This paper presents a framework for discussing issues of ownership in connection to virtual worlds. We explore how divergent interests in virtual property can be mediated by applying a constructivist perspective to the concept ownership. The simple solutions offered today entail that a contract between the game producer and the gamer gives the game developer exclusive rights to all virtual property. This appears to be unsatisfactory. A number of legitimate interests on part of both producers and gamers may be readily (...) distinguished. More complex distributions of rights would allow many of these interests to be consistently respected. (shrink)

Epidemiological studies indicate that the incidence of shaken baby cases is overestimated and that this is due to biased classifications, based on ethical rather than scientific considerations. In...

A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. As an example of such a conflict, we have analyzed the genesis and development of the shaken baby syndrome paradigm. The point of departure of the analysis is a recently conducted systematic literature review, (...) which concluded that there is very low scientific evidence for the basic assumption held by Child Protection Teams: when certain signs are present the infant has been violently shaken. We suggest that such teams have developed more value-based than scientific-based criteria when classifying SBS cases. Further, we suggest that the teams are victims of “groupthink,” aggravating the difficulties in considering critics’ questioning the criteria established by the teams. (shrink)

Norms are a pervasive yet mysterious feature of social life. In Explaining Norms, four philosophers and social scientists team up to grapple with some of the many mysteries, offering a comprehensive account of norms: what they are; how and why they emerge, persist and change; and how they work.

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications (...) of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

abstract ‘Time is money’, Benjamin Franklin's ‘Poor Richard’ tells us. But instead of converting time expenditures into monetary equivalents, it makes more sense in many cases to convert money into temporal equivalents. The difficulty in putting a monetary value on time in unpaid household labour, when adjusting the National Accounts, points to the problems of the first approach. The advantages of the latter approach are illustrated by the Swedish system of specifying criminal fines in terms of the number of days (...) the offender would have to work to pay them off. (shrink)

This book provides an overview of different ethical views on animal experimentation. Special attention is given to the production and experimental use of genetically modified animals. It proposes a middle course between those positions that are very critical and those very positive. This middle course implies that animal experiments originating in vital human research interests are commonly justified, provided that animal welfare is taken seriously. Some animal experiments are not acceptable, since the expected human benefit is too low and the (...) animal suffering too severe. This position is supported by an argument from species care according to which we have special obligations to our children and other humans due to special relations. The book tries to bridge the gap between animal ethics and animal welfare science by discussing various conceptions of animal welfare: function-centered, feeling-based, and those focusing on natural living. The theoretical starting-point is “imaginative casuistry.” This approach stresses the role of moral imagination and metaphor in ethical deliberation, accepts a plurality of values, and recognizes the importance of case-by-case balancing. In the discussion of genetically modified animals, both intrinsic ethical concerns and animal welfare concerns are addressed. (shrink)

Perceptual processes differ from cognitive, this paper argues, in functioning to be causally controlled by proximal stimuli, and being modular, at least in a modest sense that excludes their being isotropic in Jerry Fodor's sense. This claim agrees with such theorists as Jacob Beck and Ben Phillips that a function of stimulus-control is needed for perceptual status. In support of this necessity claim, I argue, inter alia, that E.J. Green's recent architectural account misclassifies processes deploying knowledge of grammar as perceptual. (...) _Pace_ Beck and Phillips, however, I argue a function of stimulus-control is insufficient for perceptual as opposed to cognitive status. One consideration in favour of such insufficiency, noted but (I argue) not convincingly rebutted by these theorists, concerns perpetually grounded demonstrative thought. Two other considerations trade on the fact that a function of stimulus-control can arise not from blind nature but intentional design or social institutions, where so-functioning processes may but need not be perceptual. I offer two cases where such processes are cognitive, viz. skilful play-by-play announcing of ongoing events, and voluntary visualizing of ongoing events under the guidance of apt play-by-play announcements, dubbed announcement-driven visualizing (ADV). The cognitive status of these three diverse phenomena cannot be explained by an absence of a perception-like representational format or content (for ADV has such) or by a presence of personal-level mental states causally mediating between stimuli and outputs (for perception has such). A bettter explanation invokes, I argue, the non-modular character of the generating process. (shrink)

Reviews work on moral judgment motivational internalism from the last two decades.

