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

The normative significance of proximity in ethics is considered, giving an overview of the contemporary debates about proximity in ethics and focusing on three main perspectives that take proximity to have normative significance. The first perspective is represented by meta-ethical positions, where a basic moral claim is said to originate from an irreducible, particular and unique otherness that shows up in human vulnerability. The second perspective presents a psychologically and philosophically based analysis of human emotions, which is taken to form (...) a basis for rudimentary moral sensitivity and care. The third version of an ethics of proximity claims that personal relationships and partiality overrride impartialist and universalist ethical considerations. On the basis of this analysis, the sources of normativity and the essence of proximity as a normative consideration are elaborated. Finally, the relevance of an ethics of proximity to professional ethics in healthcare is discussed. From an ethics of proximity, it might be argued that institutions must attempt to organise medical care and nursing care so that a certain partiality and patient-centred care might be favoured and trump distributivist considerations of justice in healthcare. (shrink)

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

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

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing (...) debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals. (shrink)

This article addresses some ambiguities and normative problems with the concept of mature care in professional relationships and in health care priorities. Mature care has recently been introduced in the literature on care ethics as an alternative to prevailing altruistic conceptions of care. The essence of mature care is an emphasis on reciprocity, where the mature agent has the ability to balance the concerns of self with those of others and act from a principle of not causing harm. Our basic (...) claim is that the prevailing concept of mature care does not capture the real nature of professional relationships and role obligations in health care. As the focus of attention in professional care is and must be the patient’s particular medical and care needs, such care must principally be altruistic. Furthermore, we argue that mature care cannot adequately address moral conflict in health care without accepting some more principle-based approaches and a richer notion of partiality. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

A long-standing theme in discussion of perception and thought has been that our primary cognitive contact with individual objects and events in the world derives from our perceptual contact with them. When I look at a duck in front of me, I am not merely presented with the fact that there is at least one duck in the area, rather I seem to be presented withthisthing (as one might put it from my perspective) in front of me, which looks to (...) me to be a duck. Furthermore, such a perception would seem to put me in a position not merely to make the existential judgment that there is some duck or other present, but rather to make a singular, demonstrative judgment, that that is a duck. My grounds for an existential judgment in this case derives from my apprehension of the demonstrative thought and not vice versa. (shrink)

This book defends antitheodicism, arguing that theodicies, seeking to excuse God for evil and suffering in the world, fail to ethically acknowledge the victims of suffering. The authors argue for this view using literary and philosophical resources, commencing with Immanuel Kant's 1791 "Theodicy Essay" and its reading of the Book of Job. Three important twentieth century antitheodicist positions are explored, including "Jewish" post-Holocaust ethical antitheodicism, Wittgensteinian antitheodicism exemplified by D.Z. Phillips and pragmatist antitheodicism defended by William James. The authors argue (...) that these approaches to evil and suffering are fundamentally Kantian. Literary works such as Franz Kafka'sThe Trial, Samuel Beckett's Waiting for Godot, and George Orwell's Nineteen Eighty-Four, are examined in order to crucially advance the philosophical case for antitheodicism. (shrink)

This paper aims at addressing some questions considering the conflicting normative claims of partiality, i.e. to provide for the caring needs of the particular patient, and impartial claims of treating all patients with a relevant need equally. This ethical conflict between different conceptions of moral responsibilities within professional ethics relates to debates between an ethics of care and an ethics of justice. An ethics of care is a particularistic position that endorses some form of partiality, i.e. favouring persons to whom (...) one stands in particular relationships. This paper argues that also a professional ethics must endorse some kind of partiality at the clinical level of health care. In fact, consideration of care for particular patients is a prerequisite for giving proper and attentive care towards the individual patient. This paper will discuss how partial concerns might be balanced against claims of distributive justice within the frame of the formal principle of justice. It is concluded that there is an urgent need for the recognition of the consequences of macro-level decisions for the possibility of the discharge of moral responsibility on a clinical level of health care. This would mean that health care institutions should adapt for the possibility of a basic standard of proper care and attention for the individual patient. (shrink)

In his last book, David Armstrong sets out his metaphysical system in a set of concise and lively chapters each dealing with one aspect of the world. He begins with the assumption that all that exists is the physical world of space-time. On this foundation he constructs a coherent metaphysical scheme that gives plausible answers to many of the great problems of metaphysics. He gives accounts of properties, relations, and particulars; laws of nature; modality; abstract objects such as numbers; and (...) time and mind. (shrink)

