BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey (...) among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative (...) analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)

In this article, the vitality of premature infants will be described and discussed. Vitality was one of the main factors in a grounded theory study in which the aim was to generate knowledge concerning the ethical decision-making processes with which nurses and physicians are faced in a neonatal unit. Which assessments underlie decisions about whether to start, continue or stop medical treatment of very sick premature babies?A descriptive study design, including 120 hours of field observations and 22 qualitative in-depth interviews (...) with doctors and nurses, was chosen. Strauss and Glaser’s comparative method was used to analyse the field observations and interviews.The findings indicate that life-and-death decisions are somewhat ambivalent; experience does not always make them easier. In situations of ambiguity, decisions also seem to be based upon the vitality of the babies concerned. (shrink)

In this article, the vitality of premature infants will be described and discussed. Vitality was one of the main factors in a grounded theory study in which the aim was to generate knowledge concerning the ethical decision-making processes with which nurses and physicians are faced in a neonatal unit. Which assessments underlie decisions about whether to start, continue or stop medical treatment of very sick premature babies? A descriptive study design, including 120 hours of field observations and 22 qualitative in-depth (...) interviews with doctors and nurses, was chosen. Strauss and Glaser’s comparative method was used to analyse the field observations and interviews. The findings indicate that life-and-death decisions are somewhat ambivalent; experience does not always make them easier. In situations of ambiguity, decisions also seem to be based upon the vitality of the babies concerned. (shrink)

Background Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals’ handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. Research aim This study aimed to explore healthcare leaders’ expectations of using a digital tool for ethical reflection among their home nursing care staff. Research design A qualitative research design with vignettes and focus group interviews (...) was used. The data were analyzed using reflexive thematic analysis. Participants and Research Context The sample comprised ten healthcare leaders from municipal long-term care in Norway. Ethical Considerations Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. Findings The analysis resulted in the development of three themes representing leaders’ expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Discussion Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees’ activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool’s potential to ensure continuity in ethics work requires considerable organizational and leader involvement. Conclusions This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified. (shrink)

Background Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. Aim The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. Research (...) design The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. Participants and research context The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. Ethical considerations The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. Findings Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. Conclusion Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses’ understanding of the tool’s purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work. (shrink)

The basis of perception is the processing and categorization of perceptual stimuli from the environment. Much progress has been made in the science of perceptual categorization. Yet there is still no consensus on how the brain generates sensory individuals, from sensory input and perceptual categories in memory. This chapter argues that perceptual categorization is highly variable across perceivers due to their use of different perceptual strategies for solving perceptual problems they encounter, and that the perceptual system structurally adjusts to the (...) strategies that are most successful. Despite this variability, the different sensory individuals that result when different perceivers rely on different strategies nonetheless correspond to actual external world objects/features. This view is called 'perceptual pluralism'. (shrink)

Whether visual perceptual consciousness is gradable or dichotomous has been the subject of fierce debate in recent years. If perceptual consciousness is gradable, perceivers may have less than full access to—and thus be less than fully phenomenally aware of—perceptual information that is represented in working memory. This raises the question: In virtue of what can a subject be less than fully perceptually conscious? In this chapter, we provide an answer to this question, according to which inexact categorizations of visual input (...) may result in a representation of the visual information in working memory that is less than fully available to the perceiver, and of which the perceiver is therefore less than fully phenomenally aware. The latter proposal is a natural extension of a theory of perception we have proposed in previous works, namely, the template tuning theory (TTT). We argue that although TTT is compatible with both gradable and dichotomous conceptions of perceptual consciousness, the available empirical evidence favours a gradable conception of perceptual consciousness. (shrink)