People taking part in research vary in the extent to which they understand information concerning their participation. Since they may choose to limit the time and effort spent on such information, lack of understanding is not necessarily an ethical problem. Researchers who notice a lack of understanding are in the quandary of not knowing whether this is due to flaws in the information process or to participants’ deliberate choices. We argue that the two explanations call for different responses.A tool for (...) identifying those research participants who want limited information is presented. This consists of a restricted number of questions about trust in and appraisal of research, priority of time and privacy, and perception of a duty to participate. It is argued that an important group of participants who purposely lack understanding of the study can be identified with this tool. Some limitations to this approach are also discussed. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

Motivational internalism postulates a necessary connection between moral judgments and motivation. In arguing for and against internalism, metaethicists traditionally appeal to intuitions about cases, but crucial cases often yield conflicting intuitions. One way to try to make progress, possibly uncovering theoretical bias and revealing whether people have conceptions of moral judgments required for noncognitivist accounts of moral disagreement, is to investigate non-philosophers' willingness to attribute moral judgments. A pioneering study by Shaun Nichols seemed to undermine internalism, as a large majority (...) of subjects were willing to attribute moral understanding to an agent lacking moral motivation. However, our attempts to replicate this study yielded quite different results, and we identified a number of problems with Nichols' experimental paradigm. The results from a series of surveys designed to rule out these problems show that people are more willing to attribute moral understanding than mor.. (shrink)

Voices on the political right have long claimed that the welfare state ought to be kept small, and that charities can take over many of the tasks involved in helping those at the bottom of society. The arguments in favor of this claim are controversial, but even if they are accepted at face value the policy proposal remains problematic. For the proposal presupposes that charities would, in fact, be able to raise enough money to provide adequate help to those in (...) need, and therefore assumes that charities are able to very significantly increase the number and/or size of donations they receive. We argue that there are good reasons for doubting that charities will be able to do this. Our argument turns on the fact that the most powerful strategy for eliciting donations—namely, allowing donors to use their donation to signal their pro-sociality—has an inbuilt upper limit. If too much emphasis is placed on the signaling opportunities donating to charity provides, donating no longer functions as an effective signal and the motivation to donate declines. (shrink)

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

Over the past few decades, a body of research has developed examining the academic dishonesty of university and college students. While research has explored academic dishonesty amongst American criminal justice and policing students, no research has specifically focused on investigating the dynamics and correlates of academic dishonesty amongst Australian criminology students. This study drew upon data obtained from a survey of 79 undergraduate criminal justice and policing students studying at an Australian university. Overall, the results suggest that male gender, viewing (...) academic dishonesty as less serious and holding justifications for engaging in this type of behaviour were significant predictors of self-reported academic dishonesty. The findings suggest that more proactive strategies need to be implemented by universities to prevent student involvement in academic dishonesty. (shrink)

Our starting point in this article is the debate between John Harris and Iain Brassington on whether or not there is a duty to take part in scientific research. We consider the arguments that have been put forward based on fairness and a duty to rescue, and suggest an alternative justification grounded in a hypothetical agreement: that is, because effective healthcare cannot be taken for granted, but requires continuous medical research, and nobody knows what kind of healthcare they will need, (...) participating in research should be viewed from the perspective of a social contract, based on our mutual need for medical advances. (shrink)

For successful climate change adaptation, the distribution of responsibility within society is an important question. While the literature highlights the need for involving both public and private actors, little is still known of how citizens perceive their own and others’ responsibility, let alone the moral groundings for such perceptions. In this paper, we report the results of a survey regarding people’s attitudes towards different ways of distributing responsibility for climate change adaptation. The survey was distributed to citizens in six Swedish (...) municipalities and completed by 510 respondents. A large number of respondents wanted to assign responsibility for making decisions about and implementing adaptation measures to local governments, but also to property owners, whereas the national government was raised as responsible for setting decision boundaries and for financial support. The most preferred principles for a fair distribution of responsibility among the respondents were desert, ability, efficiency and need, while the principle of equal shares found less support. All principles received some support, indicating that it is necessary to consider several principles when distributing responsibility for climate change adaptation. Compared to earlier studies, this study shows more nuanced perceptions on who should be responsible and on what moral grounds. (shrink)