Is consciousness a purely physical phenomenon? Most contemporary philosophers and theorists hold that it is, and take this to be supported by modern science. But a significant minority endorse non-physicalist theories such as dualism, idealism and panpsychism, among other reasons because it may seem impossible to fully explain consciousness, or capture what it's like to be in conscious states (such as seeing red, or being in pain), in physical terms. This Element will introduce the main non-physicalist theories of consciousness and (...) explain the most important arguments for them, and consider how they each respond to the scientific and other arguments in support of physicalism. This title is also available as Open Access on Cambridge Core. (shrink)

Western democracy is now at a critical juncture. Some worry that power has been wrested from the people and placed in the hands of a small political elite. Others argue that the democratic system gives too much power to a populace that is largely ill-informed and easily swayed by demagogues. This classic study of democratic principles is thus now more relevant than ever. A renowned historian of antiquity and political philosophy, Sir M.I. Finley offers a comparative analysis of Greek and (...) modern conceptions of democracy. As he puts the ancient Greeks in dialogue with their contemporary counterparts, Finley tackles some of the most pressing issues of our day, including public apathy, partisanship, consensus politics, distrust of professional politicians, and the limits of free speech. Including three lectures that Finley delivered at Rutgers University, plus two additional essays that further illuminate his thinking, _Democracy Ancient and Modern _explores the dramatic differences between the close-knit civil society of the ancient Greeks and our own atomized mass societies. By mapping out democracy’s past and its present manifestations, this book helps us plot a course for democracy’s future. (shrink)

This book presents a collection of essays on institutional theory written by the German sociologist and Weber-expert M. Rainer Lepsius. Based on Weber's work, the author develops concepts of institutional theory, which he subsequently applies to topics such as National Socialism, democratization processes, German unification, and the institutionalization of the European Union. By showing how charismatic leadership can under certain circumstances threaten democratic structures and curtail individual freedoms, and by analyzing the structural and cultural conditions under which people develop trust (...) in political and social structures and ultimately come to support and comply with them, the author provides a sound analytical understanding of the development of democratic institutions and a democratic political culture. This collection of essays was edited, translated and commented on by Claus Wendt. (shrink)

The Ismaili Imam and Imamat -- Ethical foundations -- Tradition and modernity -- The ethos of modernism -- Pluralism and cosmopolitan ethics -- Cohesion within the Umma -- Islam and the West -- Cultivating and enabling environment -- Living the ethics of Islam -- Global convergence.

The socialist construction in Vietnam, aspect of human role.

The given is the state of a mind in its primary engagement with the world. A satisfactory epistemology—one, it turns out, that is foundationalist and includes a naïve realist view of perception—requires a certain account of the given. Moreover, knowledge based on the given requires both a particular view of the world itself and a heterodox account of judgment. These admittedly controversial claims are supported by basic ontological considerations. I begin, then, with two contradictory views of the world per se (...) and the structure one experiences. I draw out the consequences of these two views for what intentionality is. The two views yield incompatible accounts of the given. The definitive spontaneity of the one account, and passivity of the other, can be understood in terms of the structure (or lack thereof) in the given. In defense of the claim that a structured given is not an apt epistemic basis, I examine an attempt to found an epistemology on such an account in light of the so-called myth of the given. I maintain that the given, if it is to provide some justification for taking the world to be a particular way, must be unstructured. To support this, I first discuss a significant problem with traditional foundationalism. I then argue that a satisfactory (foundationalist) epistemology requires the rejection of the orthodox propositional view of judgment in favor of a non-propositional, reistic view. (shrink)

Eliminative materialism is the thesis that our common-sense conception of psychological phenomena constitutes a radically false theory, a theory so fundamentally defective that both the principles and the ontology of that theory will eventually be displaced, rather than smoothly reduced, by completed neuroscience. Our mutual understanding and even our introspection may then be reconstituted within the conceptual framework of completed neuroscience, a theory we may expect to be more powerful by far than the common-sense psychology it displaces, and more substantially (...) integrated within physical science generally. My purpose in this paper is to explore these projections, especially as they bear on (1) the principal elements of common-sense psychology: the propositional attitudes (beliefs, desires, etc.), and (2) the conception of rationality in which these elements figure. (shrink)

A selection of important writings which together suggest that legal philosophy is the nerve of legal reasoning.

