This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Based on an empirical study regarding ethical challenges within intercultural health care, the focus of this article is upon autonomy and disclosure, discussed in light of philosophy and anthropology. What are the consequences for patients if the patients’ right to be autonomous and to participate in treatment and care decisions by health care workers is interpreted as an obligation to participate? To force a person to make independent choices who is socio-culturally unprepared to do so, may violate his/her integrity. This (...) may in turn jeopardise the respect, integrity and human worth the principle of autonomy was meant to ensure, and if so, may damage any relationship of trust that may exist between patient and health care worker. There is necessarily a link between autonomy and disclosure. Western disclosure practices may make the relationship between patients and health care workers difficult -- even distrustful. To confront a patient with a very serious diagnosis may be seen not only as a tactless action, but also an unforgivable one. Hence, among many ethnic groups it is a family member’s duty to shield patients from bad or disquieting news, e.g., a cancer diagnosis. If a family member is used to interpret in such situations, will the information given equal the information communicated by that interpreter? Even though respect for a person’s autonomy is part of the respect for a person, one’s respect for the person in question should not depend on his/her ability or aptitude to act autonomously. (shrink)

BackgroundNon-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate.AimTo learn what ethical issues operating room nurses perceive as important regarding non-technical skills.Research designQualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis.Participants and research contextEleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian (...) university hospital.Ethical considerationsApproval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer.FindingsThree main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety.DiscussionDefending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner.ConclusionBeing respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team. (shrink)

Background: In the neonatal intensive care unit, immigrant parents may experience even greater anxiety than other parents, particularly if they and the nurses do not share a common language. Aim: To explore the complex issues of trust and the nurse–mother relationship in neonatal intensive care units when they do not share a common language. Design and methods: This study has a qualitative design. Individual semi-structured in-depth interviews and two focus group interviews were conducted with eight immigrant mothers and eight neonatal (...) intensive care unit nurses, respectively. Data analysis was based on Braun and Clarke’s thematic analytic method. Ethical considerations: Approval was obtained from the hospital’s Scientific Committee and the Data Protection Officer. Interviewees were informed in their native language about confidentiality and they signed an informed consent form. Results: Trust was a focus for mothers and nurses alike. The mothers held that they were satisfied that their infants received the very best care. They seemed to find the nurses’ care and compassion unexpected and said they felt empowered by learning how to care for their infant. The nurses discussed the mother’s vulnerability, dependency on their actions, attitudes and behaviour. Discussion: Lack of a common language created a challenge. Both parties depended on non-verbal communication and eye contact. The nurses found that being compassionate, competent and knowledgeable were important trust-building factors. The mothers were relieved to find that they were welcome, could feel safe and their infants were well cared for. Conclusion: The parents of an infant admitted to the neonatal intensive care unit have no choice but to trust the treatment and care their infant receives. Maternal vulnerability challenges the nurse’s awareness of the asymmetric distribution of power and ability to establish a trusting relationship with the mother. This is particularly important when mother and nurse do not share a verbal language. The nurses worked purposefully to gain trust. (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual in-depth interviews (...) with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

Two areas of ethical conflict in intercultural nursing — who needs single rooms more, and how far should nurses go to comply with ethnic minority patients’ wishes? — are discussed from a utilitarian and common-sense morality point of view. These theories may mirror nurses’ way of thinking better than principled ethics, and both philosophies play a significant role in shaping nurses’ decision making. Questions concerning room allocation, noisy behaviour, and demands that nurses are unprepared or unequipped for may be hard (...) to cope with owing to physical restrictions and other patients’ needs. Unsolvable problems may cause stress and a bad conscience as no solution is ‘right’ for all the patients concerned. Nurses experience a moral state of disequilibrium, which occurs when they feel responsible for the outcomes of their actions in situations that have no clear-cut solution. (shrink)