Distribution of responsibility is one of the main focus areas in discussions about climate change ethics. Most of these discussions deal with the distribution of responsibility for climate change mitigation at the international level. The aim of this paper is to investigate if and how these principles can be used to inform the search for a fair distribution of responsibility for climate change adaptation on the local level. We found that the most influential distribution principles on the international level were (...) in turn built on one or more of seven basic principles: (P1) equal shares, (P2) desert, (P3) beneficiary pays, (P4) ability, (P5) self-help, (P6) limited responsibility for the worst off, and (P7) status quo preservation. It was found that all the basic principles, but P1, P3, and P7, are to some extent translatable to local climate adaptation. Two major problems hamper their usefulness on the local level: (1) several categories of agents need to take on responsibility; and (2) emissions do not work as a base for all principles. P4, P5, and P6 are applicable to local adaptation without changes. P4 is of particular importance as it seems to solve the first problem. P2 is applicable only if the second problem is solved, which can be achieved by using risk of harm instead of emissions as the basis for desert. (shrink)

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

In _Plato on Democracy and Political technē_ Anders Dahl Sørensen offers an in-depth investigation of Plato’s discussions of democracy’s ‘epistemic potential’, arguing that this question is far more central to his political thought than is usually assumed.

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

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

Probabilism is committed to two theses: 1) Opinion comes in degrees—call them degrees of belief, or credences. 2) The degrees of belief of a rational agent obey the probability calculus. Correspondingly, a natural way to argue for probabilism is: i) to give an account of what degrees of belief are, and then ii) to show that those things should be probabilities, on pain of irrationality. Most of the action in the literature concerns stage ii). Assuming that stage i) has been (...) adequately discharged, various authors move on to stage ii) with varied and ingenious arguments. But an unsatisfactory response at stage i) clearly undermines any gains that might be accrued at stage ii) as far as probabilism is concerned: if those things are not degrees of belief, then it is irrelevant to probabilism whether they should be probabilities or not. In this paper we scrutinize the state of play regarding stage i). We critically examine several of the leading accounts of degrees of belief: reducing them to corresponding betting behavior (de Finetti); measuring them by that behavior (Jeffrey); and analyzing them in terms of preferences and their role in decision-making more generally (Ramsey, Lewis, Maher). We argue that the accounts fail, and so they are unfit to subserve arguments for probabilism. We conclude more positively: ‘degree of belief’ should be taken as a primitive concept that forms the basis of our best theory of rational belief and decision: probabilism. (shrink)

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

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

What is the relation between norms (in the sense of ?socially accepted rules?) and conventions? A number of philosophers have suggested that there is some kind of conceptual or constitutive relation between them. Some hold that conventions are or entail special kinds of norms (the ?conventions-as-norms thesis?). Others hold that at least some norms are or entail special kinds of conventions (the ?norms-as-conventions thesis?). We argue that both theses are false. Norms and conventions are crucially different conceptually and functionally in (...) ways that make it the case that it is a serious mistake to try to assimilate them. They are crucially different conceptually in that whereas conventions are not normative and are behaviour dependent and desire dependent, norms are normative, behaviour independent, and desire independent. They are crucially different functionally in that whereas conventions principally serve the function of facilitating coordination, norms principally serve the function of making us accountable to one another. (shrink)

