the motivation of scientists. As a result, I argue, collaborative research may have adverse effects on what sorts of things scientists can effectively investigate. Second, collaborative research makes it more difficult to hold scientists accountable. I argue that the authors of multi-authored articles are aptly described as plural subjects, corporate bodies that are more than the sum of the individuals involved. Though journal editors do not currently (...) conceive of the authors of multi-authored articles this way, this conception provides us with the conceptual resources to make sense of how collaborating scientists behave.Keywords: Collaborative research; Authorship; Multi-authored articles; Responsibility; Reward system; Plural subject. (shrink)

In welchem Verhaltnis steht die Seelenlehre zur Kosmologie in Platons Phaidon?

As studies continue to accumulate on leader humility, it has become clear that humility in a leader is largely beneficial to his or her followers. While the majority of the empirical research on this topic has demonstrated the positive effects of leader humility, this study challenges that consensus by arguing that a leader’s humble behavior can have contradictory outcomes in followers’ voice behavior. Drawing on attachment theory, we develop a model which takes into account the ways in which leader humility (...) influences the seemingly contradictory voice behavior of followers, i.e., inducing challenging voice, and defensive voice depending on the followers’ sense of security as reflected by feeling trusted and self-efficacy for voice. The results of this empirical study confirm that leader humility influences followers’ voice in a contradictory way through their sense of security. (shrink)

Over the past hundred years, a number of scientific investigators claim to have adduced experimental evidence for phenomena information” seems to behave like a weak signal that has to compete for the information-processing resources of the organism, a reduction of ongoing sensorimotor activity may facilitate ESP detection. Such a meaningful convergence of results suggests that psi phenomena may represent a unitary, coherent process whose nature and compatibility with current physical theory have yet to be determined. The theoretical implications and potential (...) practical applications of psi could be significant, irrespective of the small magnitude of psi effects in laboratory settings. (shrink)

A Greek English Lexicon of the New Testament, being Grimm's Wilke's Clavis Novi Testamenti. Translated, Revised and Enlarged by Joseph Henry Thayer, D.D., Bussey Professor of New Testament Criticism and Interpretation in the Divinity School of Harvard University. Edinburgh, T. and T. Clark. 1886. 4to. pp. 726. 36s.Biblico Theological Lexicon to New Testament Greek. by Hermann Cremer, D.D., Professor of Theology in the University of Greifswald. Third English Edition. With Supplement. Translated from the latest German Edition by William Uewick, M.A. (...) Edinburgh, T. and T. Clark. 1886. 4to. pp. 943. 38s. (shrink)

K. E. Boxer explores moral responsibility, and whether it is compatible with causal determinism. She suggests that to answer this question we must focus on responsibility in the sense of liability, and that an incompatibilist view may only be preserved on an understanding of the moral desert of punishment that many find morally problematic.

Argues against D. Hume's (1825) treatise "Of Miracles," which is often used to disprove the existence of psi. Hume states that a miracle is a violation of the laws of nature which are proved to be true by common experience, and that the only sufficient testimony for a miracle would be testimony whose falsehood would be even more miraculous than the miracle itself. The primary objections to Hume's argument are that (1) it is tautological, since it presupposes the nonexistence of (...) miraculous events, and (2) as a metaphysical statement, it is inappropriate when considering empirical evidence, which should be judged by its own rule. (shrink)

It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services—the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to ‘ordinary medical fairness’ in non-ideal circumstances (...) when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of ‘healthcare need’ and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification. (shrink)