Predictive processing models of perception take issue with standard models of perception as hierarchical bottom-up processing modulated by memory and attention. The predictive framework posits that the brain generates predictions about stimuli, which are matched to the incoming signal. Mismatches between predictions and the incoming signal – so-called prediction errors – are then used to generate new and better predictions until the prediction errors have been minimized, at which point a perception arises. Predictive models hold that all bottom-up processes are (...) signals conveying prediction errors to higher areas, which respond by updating their predictions. We take issue with this claim and argue that object recognition requires bottom-up processing that cannot be understood in terms of prediction errors. Along the way, we expand on previous work casting doubt on the framework's ability to account for attention. Specifically, we argue that the type of attention that allows us to rapidly extract the gist of an object or scene presents an additional challenge to the predictive approach. We conclude by considering how the framework may be augmented to avoid these problems. (shrink)

The aim of this article is to generate knowledge about parents’ participation in life-and-death decisions concerning their very premature and/or critically ill infants in hospital neonatal units. The question is: what are parents’ attitudes towards their involvement in such decision making? A descriptive study design using in-depth interviews was chosen. During the period 1997-2000, 20 qualitative interviews with 35 parents of 26 children were carried out. Ten of the infants died; 16 were alive at the time of the interview. The (...) comparative method (grounded theory) was used to analyse the data. The analysis was carried out continuously and in parallel with data collection. Six categories were revealed by the analysis: indecision and uncertainty (ambivalence); information and communication; participate, but do not decide; seeming to be included; the parents’ child; and individual consideration. The findings appear to indicate that parents agree that they should not have the final word in decisions concerning their infants’ future life or death. Such a responsibility would put too heavy a burden on parents who lack the medical knowledge and the professional experience needed to make such a decision, and would be likely to lead to them experiencing strong feelings of guilt. The findings show that parents should be well informed and listened to during the whole decision-making process. Their primary concern was how nurses and physicians communicate with parents who are experiencing a crisis, and how this serious information is presented. (shrink)

The aim of this study was to generate knowledge about how parents who have been part of an ethical decision-making process concerning a son or daughter in a neonatal unit experience life with a severely disabled child. A descriptive study design was chosen using 30 hours of field observations and seven in-depth interviews, carried out over a period of five months with parents who had been faced with ethical decisions concerning their own children in a neonatal unit. Strauss and Glaser’s (...) constant comparative method was used for the analysis. The findings seem to indicate that these parents have an extremely tough life. Their relationships with their children are somewhat ambivalent. The children are very dependent on their parents, who in some ways both love and hate them. Too little rest and sleep and feeding the children are the most serious problems. The parents require respite facilities. The home can seem like a prison, from which it is impossible to escape. It is like having a baby who never grows up. (shrink)

The aim of this study was to obtain in-depth knowledge about caring confirmation of patients with cancer, from the patients’ point of view. The research topic was: what is the significance for patients of their being confirmed by nursing personnel? Fifteen men and women between 43 and 80 years of age participated in this study. The method of data collection used was qualitative research interviewing. A hermeneutic approach was used to interpret the data, in which Kvale’s self-perception, the ‘common sense’ (...) level, and theoretical levels were applied. The results are summarized in three areas: an outer confirmation, an inner confirmation, and a lack of the latter. Outer confirmation meant being understood and taken seriously; the maintenance of human dignity and worth indicated inner confirmation. A lack of inner confirmation is primarily manifest in terms of patients’ mental, spiritual and existential concerns. In relation to the theory of Eriksson, these patients were confirmed at the level of having and being, but seldom at the level of becoming. (shrink)

Studying women farmers who are equal to men in their formal status, this article explores the extent to which women's entry into a male occupation challenges the existing gender system. Our analysis shows that young women farmers represent a change toward a new work role for women in farming. They have become similar to men farmers in many important aspects of farming such as vocational training, technological know-how, and union membership; however, important aspects of the existing gender system are being (...) preserved. Young women farmers still have the main responsibility for domestic work; their income from farming is less important for the household than their husband's; and, compared to men farmers, their farm income is less. There is no indication that young women farmers challenge the masculinist way of farming. (shrink)

The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being (...) pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed. (shrink)