The purpose of this study was to explore the views and experiences of adult cancer patients about patient participation in care and decision making and the preconditions for this participation. The data were collected by means of focused interviews; in addition the patients completed depression and problem-solving instruments. The sample comprised 34 cancer patients from the haematological and oncological wards of one university hospital in Finland. The results revealed considerable variation in the patients’ views on their participation in care and (...) decision making. Some of the patients understood participation either in terms of contributing to the decision making or in terms of expressing their views on treatment options. Some considered that their participation in care was impossible. Patient participation in care and decision making was promoted by good health, access to information, assertiveness, good interactive relationships with nurses and physicians, and encouragement by nurses and physicians to participate. Factors restricting such patient participation were poor health, ignorance, anxiety, age, time pressures of staff, lack of time, high staff turnover and poor interactive relationships. With regard to participation in medical decision making, the patients were divided into three groups: active participants, patients giving active consent, and patients giving passive consent to medical decisions. (shrink)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of (...) Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

The aim of this study was to explore the ethical foundations for a caring conversation. The analysis is based on the ethics of Paul Ricoeur and deals with questions such as what kind of person the nurse ought to be and how she or he engages in caring conversations with suffering others. According to Ricoeur, ethics (the aim of an accomplished life) has primacy over morality (the articulation of aims in norms). At the ethical level, self-esteem and autonomy were shown (...) to be essential for a person (nurse) to act with respect and responsibility. The ethical relationship of a caring conversation was found to be asymmetrical, because of the passivity inflicted by suffering. This asymmetry was found to be potentially unethical if not balanced with reciprocity. In the ethical context, the caring conversation is one in which the nurse makes room through the ethos of caritas for a suffering person to regain his or her self-esteem, and thus makes a good life possible. (shrink)

There has been a particular emphasis on knowledge and competence as increasingly important resources for successful enterprises. This notion of knowledge is based on “positive knowledge” that knowing is merely a constructive, linear and accumulative process. We will introduce the notion of “negative knowledge” that involves “giving up” or “bracketing” knowledge in certain situations. When experts encounter something that is incompatible with their knowledge, they should be sensitive enough to recognise a new situation by suspending their action. In addition to (...) exploring the idea of “unlearning”, the paper introduces three other aspects of negative knowledge: “to know what we do not know”, “to know what not to do” and the value of failures. Negative knowledge seems to be possible, useful, and even necessary in expert organisations since old ways of thinking or knowing something often prevent us to see new potentials. (shrink)

This paper highlights a feature common to many ethical guidelines—namely, the idea that the interests of the individual shall always prevail over the interests of science and society. The paper presents how some major ethical guidelines treat the balancing of research interests against those of research subjects and spells out the difficulties in interpreting the principle of the primacy of the individual in a way that can be action-guiding. It suggests various alternative interpretations of the primacy of the individual and (...) argues that they do not hold. Finally, the implications of this analysis for ethical guidelines are discussed. (shrink)

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

Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents (ethics guidelines), overseeing bodies (research ethics committees) and formal procedures (informed consent). The process of institutionalizing distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure the trustworthiness of the research system. This article examines some limitations of this approach. (...) First, past atrocities cannot provide the necessary justification unless institutionalized distrust is a necessary or efficient means to prevent future ones – and there are several reasons to doubt this. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers – the very qualities that institutionalized distrust calls into question. Third, ethics guidelines cannot, as is sometimes assumed, educate or guide researchers in moral behaviour unless they already possess considerable capacity for moral judgment. Fourth, institutionalized distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences if their moral competence is allowed to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and are not obstructed from so doing. (shrink)

People often justify their moral opinions by referring to larger moral concerns. Is there a general agreement about what concerns apply to different moral opinions? We used surveys in the United States and the United Kingdom to measure the perceived applicability of eight concerns to a wide range of moral opinions. Within countries, argument applicability scores were largely similar whether they were calculated among women or men, among young or old, among liberals or conservatives, or among people with or without (...) higher education. Thus, the applicability of a given moral concern to a specific opinion can be viewed as an objective quality of the opinion, largely independent of the population in which it is measured. Finally, we used similar surveys in Israel and Brazil to establish that this independence of populations also extended to populations in different countries. However, the extent to which this holds across cultures beyond those included in the current study is still an open question. (shrink)

Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients’ decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism (...) for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating. (shrink)