This article investigates the hitherto under-examined relations between affirmative action, paternalism and respect. We provide three main arguments. First, we argue that affirmative action initiatives are typically paternalistic and thus disrespectful towards those intended beneficiaries who oppose the initiatives in question. Second, we argue that not introducing affirmative action can also be disrespectful towards these potential beneficiaries because such inaction involves a failure to adequately recognize their moral worth. Third, we argue that the paternalistic disrespect involved in affirmative action is (...) alleviated when the potential beneficiaries’ preferences against such initiatives are adaptive. We conclude that although there is a relevant sense in which paternalistic affirmative action is disrespectful, it may well be more disrespectful not to pursue such policies. (shrink)

Dilation occurs when an interval probability estimate of some event E is properly included in the interval probability estimate of E conditional on every event F of some partition, which means that one’s initial estimate of E becomes less precise no matter how an experiment turns out. Critics maintain that dilation is a pathological feature of imprecise probability models, while others have thought the problem is with Bayesian updating. However, two points are often overlooked: (1) knowing that E is stochastically (...) independent of F (for all F in a partition of the underlying state space) is sufficient to avoid dilation, but (2) stochastic independence is not the only independence concept at play within imprecise probability models. In this paper we give a simple characterization of dilation formulated in terms of deviation from stochastic independence, propose a measure of dilation, and distinguish between proper and improper dilation. Through this we revisit the most sensational examples of dilation, which play up independence between dilator and dilatee, and find the sensationalism undermined by either fallacious reasoning with imprecise probabilities or improperly constructed imprecise probability models. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The (...) aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

We propose a ‘Moral Imagination’ methodology to facilitate a culture of responsible innovation for engineering and product teams in technology companies. Our approach has been operationalized over the past two years at Google, where we have conducted over 50 workshops with teams from across the organization. We argue that our approach is a crucial complement to existing formal and informal initiatives for fostering a culture of ethical awareness, deliberation, and decision-making in technology design such as company principles, ethics and privacy (...) review procedures, and compliance controls. We characterize some distinctive benefits of our methodology for the technology sector in particular. (shrink)

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.

We review the "Entitlement" projects of Tyler Burge and Crispin Wright in light of recent work from and surrounding both philosophers. Our review dispels three misunderstandings. First, Burge and Wright are not involved in a common “entitlement” project. Second, though for both Wright and Burge entitlement is the new notion, “entitlement” is not some altogether third topic not clearly connected to the nature of knowledge or the encounter with skepticism. Third, entitlement vs. justification does not align with the externalism vs. (...) internalism distinction. (shrink)

The relative merits and demerits of historically prominent views such as the correspondence theory, coherentism, pragmatism, verificationism, and instrumentalism have been subject to much attention in the truth literature and have fueled the long-lived debate over which of these views is the most plausible one. While diverging in their specific philosophical commitments, adherents of these historically prominent views agree in at least one fundamental respect. They are all alethic monists. They all endorse the thesis that there is only one property (...) in virtue of which propositions can be true, and so, in this sense, take truth to be one. The truth pluralist, on the other hand, rejects this idea. There are several properties in virtue of which propositions can be true. The literature on truth pluralism has been growing steadily for the past twenty years. This volume, however, is the first of its kind—the first collection of papers focused specifically on pluralism about truth. Part I is dedicated to the development, investigation, and critical discussion of different forms of pluralism. An additional reason to look at truth pluralism with interest is the significant connections it bears to other debates in the truth literature—the debates concerning traditional theories of truth and the deflationism/inflationism divide being cases in hand. Parts II and III of the volume connect truth pluralism to these two debates. (shrink)

This is the introduction to Moretti, Luca and Nikolaj Pedersen (eds), Non-Evidentialist Epistemology. Brill. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti.

The first clinical ethics committees in Norway were established in 1996. This started as an initiative from hospital clinicians, the Norwegian Medical Association, and health authorities and politicians. Norwegian hospitals are, by and large, publicly funded through taxation, and all inpatient treatment is free of charge. Today, all the 23 hospital trusts have established at least one committee. Center for Medical Ethics , University of Oslo, receives an annual amount of US$335,000 from the Ministry of Health and Care Services to (...) coordinate the committees and to facilitate competency building for committee members. (shrink)

The aim of this paper is to provide an overview of various forms of alethic pluralism. Along the way we will draw a number of distinctions that, hopefully, will be useful in mapping the pluralist landscape. Finally, we will argue that a commitment to alethic disjunctivism, a certain brand of pluralism, might be difficult to avoid for adherents of the other pluralist views to be discussed. We will proceed as follows: Section 1 introduces alethic monism and alethic pluralism. Section 2 (...) presents a distinction between strong and moderate versions of monism and pluralism, understood as theses about the existence of truth properties. Section 3 introduces four pluralist positions: strong alethic pluralism, alethic disjunctivism, second-order functionalism and manifestation functionalism. These positions are classified using the basic framework from Section 2, and a further distinction between pure and mixed versions of pluralism is drawn. Interestingly, alethic disjunctivism and the two kinds of functionalism—i.e. three out of four positions— have a mixed character. They incorporate a monist thesis. The only pure form of pluralism is strong alethic pluralism. Section 4 adds another distinction to the stock: one-level and two-level views. Each of the mixed positions operates with two levels, locating certain “alethically potent”—or grounding—properties at a lower level and others at a higher level. We briefly discuss the nature of grounding. In Section 5, we answer a question about mixed, two-level views, viz. whether they are as much monist as pluralist in nature, or more. They are not. Section 6 is devoted to the task of arguing that the strong pluralist, the second-order functionalist, and the manifestation functionalist will find it hard to deny a commitment to alethic disjunctivism. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers’ needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these (...) challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices. (shrink)