Does a factive conception of knowability figure in ordinary use? There is some reason to think so. ‘Knowable’ and related terms such as ‘discoverable’, ‘observable’, and ‘verifiable’ all seem to operate factively in ordinary discourse. Consider the following example, a dialog between colleagues A and B: A: We could be discovered. B: Discovered doing what? A: Someone might discover that we're having an affair. B: But we are not having an affair! A: I didn’t say that we were. A’s remarks (...) sound contradictory. In this context the factivity of ‘someone might discover that’ explains this fact. So there is some reason to believe that knowability and related modalities are factive in ordinary use. For factive treatments of knowability in the context of epistemic theories of truth, compare Tennant (2000: 829) and Wright (2001: 59-60, n. 17). (shrink)

The aim of this chapter is to shed new light on the question of what newly sighted subjects are capable of seeing on the basis of previous experience with mind- independent, external objects and their properties through touch alone. This question is also known as "Molyneux’s question." Much of the empirically driven debate surrounding this question has been centered on the nature of the representational content of the subjects' visual experiences. It has generally been assumed that the meaning of "seeing" (...) deployed in these disputes is more or less clear and unproblematic, and therefore requires no analysis or clarification. In this chapter, we wish to challenge this assumption. We argue that getting clear on the meaning of "seeing" is the only feasible way to determine whether the empirical attempts to answer Molyneux’s question accurately capture what newly sighted subjects are in fact capable of seeing. Specifically, we show that the dominant interpretations of the empirical results from a recent study (Held et al., 2011) fail to take into account that seeing can be not only purely visual but also epistemic in that it requires background knowledge (such as what an object with a particular viewpoint-independent shape looks like from a particular perspective). (shrink)

Background:Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work.Objectives:The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making for the patient?”Design (...) and method:We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed.Ethical considerations:The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki. The participants were assured that privacy, and confidentiality would be duly protected.Results:Four key themes emerged: confusion in relation to professional and operational expectations of role, ideal somnolence, inadequate argumentation skills, and compound pressure.Conclusion:Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

The question of whether blindsight is a form of unconscious perception continues to spark fierce debate in philosophy and psychology. One side of the debate holds that while the visual information categorized in blindsight is not access-conscious, it is nonetheless a form of perception, albeit a form of unconscious perception. The opposition, by contrast, holds that blindsight is just a form of degraded conscious perception that makes the categorized information harder to access because it is degraded. In this chapter, we (...) address the opposition’s arguments for thinking that blindsight is a form of degraded conscious vision and then argue that the residual awareness found in blindsight is a form of non-perceptual awareness. To back this claim, we examine the residual visual abilities to detect and discriminate colour found in some blindsight patients and show that residual consciousness in blindsight is indirect and lacks the phenomenal character characteristic of conscious vision. (shrink)

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: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Abstract Ernest Sosa has argued that the relevant alternatives theory of knowledge has yet to overcome serious difficulties. The most serious difficulty is that of providing criteria for when a rival alternative to a claim is relevant. Without such criteria, the theory is ad hoc. I argue that most other externalist theories of knowledge, including Sosa's own, fall victim to this criticism. At the end of the paper I make a suggestion as to why Sosa's objection might not be as (...) damaging as it at first seems. (shrink)

Integration information theories posit that the integration of information is necessary and/or sufficient for consciousness. In this paper, we focus on three of the most prominent information integration theories: Information Integration Theory, Global Workspace Theory, and Attended Intermediate-Level Theory. We begin by explicating each theory and key concepts they utilize. We then argue that the current evidence indicates that the integration of information is neither necessary nor sufficient for consciousness. Unlike GWT and AIR, IIT maintains that conscious experience is both (...) necessary and sufficient for consciousness. We present empirical evidence indicating that simple features are experienced in the absence of feature integration and argue that it challenges IIT’s necessity claim. In addition, we challenge IIT’s sufficiency claim by presenting evidence from hemineglect cases and amodal completion indicating that contents may be integrated and yet fail to give rise to subjective experience. Moreover, we present empirical evidence from subjects with frontal lesions who are unable to carry out simple instructions and argue that they are irreconcilable with GWT. Lastly, we argue that empirical evidence indicating that patients with visual agnosia fail to identify objects they report being conscious of present a challenge to AIR’s necessity claim. (shrink)