Concerns have been voiced about the ethical implications of patenting practices in the field of biotechnology. Some of these have also been incorporated into regulation, such as the European Commission Directive 98/44 on the legal protection of biotechnological inventions. However, the incorporation of ethically based restrictions into patent legislation has not had the effect of satisfying all concerns. In this article, we will systematically compare the richness of ethical concerns surrounding biotech patenting, with the limited scope of ethical concerns actually (...) addressed in the patent system. As sources of our analyses we will use literature and document studies and a survey with important stakeholders and experts related to Norwegian patenting in the aquacultural biotechnology sector. We will structure the analyses with an ethical matrix, developed for this purpose. Showing the misalignment of the discussions within and outside the patent system, we suggest that an important reason for the ethical controversy still surrounding patenting is that ethical questions keep being framed in a narrow way within the system. Until a richer set of ethical considerations is addressed head-on within the patent system, the patent system will continue to evoke academic and interest group criticism, potentially contributing to a legitimacy crisis of the whole system. (shrink)

Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make (...) oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience. (shrink)

BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility (...) of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played (...) the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be. (shrink)

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

En quoi le corps participe-t-il de l'entente que l'homme a du monde? Que signifie dès lors écouter? Comment établir un rapport juste à l'animal? Quel sens prêter aux couleurs? Pourquoi la tonalité décisive de notre rapport au monde peut-elle advenir à la faveur d'expériences olfactives et gustatives? En quoi la tactilité incite-t-elle à considérer le corps vif comme une donnée originaire et à reconnaître qu'il est bien une vulnérabilité dotée d'aptitudes qui nous dispose au monde? Comment l'angoisse, révélée et cachée (...) tout à la fois par la maladie, est-elle chevillée au corps de l'être-au-monde, le Dasein? Qu'en est-il du corps dans la nostalgie, dans la mélancolie, dans l'ennui et dans la joie? Pourquoi la coexistence, supposant relations et rencontres, implique-t-elle l'articulation des corporéités vives comme dans le tact sensitif ou dans la jalousie amoureuse et dans l'amour pensé en terme de tonalité érotique? Comment comprendre la mobilité et parvenir ainsi jusqu'à l'éminente dignité ontologique du mouvement? De quoi la pensée est-elle redevable au corps? Telles sont les questions qui jalonnent cet ouvrage. Par son orientation résolument phénoménologique, l'Intelligence du corps entend renouveler l'entente du phénomène le plus proprement humain et, cependant, le plus malmené par la métaphysique. Prenant librement appui sur les vues inouïes de Martin Heidegger, consciente de l'actuelle soumission du corps de l'homme à l'arraisonnement technique, Ingrid Auriol ouvre une voie d'accès à l'intelligence du corps libérée de cette violence. (shrink)

The Proceedings present the contributions to the 13th International Kant Congress which was held at the University of Oslo, August 6-9, 2019. The congress, which hosted speakers from more than thirty countries and five continents, was dedicated to the topic of the court of reason. The idea that reason stands before itself as a tribunal characterizes the whole of Kant's critical project. Without such a court, reason falls into conflict with itself. With such a court in place, however, it may (...) succeed in establishing the possibility and limits of metaphysics, ethics, aesthetics, law and science. The idea of reason being its own judge is not only pivotal to a proper understanding of Kant's philosophy, but can also shed light on the burgeoning fields of meta-philosophy and philosophical methodology. The 2019 Kant Congress put special emphasis on Kant's methodology, his account of conceptual critique, and the relevance of his ideas to current issues in especially political philosophy and the philosophy of law. Additional sections discussed a wide range of topics in Kant's philosophy. The Proceedings will provide anyone who is interested in exploring the variety of present-day work on Kant and Kantian themes with a wealth of fruitful inspiration. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)

The main purpose of this dissertation is to examine critically and discuss the role of imagination in science and religion, with particular emphasis on its possible epistemic, creative, and meaning-making functions. In order to answer my research questions, I apply theories and concepts from contemporary philosophy of mind on scientific and religious practices. This framework allows me to explore the mental state of imagination, not as an isolated phenomenon but, rather, as one of many mental states that co-exist and interplay (...) in our cogntive architecture. Based on the philosophical discourse of philosophy of mind, four types of imagination are indentified and conceptualized: sensory, propositional, experiential, and creative imagination. These categories are then employed on five phenomena that can be found in scientific and religious environments: metaphors, models, thought experiments, aspect perception, and - in the religious case - rituals. In relation to the concept of religious "seeing" I consider how imaginings may influence visionary experiences and visualization, and compare these phenomena with cases of scientific visualization and eureka experiences. In regard to scientific and religious models, a distinction is made between, on the one hand, two notions of truth and, on the other hand, truth-independent meaning-making. In light of these categories, I differentiate between, and critically discuss, the use of imagination in doxastic, non-doxastic and fictionalist accounts. In light of this investigation, I formulate and defend the position of interactivism, which acknowledges a constant interplay between different attitudes and mental states. In my examination of rituals and scientific and religious thought experiments, special attention is given to the mental capacity to recreate the experiences that are entailed in an imagined scenario. At the end of the investigation, I consider the possible impact that my study might have on how we view science and religion as well as the dialogue bewteen these two fields. (shrink)

