BackgroundHuman embryonic stem cells as a source for the development of advanced therapy medicinal products are considered for treatment of Parkinson’s disease. Research has shown promising results and opened an avenue of great importance for patients who currently lack a disease modifying therapy. The use of hESC has given rise to moral concerns and been the focus of often heated debates on the moral status of human embryos. Approval for marketing is still pending.ObjectiveTo Investigate the perspectives and concerns of patients (...) with PD, patients being the directly concerned stakeholders in the ethical discussion.MethodsQualitative semi-structured interviews related to this new therapy in seventeen patients from two Swedish cities.ResultsThe participants expressed various interests related to the use of human embryos for development of medicinal therapies; however, overall, they were positive towards the use of hESC for treatment of PD. It was deemed important that the donating woman or couple made the choice to donate embryos voluntarily. Furthermore, there were concerns that the industry does not always prioritise the patient over profit; thus, transparency was seen as important. (shrink)

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries (...) that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

Incompetent patients need to have someone else make decisions on their behalf. According to the Substituted Judgment Standard the surrogate decision maker ought to make the decision that the patient would have made, had he or she been competent. Objections have been raised against this traditional construal of the standard on the grounds that it involves flawed counterfactual reasoning, and amendments have been suggested within the framework of possible worlds semantics. The paper shows that while this approach may circumvent the (...) alleged problem, the way it has so far been elaborated reflects insufficient understanding of the moral underpinnings of the idea of substituted judgment. Proper recognition of these moral underpinnings has potentially far-reaching implications for our normative assumptions about accuracy and objectivity in surrogate decision making. (shrink)

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, a surrogate decision maker ought to make the decision that the incompetent patient would have made, had he or she been competent. Empirical research has been conducted in order to find out whether surrogate decision makers are sufficiently good at doing their job, as this is defined by the substituted judgment standard. This research investigates to what extent surrogates (...) are able to predict what the patient would have preferred in the relevant circumstances. In this paper we address a methodological shortcoming evident in a significant number of studies. The mistake consists in categorizing responses that only express uncertainty as predictions that the patient would be positive to treatment, on the grounds that the clinical default is to provide treatment unless it is refused. We argue that this practice is based on confusion and that it risks damaging the research on surrogate accuracy. (shrink)

BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available (...) knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells. (shrink)

Part of the standard protection of decisionally incapacitated research subjects is a prohibition against enrolling them unless surrogate decision makers authorize it. A common view is that surrogates primarily ought to make their decisions based on what the decisionally incapacitated subject would have wanted regarding research participation. However, empirical studies indicate that surrogate predictions about such preferences are not very accurate. The focus of this article is the significance of surrogate accuracy in the context of research that is not expected (...) to benefit the research subject. We identify three morally relevant asymmetries between being enrolled and not being enrolled in such non-beneficial research, and conclude that when there is a non-negligible probability that surrogates’ predictions are wrong, it will generally be better to err on the side of not authorizing enrollment. (shrink)

Research on incompetent humans raises ethical challenges, especially when there is no direct benefit to these research subjects. Contemporary codes of research ethics typically require that such research must specifically serve to benefit the population to which the research subjects belong. The article critically examines this “same-population condition”, raising issues of both interpretation and moral justification. Of particular concern is the risk that the way in which the condition is articulated and rationalized in effect disguises or downplays the instrumentalization of (...) incompetent individuals. (shrink)

According to the Substituted Judgment Standard a surrogate decision maker ought to make the decision that the incompetent patient would have made, had he or she been competent. This standard has received a fair amount of criticism, but the objections raised are often wide of the mark. In this article we discuss three objections based on empirical research, and explain why these do not give us reason to abandon the Substituted Judgment Standard.