I start out by reviewing the semantics of ‘seem’. As ‘seem’ is a subject-raising verb, ‘it seems’ can be treated as a sentential operator. I look at the semantic and logical properties of ‘it seems’. I argue that ‘it seems’ is a hyperintensional and contextually flexible operator. The operator distributes over conjunction but not over disjunction, conditionals or semantic entailments. I further argue that ‘it seems’ does not commute with negation and does not agglomerate with conjunction. I then show that (...) the mental states expressed by perceptual uses of ‘seem’ have non-conceptual, yet perspectival contents. In the final part of the paper I argue that while the content of the mental states expressed by perceptual uses of ‘seem’ are non-conceptual, having a mental state of this type requires possessing conceptual abilities corresponding to what the mental state represents. (shrink)

According to the inferential view of language comprehension, we hear a speaker’s utterance and infer what was said, drawing on our competence in the syntax and semantics of the language together with background information. On the alternative perceptual view, fluent speakers have a non-inferential capacity to perceive the content of speech. On this view, when we hear a speaker’s utterance, the experience confers some degree of justification on our beliefs about what was said in the absence of defeaters. So, in (...) the absence of defeaters, we can come to know what was said merely on the basis of hearing the utterance. Several arguments have been offered against a pure perceptual view of language comprehension, among others, arguments pointing to its alleged difficulties accounting for homophones and the context-sensitivity of ordinary language. After responding to the arguments against the perceptual view of language comprehension, I provide a new argument in favor of the perceptual view by looking closer at the dependence of the justificatory qualities of experience on the notion of a defeater as well as the perceptual nature of language learning and language processing. (shrink)

This chapter examines an evidentialist ethics of belief, and W. K. Clifford’s proposal in particular. It argues that regardless of how one understands the notion of evidence, it is implausible that we could have a moral obligation to refrain from believing something whenever we lack sufficient evidence. Alternatively, this chapter argues that there are wide-scope conditional requirements on beliefs but that these requirements can be met without having sufficient evidence for the belief in question. It then argues that we are (...) epistemically, though not morally, required to form epistemically valuable beliefs. However, these beliefs, too, need not be beliefs for which we have sufficient evidence—epistemically good beliefs need not be based on sufficient evidence. (shrink)

Background:Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual.Objectives:The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway’s renamed and revised Patients’ and Service Users’ Rights Act (originally Patients’ Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian (...) Ministry of Health and Care Service.Research design:A constructivist design was used, and Fairclough’s critical discourse approach was adopted to analyze the text of the Patients’ and Service Users’ Rights Act and comments.Findings:The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients’ trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as “troublesome.”Conclusion:Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient. (shrink)

The research presented in this work represents reflections in the light of Julia Kristeva's philosophy concerning empirical data drawn from research describing the everyday life of people dependent on ventilators. It also presents a qualitative and narrative methodological approach from a person‐centred perspective. Most research on home ventilator treatment is biomedical. There are a few published studies describing the situation of people living at home on a ventilator but no previous publications have used the thoughts in Kristeva's philosophy applied to (...) this topic from a caring science perspective. The paper also addresses what a life at home on a ventilator may be like and will hopefully add some new aspects to the discussion of philosophical issues in nursing and the very essence of care. Kristeva's philosophy embraces phenomena such as language, abjection, body, and love, allowing her writings to make a fruitful contribution to nursing philosophy in that they strengthen, expand, and deepen a caring perspective. Moreover, her writings about revolt having the power to create hope add an interesting aspect to the work of earlier philosophers and nursing theorists. (shrink)