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

A IDENTIFICAÇÃO DO DIREITO AMBIENTAL MARÍTIMO.

A IMPORTÂNCIA DE TRATAMENTO DE ÁGUAS RESIDUAIS ATRAVÉS DA BIORREMEDIAÇÃO: UMA ANÁLISE PRINCIPIOLÓGICA.

We answer a question of Ambos-Spies and Kuˇcera in the affirmative. They asked whether, when a real is low for Schnorr randomness, it is already low for Schnorr tests.

Against the background of high demand for protein-rich feed in the EU and the environmental degradation associated with intensive livestock farming, insect-based feed is discussed as a potential sustainable alternative to conventional feed. However, the establishment of such an innovation depends not only upon technical and economic feasibility, but also on social factors impacting acceptability. The aim of this paper was to determine the acceptability of different social actor groups towards the use of insects as livestock feed, and to gain (...) insights into value-based arguments leading to positive or negative attitudes and perceived benefits and risks. By means of qualitative content analysis, we analysed responses of an EU public consultation process linked to the authorization of insect protein in pig and poultry feed. We found a broad range of value-based arguments that influence the complex judgement process of acceptability that have been neglected in prior quantitative surveys. In particular, our results bring forward more critical voices, such as animal welfare concerns and scepticism that insect-based feed can contribute to a more sustainable livestock system. Based on these findings, we discuss whether insects as feed are a viable contribution to a sustainability-oriented transformation of the agri-food system. We conclude that under certain conditions (when raised on low-value organic side streams such as manure) insect-based livestock feed may contribute to incremental sustainability improvements. Overall, however, the innovation has limitations, not only in terms of regulatory conditions but especially with regard to ethical concerns. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

Journal of Economic Methodology, Volume 19, Issue 2, Page 159-163, June 2012.

Throughout the ages, the mystery of what happens when we die and the nature of the human mind has fascinated humankind. In this collection of essays, leading scientists and authors contemplate the nature of consciousness, quantum mechanics, string theory, dimensions, space and time, non-local space, the hologram, and the effect of death on the consciousness"--Provided by publisher.