The role of mothers in prenatal research has been discussed extensively. Significantly less work has been done on the father’s role. In this article, focusing on ethical issues, we seek to redress this imbalance. Examining the father’s position in research conducted on pregnant women, we ask whether or not paternal consent ought to be required in addition to that of the pregnant woman. Having distinguished between different concepts of father and mother, we proceed by giving an overview of the reasons (...) for requiring consent of the woman who is carrying the child. We then examine which of these reasons apply to the biological father, and show that some of them are relevant to the father. The case, roughly speaking, revolves around privacy issues, the father’s future legal responsibilities, and the likelihood that he will care about the health and wellbeing of his future child. These factors in the decision problem should all be recognized, as should the fact that they can in principle be trumped by other considerations. (shrink)

After a brief sketch of the historical background, the current political situation in Sweden is outlined. Since 1985 the National Council on Medical Ethics has played an important role in the biopolitical debate in Sweden, and its activities and influence are described. Religious teachings are often combined with moral precepts. But what makes a statement religious is not easy to say, especially in societies where religious concerns have been intertwined with humanitarian common sense morality for a long time. Summing up, (...) it can be said that the debate in Sweden on biopolitical issues has not shown many signs of the influence of religious arguments, though some religious actors are active in this debate. (shrink)

The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care. Although the principle is much discussed in the academic literature, one important aspect has been neglected, namely the fact that real-world decision making is temporally extended, in the sense that it generally takes some time from the point at which the physician determines that there is a (...) decision to be made and that the patient is capable of making it, to the point at which the patient is actually asked for his or her view. This article asks under what circumstances, if any, temporising—waiting to pose a certain treatment question to a patient judged to have decision-making capacity—is compatible with the principle of self-determination. (shrink)

Allocating on the basis of need is a distinguishing principle in publicly funded health care systems. Resources ought to be directed to patients, or the health program, where the need is considered greatest. In Sweden support of this principle can be found in health care legislation. Today however some domains of what appear to be health care needs are excluded from the responsibilities of the publicly funded health care system. Corrections of eye disorders known as refractive errors is one such (...) domain. In this article the moral legitimacy of this exception is explored. Individuals with refractive errors need spectacles, contact lenses or refractive surgery to do all kinds of thing, including participating in everyday activities, managing certain jobs, and accomplishing various goals in life. The relief of correctable visual impairments fits well into the category of what we typically consider a health care need. The study of refractive errors does belong to the field of medical science, interventions to correct such errors can be performed by medical means, and the skills of registered health care professionals are required when it comes to correcting refractive error. As visual impairments caused by other conditions than refractive errors are treated and funded within the public health care system in Sweden this is an inconsistency that needs to be addressed. (shrink)

In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While (...) conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically “non-actionable,” we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients’ comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient’s situation and the underlying considerations shaping health care professionals’ choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person. (shrink)

The so-called Substituted Judgment Standard is one of several competing principles on how certain health care decisions ought to be made for patients who are not themselves capable of making decisions of the relevant kind. It says that a surrogate decision-maker, acting on behalf of the patient, ought to make the decision the patient would have made, had the latter been competent. The most common way of justifying the Substituted Judgment Standard is to maintain that this standard protects patients’ right (...) to autonomy, or self-determination, in the situation where they are no longer able to exercise this right on their own. In this paper we question this justification, by arguing that the most commonly suggested moral reasons for allowing and encouraging people to make their own choices seem not to apply when the patient’s decision-making is merely hypothetical. We end with some brief sketches of possible alternative ways of justifying the Substituted Judgment Standard. (shrink)

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, is indeterminate in content (...) and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the patient’s hypothetical outlook and the circumstances surrounding his or her decision making. The article discusses this problem of underdetermined decision conditions. (shrink)