Attitude reports are reports about people’s states of mind. They are reports about what people think, believe, know, know a priori, imagine, hate, wish, fear, and the like. So, for example, I might report that s knows p, or that she imagines p, or that she hates p, where p specifies the content to which s is purportedly related. One lively current debate centers around the question of what sort of specification is involved when such attitude reports are successful. Some (...) hold that it is specification of the precise content of a mental state; others hold that it is specification of the content of a mental state only relative to a mode of presentation; yet others hold that it is merely a description or characterization of the content of a mental state. After providing a brief introduction to the traditional debate on attitude reports, this entry argues that for certain kinds of knowledge reports and for so-called de re attitude reports, descriptive theories emerge as the most plausible. The entry concludes with a discussion of how the characterizing relation between attitude reports and mental states might be construed. (shrink)

Hatred: Understanding Our Most Dangerous Emotion The first in-depth philosophical analysis of personal hate and group hate, Hate: Understanding Our Most Dangerous Emotion explores how personal hatred can foster domestic violence and emotional abuse, how hate-proneness is a main contributor to the aggressive tendencies of borderlines, narcissists and psychopaths, how seemingly ordinary people embark on some of history's worst hate crimes, and how cohesive groups, subjected to spontaneous forces of group polarization, can develop extremist viewpoints of the sort that motivate (...) hate crimes, mass shootings, and terrorism. The book's first part explores hate in intimate relationships, looking for an answer to the question of why our intimate relationships can survive hate and resentment, but not disrespect or contempt. Berit "Brit" Brogaard shows that where contempt creates an irreparable power imbalance, hate is tied to fear, which our brains may reinterpret as thrill, attraction and excitement. But this can also make hate a dangerous emotion that convinces people to hang onto abusive relationships. When tied to vengeance and the dark triad of personality, hate is not only dangerous but also dehumanizing. Vengeance and the dark personalities are not essential to hate, however. Without them, hate can have more admirable ends. The book's second part explores the polarizing forces that can bias cohesive groups of like-minded individuals and contribute to what is effectively a hate crisis. Drawing on history, politics, legal theory, philosophy, and psychology, Brogaard shows how cultural myths about femininity, ethnic groups, and the land of opportunity perpetuate misogyny, white supremacy and anti-Semitism. But, she argues, politicians and policymakers have it in their power to address the hate crisis through legislation that preserves the original incentive behind the first-amendment right to free speech. (shrink)

Reductionists about knowledge-wh hold that "s knows-wh" (e.g. "John knows who stole his car") is reducible to "there is a proposition p such that s knows that p, and p answers the indirect question of the wh-clause." Anti-reductionists hold that "s knows-wh" is reducible to "s knows that p, as the true answer to the indirect question of the wh-clause." I argue that both of these positions are defective. I then offer a new analysis of knowledge-wh as a special kind (...) of de re knowledge. (shrink)

David Milner and Melvyn Goodale’s dissociation hypothesis is commonly taken to state that there are two functionally specialized cortical streams of visual processing originating in striate (V1) cortex: a dorsal, action-related “unconscious” stream and a ventral, perception-related “conscious” stream. As Milner and Goodale acknowledge, findings from blindsight studies suggest a more sophisticated picture that replaces the distinction between unconscious vision for action and conscious vision for perception with a tripartite division between unconscious vision for action, conscious vision for perception, and (...) unconscious vision for perception. The combination excluded by the tripartite division is the possibility of conscious vision for action. But are there good grounds for concluding that there is no conscious vision for action? There is now overwhelming evidence that illusions and perceived size can have a significant effect on action (Bruno & Franz, 2009; Dassonville & Bala, 2004; Franz & Gegenfurtner, 2008; McIntosh & Lashley, 2008). There is also suggestive evidence that any sophisticated visual behavior requires collaboration between the two visual streams at every stage of the process (Schenk & McIntosh, 2010). I nonetheless want to make a case for the tripartite division between unconscious vision for action, conscious vision for perception, and unconscious vision for perception. My aim here is not to refute the evidence showing that conscious vision can affect action but rather to argue (a) that we cannot gain cognitive access to action-guiding dorsal stream representations, and (b) that these representations do not correlate with phenomenal consciousness. This vindicates the semi-conservative view that the dissociation hypothesis is best understood as a tripartite division. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...) tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family (...) wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