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

My dissertation, “Love, Self-Constitution, and Practical Necessity,” offers an interpretation of love between people. Love is puzzling because it appears to involve essentially both rational and non-rational phenomena. We are accountable to those we love, so love seems to participate in forms of necessity, commitment, and expectation, which are associated with morality. But non-rational attitudes—forms of desire, attraction, and feeling—are also central to love. Consequently, love is not obviously based in rationality or inclination. In contrast to views that attempt to (...) fit love into existing models of practical reasoning, I argue that love participates in a unique form of practical necessity, different from both moral and psychological necessity, yet bearing resemblances to each. Distinctive to this type of practical necessity is a direct appeal to another particular person that cannot be delivered in third-personal terms—that is, a non-moral yet normative type of expectation on another person. This type of expectation is predominant in loving relationships, but can also make better sense of the experiences of humor and beauty, as well as attitudes like forgiveness, gratitude, and agent-regret. I treat Immanuel Kant’s discussion of the experience of beauty in the Critique of Judgment and Christine Korsgaard’s work on self-constitution as fruitful starting points for this account of love. I conclude that our loving relationships enable us to have distinctive personal selves, and provide support for this account of love by offering a complementary theory of grief. In Part One of the dissertation, I focus on two prominent approaches to love characteristic of the sentimentalist and rationalist traditions. I begin with the work of David Hume, which treats desire (understood as something like a simple impulse or craving) as the paradigmatic mental state, and emphasizes our personal and affective dimensions. Hume has the valuable insight that loving someone affects our sense of ourselves. But Hume’s view becomes unsatisfying when he claims that love is essentially enfeebling, implying that to love is to be passive toward and readily overcome by another person. While this indicates Hume’s awareness that love involves being open and receptive to another person, the problem is that love is also a demanding attitude. Hume lacks the conceptual resources to offer a nuanced view of the self, in which we can—with one attitude—be both demanding of and vulnerable to another person. Hume’s model of a desire-based deliberative process has recently been revived in Harry Frankfurt’s discussions on love and rationality. Frankfurt, however, goes beyond Hume’s picture of the self by introducing a notion of “identification,” which he offers to make sense of our apparent ability to commit ourselves decisively to certain projects or people. I argue that active powers like identification and commitment cannot be accommodated within any basically Humean moral psychology. Such abilities, and with them the possibility of love, depend on something closer to a Kantian conception of rational agency. I next focus on the work of Kant, who provides the substantial counterpart to Humean-inspired moral theories, but is not known for his insight into our emotional lives. In the Metaphysics of Morals, Kant divides love into “practical love”—what we experience when we are morally motivated to help someone—and “pathological love”—what we experience when we feel fond of something. But in reality, we experience love neither as a mere preference for another person, nor as something that generates the kind of demands that would be binding on any rational creature. David Velleman attempts to remedy the deficiency of Kant’s dichotomy. Velleman offers a Kantian theory in which he describes love and respect as two ends of a continuum of attitudes that it is morally appropriate to have toward people. Velleman’s view has the peculiar implication that everyone deserves the love of everyone else, and I argue that this is a fatal flaw. Like Kant and Velleman, Korsgaard characterizes personal love as involving the treatment of other people as Kantian ends-in-themselves to a heightened degree. Korsgaard, though, also contends that our individual identities depend upon our personal relationships, and I take this position seriously for the remainder of the dissertation. Ultimately, however, characterizations of loving relations as subsets of moral relations can account for the authority of the demands of love, but not its particularity. The major conclusion of Part One is that any attempt to understand love primarily on a model of practical reasoning with which we are already familiar is doomed to fail. Our experience of love calls for a theory of a unique type of practical necessity. In Part Two I take seriously the possibility that love is simultaneously inescapable (in something like the way morality is supposed to be), and yet ineluctably personal. In love, we experience an engagement with a person as essentially particular, rather than as an instance of a rational agent in general. To make sense of this direct attachment to an individual, I argue that love involves distinctive forms of expectation and disappointment. When those we love let us down, they hurt our feelings, which is not a response to a failed prediction, but nor is it a reaction to a moral insult or offense. According to Peter Strawson and Stephen Darwall, second-personal moral reactive attitudes (such as resentment) always have third-personal analogues (such as indignation). In contrast, I argue that the type of hurt feelings associated with love is a second-personal reactive attitude that does not have a third-personal corollary. I take this as evidence that the expectations involved in love are not objective in the way that the moral is objective. Nor, however, is love a matter of mere preference. On my interpretation, Kant introduces this different type of expectation in the Critique of Judgment. Whereas he characterizes moral judgments as universally communicable, judgments of beauty implicitly involve only second-personal address: I appeal to your direct experience with a particular object. This provides the conceptual space for an account of love according to which it involves a uniquely second-personal form of practical necessity. I contend that the second-personal addresses we make in love are appeals to strengthen the intimacy implicit in the loving relationship, and I identify three interrelated dimensions of that intimacy. First, those we love have the standing to interpret us in a constitutive manner. We fine-tune and make determinate the character of our concerns and interests in part by accepting the interpretations provided by those we love. In that way, the people we love have the normative power to constitute who we are. Second, we share a perspective with those we love in a way that is not reducible to or derivative of our independent perspectives. Loving someone centrally involves the activity of forming concerns together, and we do this in a mode best understood on the model of playing a spontaneous game or improvising music. Finally, being loved enables us to see ourselves as distinctive and special, because the concern those who love us have for us does not track the objective merit of our characteristics. These dimensions of the intimacy that characterizes a loving relationship reveal what it is that we appeal for in love, and how we are hurt when our appeals are rebuffed. In broad terms, this dissertation advocates the recognition of a non-moral yet normative type of expectation, which is predominant in loving relationships. Humor and beauty, too, make more sense when understood in terms of this non-moral yet normative type of expectation, as they involve appeals to others that are more than mere predictions of, but less than rational demands for, a certain kind of response. Introducing this alternative notion of expectation into the discourse of moral philosophy can shed light on other common attitudes that are clearly normative, but defy translation into objective, third-personal terms. Such attitudes include certain experiences of pride and shame, apology and forgiveness, the bestowing of mercy, gratitude, agent-regret, and perhaps a basic sense of trust we have in others. Ultimately, I situate love in respect to grief, which demonstrates my theory’s ability to make sense of related dimensions of our emotional lives. The people we love and grieve over give us a sense of who we are as distinctive, particular individuals, as the three interrelated dimensions of intimacy in loving relationships reveal. Consequently, grief is best understood as a type of practical disorientation—namely, a disorientation that involves the loss of the personal self. I present my account of grief against the type of account that would draw philosophical conclusions about the nature of love and grief from empirical psychological data alone. In particular, these data indicate that we recover quickly from the deaths of loved ones, and Dan Moller draws the philosophical conclusion that those we love fulfill certain roles in our lives and are replaceable. In contrast, I contend that while we should acknowledge the truth of the objective judgment, made in the third-person, that we will likely recover after the deaths of those we love, it does not follow that we must affirm such a claim from the internal perspective of one person who loves another. As a result, the case of love and grief supports a general claim concerning the proper work of moral philosophy, which is that the understanding of ourselves gained through empirical data is not a substitute for the normative conclusions that are revealed through first-personal reflections on our relationships. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