Non-therapeutic research on children raises ethical concerns. Such research is not only conducted on individuals who are incapable of providing informed consent. It also typically involves some degree of risk or discomfort, without prospects of medically benefiting the participating children. Therefore, these children seem to be instrumentalized. Some ethicists, however, have tried to sidestep this problem by arguing that the children may indirectly benefit from participating in such research, in ways not related to the medical intervention as such. It has (...) been argued, for example, that non-therapeutic pediatric research does not instrumentalize the children enrolled since it has the prospects of furthering their moral development. We argue that this argument is far too undeveloped to be taken seriously. (shrink)

The project “A Plurality of Lives” was funded and hosted by the Pufendorf Institute for Advanced Studies at Lund University, Sweden. The aim of the project was to better understand how a second origin of life, either in the form of a discovery of extraterrestrial life, life developed in a laboratory, or machines equipped with abilities previously only ascribed to living beings, will change how we understand and relate to life. Because of the inherently interdisciplinary nature of the project aim, (...) the project took an interdisciplinary approach with a research group made up of 12 senior researchers representing 12 different disciplines. The project resulted in a joint volume, an international symposium, several new projects, and a network of researchers in the field, all continuing to communicate about and advance the aim of the project. (shrink)

The counterfactual comparative account of harm has counterintuitive implications in cases involving overdetermination and preemption. A popular strategy for dealing with these problems appeals to plural harm—several events being jointly harmful. Björn Petersson criticizes this strategy on the grounds that it conflicts with a strong intuition that helps to motivate the counterfactual comparative account, namely, that harming someone essentially involves making a difference for the worse for her. In this paper, I argue that Petersson’s argument is unconvincing.

In this article I argue for an empiricist view on laws. Some laws are fundamental in the sense that they are the result of inductive generalisations of observed regularities and at the same time in their formulation contain a new theoretical predicate. The inductive generalisations simul- taneously function as implicit definitions of these new predicates. Other laws are either explicit definitions or consequences of other previously established laws. I discuss the laws of classical mechanics, relativity theory and electromagnetism in detail. (...) Laws are necessary, whereas acciden- tal generalisations are not. But necessity here is not a modal concept, but rather interpreted as short for the semantic predicate “... is necessarily true”. Thus no modal logic is needed. The neces- sity attributed to law sentences is in turn interpreted as “necessary condition for the rest of the the- ory”, which is true since fundamental laws are implicit definitions of theoretical predicates use in the theory. (shrink)

Newtonian mechanics has a container conception of space. Space is regarded as an empty receptacle in which all material bodies exist. For a long time, most defenders of this view claimed that it must be mind-dependent. Anton Marty is the first modern philosopher to argue both that physical space is mind-independent and that it has the features characteristic of Newtonian physical space. Moreover, he works out a number of metaphysical implications of this view. Therefore, Marty ought to be given a (...) prominent place in the history of conceptions of space. As shown by Graham Nerlich, a container conception can be defended even after the twentieth-century revolutions in physics. By bringing Marty and Nerlich together, the paper claims that a container conception of space/space-time should even today be taken seriously in the philosophy of physics. (shrink)

According to the alternative semantics for focus, the semantic reflec of intonational focus is a second semantic value, which in the case of a sentence is a set of propositions. We examine a range of semantic and pragmatic applications of the theory, and extract a unitary principle specifying how the focus semantic value interacts with semantic and pragmatic processes. A strong version of the theory has the effect of making lexical or construction-specific stipulation of a focus-related effect in association-with-focus constructions (...) impossible. Furthermore, while focus has a uniform import, the sources of meaning differences in association with focus are various. (shrink)