There is little doubt that we perceive the world as tensed—that is, as consisting of a past, present and future each with a different ontological status—and transient—that is, as involving a passage of time. We also have the ability to execute precisely timed behaviors that appear to depend upon making correct temporal judgments about which changes are truly present and which are not. A common claim made by scientists and philosophers is that our experiences of entities enduring through transient changes (...) are illusory and that our apparently accurately timed behaviors do not reflect dynamical time. We argue that our experiences of objects enduring through transient changes need not be thought of as illusory even if time is not dynamic at the fundamental level of reality. For, the dynamic properties we experience objects as having need not be fundamental properties. They could be weakly emergent from static, temporal properties. Temporal properties, on this view, are similar to ordinary properties like that of being solid, which are correctly experienced as properties of medium-sized material bodies even though they are not instantiated at the fundamental level of reality. (shrink)

Traditionally, philosophers have appealed to the phenomenological similarity between visual experience and visual imagery to support the hypothesis that there is significant overlap between the perceptual and imaginative domains. The current evidence, however, is inconclusive: while evidence from transcranial brain stimulation seems to support this conclusion, neurophysiological evidence from brain lesion studies (e.g., from patients with brain lesions resulting in a loss of mental imagery but not a corresponding loss of perception and vice versa) indicates that there are functional and (...) anatomical dissociations between mental imagery and perception. Assuming that the mental imagery and perception do not overlap, at least, to the extent traditionally assumed, then the question arises as to what exactly mental imagery is and whether it parallels perception by proceeding via several functionally distinct mechanisms. In this review, we argue that even though there may not be a shared mechanism underlying vision for perception and conscious imagery, there is an overlap between the mechanisms underlying vision for action and unconscious visual imagery. On the basis of these findings, we propose a modification of Kosslyn’s model of imagery that accommodates unconscious imagination and explore possible explanations of the quasi-pictorial phenomenology of conscious visual imagery in light of the fact that its underlying neural substrates and mechanisms typically are distinct from those of visual experience. (shrink)

Are conscious states conscious in virtue of representing themselves? Content Type Journal Article Pages 1-8 DOI 10.1007/s11098-011-9762-x Authors Berit Brogaard, Department of Philosophy, University of Missouri, St. Louis, 599 Lucas Hall, One University Blvd., St. Louis, MO 63121-4400, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116.

In "The Epistemic Significance of Perceptual Learning," Elijah Chudnoff (this issue) argues that cases from perceptual learning show that perception not only generates reasons for beliefs but also preserves those reasons over time in perceptual learning cases. In this paper, we dispute the idea that perceptual learning enables the preservation of perceptual reasons. We then argue for an alternative view, viz. the view that perceptual learning is epistemically significant insofar as it modifies our perceptual system in such a way as (...) to make us capable of perceiving subtle low-level properties (e.g. lightness) and high-level properties (e.g. chess configurations). Acquiring the capacity to perceive these properties is what enables us to achieve expertise in a variety of subject matters (e.g. chicken sexing, chess playing, language fluency). Along the way, we argue against two main points in Chudnoff’s paper. The first is that, pace Chudnoff, perceptual learning does not result in the acquisition of new facts. It only results in the acquisition of a new perceptual capacity. The second is that experiences resulting from perceptual learning can always serve as immediate justifiers of beliefs and hence do not need supporting background information in order to serve as reasons. (shrink)

This paper defends the view that we have special relationship duties that do not derive from our moral duties. Our special relationship duties, I argue, are grounded in what I call close relationships. Sharing a close relationship with another person, I suggest, requires that both people conceive of themselves as being motivated to promote the other’s interests. So, staying true to oneself demands being committed to promoting the interests of those with whom we share a close relationship. Finally, I show (...) that the proposed account of special relationship duties circumvents two problems facing self-conception accounts of special relationship duties. (shrink)