For many, the Holocaust made thinking about ethics in traditional ways impossible. It called into question the predominance of speculative ontology in Western thought, and left many arguing that Western political, cultural and philosophical inattention to universal ethics were both a cause and an effect of European civilization's collapse in the twentieth century. Emmanuel Levinas, Elie Wiesel and Richard Rubenstein respond to this problem by insisting that ethics must be Western thought's first concern. Unlike previous thinkers, they locate humanity's source (...) of universal ethical obligation in the temporal world of experience, where human suffering, rather than metaphysics, provides the ground for ethical engagement. All three thinkers contend that Judaism’s key lesson is that our fellow human is our responsibility, and use Judaism to develop a contemporary ethics that could operate with or without God. _Ethics and Suffering since the Holocaust_ explores selected works of Levinas, Wiesel, and Rubenstein for practical applications of their ethics, analyzing the role of suffering and examining the use each thinker makes of Jewish sources and the advantages and disadvantages of this use. Finally, it suggests how the work of Jewish thinkers living in the wake of the Holocaust can be of unique value to those interested in the problem of ethics in the twentieth and twenty-first centuries. Presenting a thorough investigation of the work of Levinas, Wiesel and Rubinstein, this book is of key interest to students and scholars of Jewish studies, as well as Jewish ethics and philosophy. (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

Social enterprises are seen as innovative towards solving societal problems, but little research exists on possible negative aspects, the so‐called dark sides. In this study, the emphasis is on dark sides of social entrepreneurship, how they are managed, and how systems thinking can contribute towards managing these effects. Dark sides of social entrepreneurship can take many forms, like unethical or insincere motives and unintended outcomes like the negative impact on the well‐being of founders and employees, but they are also a (...) call for a critical reflection on the role of the government in society and the economic system social enterprises have to operate in. This paper aims to contribute to the dark side theory of social entrepreneurship by linking system archetypes to themes of dark side thereby stressing how management strategies act as balancing feedback loops to mitigate or prevent dark sides. A qualitative research was conducted by interviewing 21 respondents who play an important role in the world of social entrepreneurship in Belgium. The results show that dark sides of social enterprises manifest itself mostly in the form of trade‐offs and financial, business, and management related issues. Taking over the habits of profit‐oriented companies emerged as a new dark side element. Management strategies include anchoring goals, transparency, obtaining external views, changing the system, and above all reflection. The latter is an important first step to become aware of these issues to be able to change the negative dynamism of these dark sides. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.