Electromagnetism is usually understood as a theory describing how charged particles and eletromagnetic fields interact. In this paper I argue that a double ontology comprising both particles and fields is problematic. Either we should think of electromagnetism as a theory about charged particles directly interacting with each other, or as theory of fields whose local interactions are manifested as field quanta, called "particles." From a purely theoretical point of view the choice between a particle and a field interpretation does not (...) matter much when it concerns classical electromagnetism; both interpretations are possible and, as shown by Quine, there is a general method for translating a theory about one kind of objects into a theory assuming another kind of objects, provided these theories are empirically equivalent. From an empiricist point of view, however, the particle interpretation is the choice, since some particles are directly observable. Testable predictions of electromagnetism are predictions of the motion of charged bodies, in theory represented as particles, so this must be the empiricists' choice of ontology. In quantum electrodynamics one is however forced to chose a field ontology, since a particle ontology for this theory is impossible. So called "quantum particles" are field quanta, which cannot be treated as individuals making up a domain of quantification. There is thus a tension regarding ontology between classical and quantum electrodynamics. But this tension is nothing else than the much debated measurement problem of quantum mechanics. (shrink)

We have argued that the counterfactual comparative account of harm and benefit (CCA) violates the plausible adequacy condition that an act that would harm an agent cannot leave her much better off than an alternative act that would benefit her. In a recent paper in this journal, however, Neil Feit objects that our argument presupposes questionable counterfactual backtracking. He also argues that CCA proponents can justifiably reject the condition by invoking so-called plural harm and benefit. In this reply, we argue (...) that Feit’s lines of criticism are both unsuccessful. (shrink)

In this paper, we put forward two novel arguments against the counterfactual comparative account (CCA) of harm and benefit. In both arguments, the central theme is that CCA conflicts with plausible judgements about benefit and prudence.

Measures of happiness are increasingly being used throughout the social sciences. While these measures have attracted numerous types of criticisms, a crucial aspect of these measures has been left largely unexplored—their calibration. Using Eran Tal’s recently developed notion of calibration we argue first that the prospect of continued calibration of happiness measures is crucial for the science of happiness, and second, that continued calibration of happiness measures faces a particular problem—The Two Unknowns Problem. The Two Unknowns Problem relies on the (...) claim that individuals are necessarily a part of the measurement apparatus in first person measures of happiness, and the claim that we have no reason to believe that the evaluation standards people employ are invariant across individuals and time. We argue that calibrating happiness measures therefore involves solving an equation with two unknowns—an individual’s degree of happiness, and their evaluation standards—which is, generally, not possible. Third, we consider two possible escape routes from this problem and we suggest that the most promising route requires yet unexplored empirical and theoretical work on linking happiness to behavioral or neural evidence. (shrink)

Everyday resistance is about the many ways people undermine power and domination through their routine and everyday actions. Unlike open rebellions or demonstrations, it is typically hidden, not politically articulated, and often ingenious. But because of its disguised nature, it is often poorly understood as a form of politics and its potential underestimated. Conceptualizing Everyday Resistance presents an analytical framework and theoretical tools to understand the entanglements of everyday power and resistance. These are applied to diverse empirical cases including queer (...) relationships in the context of heteronormativity, Palestinian daily life under military occupation, workplace behaviors under office surveillance, and the tactics of fat acceptance bloggers facing the War against obesity. Johansson and Vinthagen argue that everyday resistance is best understood by accounting for different repertoires of tactics, relations between actors, and struggles around constructions of time and space. Through a critical dialogue with the work of James C. Scott, Michel de Certeau, and Asef Bayat, they aim to reconstruct the field of resistance studies, expanding what counts as resistance and building systematic analysis. Conceptualizing Everyday Resistance offers researchers and students from different theoretical and empirical backgrounds, an essential overview of the field and a creative framework that illuminates the potential of all people to transform society. (shrink)

Inductive thinking is a universal human habit; we generalise from our experiences the best we can. The induction problem is to identify which observed regularities provide reasonable justification for inductive conclusions. In the natural sciences, we can often use strict laws in making successful inferences about unobserved states of affairs. In the social sciences, by contrast, we have no strict laws, only regularities which most often are conditioned on ceteris paribus clauses. This makes it much more difficult to make reliable (...) inferences in the social sciences. In particular, we want knowledge about general causal relations in order to be able to determine what to do in order to achieve a certain state of affairs. Knowledge about causal relations that are also valid in the future requires experiments or so called ‘natural experiments’. Only knowledge derived from such experiences enable us to draw reasonably reliable inferences about how to act in order to achieve our goals. (shrink)