On Avicenna, 980-1037, a Muslim philosopher.

Philosophical Thought in Russia in the Second Half of the 20th Century is the first book of its kind that offers a systematic overview of an often misrepresented period in Russia's philosophy. Focusing on philosophical ideas produced during the late 1950s – early 1990s, it reconstructs the development of genuine philosophical thought in the Soviet period and introduces those non-dogmatic Russian thinkers who saw in philosophy a means of reforming social and intellectual life. Covering such areas of philosophical inquiry as (...) philosophy of science, philosophical anthropology, the history of philosophy, activity approach as well as communication and dialogue studies, the volume presents and thoroughly discusses central topics and concepts developed by Soviet thinkers in that particular fields. Written by a team of internationally recognized scholars from Russia and abroad, it examines the work of well-known Soviet philosophers (such as Mikhail Bakhtin, Evald Ilyenkov and Merab Mamardashvili) as well as those important figures (such as Vladimir Bibler, Alexander Zinoviev, Yury Lotman, Georgy Shchedrovitsky, Genrich Batishchev, Sergey Rubinstein, and others) who have often been overlooked. By introducing and examining original philosophical ideas that evolved in the Soviet period, the book confirms that not all Soviet philosophy was dogmatic and tied to orthodox Marxism and the ideology of Marxism-Leninism. It shows Russian philosophical development of the Soviet period in a new light, as a philosophy defined by a genuine discourse of exploration and intellectual progress, rather than stagnation and dogmatism. In addition to providing the historical and cultural background that explains the development of the 20th-century Russian philosophy, the book also puts the discussed ideas and theories in the context of contemporary philosophical discussions showing their relevance to nowadays debates in Western philosophy. With short biographies of key thinkers, an extensive current bibliography and a detailed chronology of Soviet philosophy, this research resource provides a new understanding of the Soviet period and its intellectual legacy 100 years after the Russian Revolution. (shrink)

Thomas Aquinas's Disputed Questions on Evil is a careful and detailed analysis of the general topic of evil, including discussions on evil as privation, human free choice, the cause of moral evil, moral failure, and the so-called seven deadly sins. This collection of ten, specially commissioned new essays, the first book-length English-language study of Disputed Questions on Evil, examines the most interesting and philosophically relevant aspects of Aquinas's work, highlighting what is distinctive about it and situating it in relation not (...) only to Aquinas's other works but also to contemporary philosophical debates in metaphysics, ethics, and philosophy of action. The essays also explore the history of the work's interpretation. The volume will be of interest to researchers in a broad range of philosophical disciplines including medieval philosophy and history of philosophy, as well as to theologians. (shrink)

This book provides a clear and nuanced appraisal of Hegel's treatment of Africa, India, and Islam, and of the implications of this treatment for postcolonial and global studies. Analyzing Hegel's master-slave dialectic and his views on Africa, India, and Islam, it situates these views not only within Hegel's historical scheme but also within a broader European philosophical context and the debates they have provoked within Hegel scholarship. Each chapter explores various in depth readings of Hegel by postcolonial critics, investigating both (...) the Eurocentric and potentially global nature of his dialectic. Ultimately, the book shows both where of this profoundly influential thinker archetypally embodies certain Eurocentric traits that have characterized modernity and how, ironically, he himself gives us the tools for working towards a more global vision. Offering a concise introduction not only to an important dimension of Hegel's thought - his orientation towards "empire" - but also to the various issues raised by postcolonial theory and global studies, this book will be of use to philosophers as well as advanced students of literary and cultural theory alike. (shrink)

In this article I examine the perceptual metaphor at the heart of perspectivism, discussing three elements: partiality, interestedness, and interaction. I argue that perspectivists should drop the visual metaphor in favor of a haptic one. Because the sense of touch requires contact and purposeful exploration on the part of the perceiver, it is obvious that with touch one apprehends an extradermal reality in virtue of and not in spite of its interactive and interested nature. By analogy, perspectivists should investigate the (...) thesis that scientific representations inform us about the natural world in virtue of their interactive and interested qualities. (shrink)