This paper offers a discussion of metaphysical pluralism, alethic pluralism, and logical pluralism. According to the metaphysical pluralist, there are several ways of being. According to the alethic pluralist, there are several ways of being true, and according to the logical pluralist, there are several ways of being valid. Each of these three forms of pluralism will be considered on its own, but the ambition of the paper is to explore possible connections between them. My primary objective is to present (...) and develop a positive account according to which the different forms of pluralism are intimately related. I will proceed in two steps. First, I will investigate the connection between alethic pluralism and logical pluralism. I will argue that a certain version of alethic pluralism supports logical pluralism. Second, I will connect alethic pluralism and logical pluralism to metaphysical pluralism. I will suggest that the former two are at least partly founded on the latter. (shrink)

Alethic pluralism is the view that the nature of truth is not uniform across domains. There are several ways of bang true $(T_1 ...\,T_n )$ A simple argument, the 'instability challenge', purports to show that this view is inherently unstable. One can simply say that something is uniformly true if and only if it is T₁ or ... or $\,T_n $ . Being uniformly true is a single truth property that applies across the board, and so the nature of truth (...) is uniform across domains, contra pluralism. I defend pluralism against the instability challenge. I show that the challenge bifurcates: one Challenge is formulated in terms of predicates, and the other is formulated in terms of properties. Vie pluralist has the resources to defuse both of these. The sparse/abundant property distinction and considerations of explanatory asymmetry play a crucial role in my argument. (shrink)

Background:Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities.Objectives:To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities.Research design:Two online questionnaires about the municipal ethics activities.Participants and research context:A total of 137 municipal contact persons for the ethics project answered the first survey, whereas 217 ethics facilitators responded to the second survey.Ethical considerations:Based on informed consent, the study was (...) approved by the Data Protection Official of the Norwegian Social Science Data Services.Findings:Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision.Discussion:This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators.Conclusion:It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors. (shrink)

Here is a well-known thought about truth: Truth consists in correspondence with reality. A sentence is true just in case what it says corresponds with how the world is. Theories of truth that incorporate this thought are naturally regarded as robust or “heavyweight”. Truth is to be understood in a realist fashion. The world decides what is true and what is not. A recent incarnation of the correspondence view is found in truth-maker theories, whose adherents maintain that truths are true (...) in virtue of there being something – a truth-maker – in the world that makes them so.2. (shrink)

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of (...) ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout. (shrink)

Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, (...) conflict, and ‘outsiders’ are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well‐known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. (shrink)

Background:To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.Methods:A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociologicals and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included.Ethical considerations:The review is conducted according to the Vancouver Protocol.Results:There are few studies that study ethical (...) challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good and inflicting harm. In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion.Conclusion:There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

This article has two objectives. In the first part, I present a critical overview of the extensive anthropological literature that may be deemed “phenomenological.” Following this critique, which is built up around a classification into four different varieties of phenomenological anthropology, I discuss the relationship between phenomenological anthropology and the ontological turn (OT). Contrary to received wisdom within the anthropological discipline, I suggest that OT has several things in common with the phenomenological project. For the same reason, I argue, it (...) is not accurate to posit OT and phenomenology as opposing or antagonistic projects, as they are often depicted among critics and advocates of OT alike. On the contrary, I go as far as suggesting, OT may be understood as one of the most concerted attempts anthropology has produced to realize a distinctly anthropological version of Husserl’s method of phenomenological bracketing, namely what could be called the ontological epoché. (shrink)

This is the first edited collection entirely dedicated to non-evidentialist epistemology or non-evidentialism—the controversial view that evidence is not required in order for doxastic attitudes to enjoy a positive epistemic status. Belief or acceptance can be epistemically justified, warranted, or rational without evidence. The volume is divided into three section: the first focuses on hinge epistemology, the second offers a critical reflection about evidentialist and non-evidentialist epistemologies, and the third explores extensions of non-evidentialism to the fields of social psychology, psychiatry, (...) and mathematics. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti. (shrink)