Two views of scientific theories dominated the philosophy of science during the twentieth century, the syntactic view of the logical empiricists and the semantic view of their successors. I show that neither view is adequate to provide a proper understanding of the connections that exist between theories at different times. I outline a new approach, a hybrid of the two, that provides the right structural connection between earlier and later theories, and that takes due account of the importance of the (...) mathematical models of a theory and of the various distinct formulations that pick out these models. (shrink)

It is often claimed that our knowledge of the evolutionary process adds an extra dimension to the classical problem of natural evil and makes this problem worse. Especially the principle of natural selection is often portrayed as morally inappropriate or “unfitting” for a perfectly good God to use as a means for creating biological complexity. In this article, I argue that this common view is misconceived, and that natural selection is a wholly innocuous principle. The real source of evolutionary evils (...) is the fact that resources in nature are scarce – a fact that was known long before Darwin. The problem of natural and evolutionary evil, therefore, is best construed as a question about why God permits scarcity in nature. I argue that recent research about the interrelation between competition and cooperation in the evolutionary process provides resources for answering this perennial question in a more satisfactory way than could be done before the advent of evolutionary theory. (shrink)

Epigrams of Lingayat saints of the 16th century espousing the Advaita school in Hindu philosophy; transcribed from a palm-leaf manuscript preserved in the Karnatak University.

Reflexive Methodology established itself as a groundbreaking success, providing researchers with an invaluable guide to a central problem in research methodology – how to put field research and interpretations in perspective, paying attention to the interpretive, political, and rhetorical nature of empirical research. Now thoroughly updated, the Second Edition includes a new chapter on positivism, social constructionism, and critical realism, and offers new conclusions on the applications of methodology. It provides further illustrations and updates that build on the acclaimed and (...) successful First Edition. (shrink)

ABSTRACT Suppose that, for every possible event and person who would exist whether or not the event were to occur, there is a well-being level that the person would occupy if the event were to occur, and a well-being level that the person would occupy if the event were not to occur. Do facts about such connections between events and well-being levels always suffice to determine whether an event would harm or benefit a person? Many seemingly attractive accounts of harm (...) and benefit entail an affirmative answer to this question, including the widely held Counterfactual Comparative Account (CCA). In this paper, however, we argue that all such accounts will be unsuccessful. (shrink)

In this paper, some conceptual issues are addressed in order to make sense of what string theory is supposed to tell us about spacetime. The dualities in string theory are used as a starting point for our argumentation. We explore the consequences of a standard view towards these dualities, namely that the dual descriptions represent the same physical situation. Given this view, one has to understand string theory in a manner such that what counts as physical spacetime is based only (...) on the shared physical content—or common core—of the dual descriptions. In general such a spatiotemporal picture does not have to agree with, or be similar to, any of the ones suggested by naïve readings of the dual descriptions. However, in certain regimes or limits, one or the other of the initial dual descriptions may give a good effective description of physical spacetime. (shrink)

Science has become a central political concern with massive increases in public investment, but resources are embedded in a complex web of expectations that vary between countries and regions. This book outlines an insightful understanding of science policy as both concerning the governance of science itself through priority-setting, funding, organization and articulation with polity, society and economy, and its extra-organizational connections in terms of higher education, innovation and national policy concerns. The New Global Politics of Science examines how science and (...) innovation have become truly global, and the consequences of this for scientists, policymakers and citizens. This book provides an overview of how research policies have evolved in different countries and contexts. It also examines how science research has been aligned with nation-building and state-formation, enmeshed in meta-governance, and how this relates to economic growth. Analysing how knowledge policies have been forged in their specific historical and geographical settings, this book will be an invaluable tool for scholars and policymakers in the fields of science, innovation and public policy. (shrink)