If you want to understand McDowell's spatial metaphors when he talks about perceptual knowledge, place him side-by-side with Dretske on perceptual knowledge. Though McDowell shows no evidence of reading Dretske's writings on knowledge from the late 1960s onwards (McDowell mentions "Epistemic Operators" once in passing), McDowell gives the same four arguments as Dretske for the conclusion that knowledge requires "conclusive" reasons that rule of the possibility of mistake. Despite various differences, we think it is best to read McDowell as re-discovering (...) Dretske on perceptual knowledge. Since Dretske is easy to understand, all of McDowell's metaphors become easy to understand. But what about McDowell's disjunctivism? Turns out McDowell is not an ontological disjunctivist, and his epistemological disjunctivism is really just the banal point that some perceptual experiences provide conclusive reasons for perceptual belief and some do not. Perceptual experiences are either conclusive or inconclusive. Dretske would agree. (shrink)

While many aspects of cognition have been shown to be shared between humans and non-human animals, there remains controversy regarding whether the capacity to mentally time travel is a uniquely human one. In this paper, we argue that there are four ways of representing when some event happened: four kinds of temporal representation. Distinguishing these four kinds of temporal representation has five benefits. First, it puts us in a position to determine the particular benefits these distinct temporal representations afford an (...) organism. Second, it provides the conceptual resources to foster a discussion about which of these representations is necessary for an organism to count as having the capacity to mentally time travel. Third, it enables us to distinguish stricter from more liberal views of mental time travel that differ regarding which kind(s) of temporal representation is taken to be necessary for mental time travel. Fourth, it allows us to determine the benefits of taking a stricter or more liberal view of mental time travel. Finally, it ensures that disagreement about whether some species can mentally time travel is not merely the product of unrecognised disagreement about which temporal representation is necessary for mental time travel. We argue for a more liberal view, on the grounds that it allows us to view mental time travel as an evolutionarily continuous phenomenon, and to recognise that differences in the ways that organisms mentally time travel might reflect different temporal representations, or combinations thereof, that they employ. Our ultimate aim, however, is to create the conceptual framework for further discussion regarding what sorts of temporal representations are required for mental time travel. (shrink)

The objective of this paper is to examine the relationship between business model innovation, corporate sustainability, and the underlying organisational values. Moreover, the paper examines how the three dimensions correlate with corporate financial performance. It is concluded that companies with innovative business models are more likely to address corporate sustainability and that business model innovation and corporate sustainability alike are typically found in organisations rooted in values of flexibility and discretion. Business model innovation and corporate sustainability thus seem to have (...) their origin in the fundamental principles guiding the organisation. In addition, the study also finds a positive relationship between the core organisational values and financial performance. The analysis of the paper is based on survey responses from 492 managers within the Swedish fashion industry. (shrink)

In this paper I discuss two fundamental challenges concerning Crispin Wright's notion of entitlement of cognitive project: firstly, whether entitlement is an epistemic kind of warrant since, seemingly, it is not underwritten by epistemic reasons, and, secondly, whether, in the absence of such reasons, the kind of rationality associated with entitlement is epistemic in nature. The paper investigates three possible lines of response to these challenges. According to the first line of response, entitlement of cognitive project is underwritten by epistemic (...) reasons – and thus supports epistemic rationality – because, when P is an entitlement, trust in P is a dominant strategy with respect to promotion of epistemic value. The second line of response replaces dominance with maximization of expected utility. I argue that both of these proposals are flawed and develop an alternative line of response. (shrink)

Table of Contents -/- 1. Introduction and Overview: Two Entitlement Projects, Peter J. Graham, Nikolaj J.L.L. Pedersen, Zachary Bachman, and Luis Rosa -/- Part I. Engaging Burge's Project -/- 2. Entitlement: The Basis of Empirical Warrant, Tyler Burge 3. Perceptual Entitlement and Scepticism, Anthony Brueckner and Jon Altschul 4. Epistemic Entitlement Its Scope and Limits, Mikkel Gerken 5. Why Should Warrant Persist in Demon Worlds?, Peter J. Graham -/- Part II. Extending the Externalist Project -/- 6. Epistemic Entitlement and Epistemic (...) Competence, Ernest Sosa 7. Extended Entitlement, Adam Carter and Duncan Pritchard 8. Moorean Pragmatics, Social Comparisons and Common Knowledge, Allan Hazlett 9. Internalism and Entitlement to Rules and Methods, Joshua Schecter -/- Part III. Engaging Wright's Project -/- 10. Full Bloodied Entitlement, Martin Smith 11. Pluralist Consequentialist Anti-Scepticism, Nikolaj Jang Lee Linding Pedersen 12. Against (Neo-Wittensteinian) Entitlements, Annalisa Coliva 13. The Truth Fairy and the Indirect Consequentialist, Daniel Elstein and Carrie S. I. Jenkins 14. Knowledge for Nothing, Patrick Greenough . (shrink)

This edited volume brings together 18 state-of-the art essays on pluralism about truth and logic. Parts I and II are dedicated to respectively truth pluralism and logical pluralism, and Part III to their interconnections. Some contributors challenge pluralism, arguing that the nature of truth or logic is uniform. The majority of contributors, however, defend pluralism, articulate novel versions of the view, or contribute to fundamental debates internal to the pluralist camp. The volume will be of interest to truth theorists and (...) philosophers of logic, as well as philosophers interested in relativism, contextualism, metaphysics, philosophy of language, semantics, paradox, epistemology, or normativity. (shrink)

While historically prominent theories of truth such as the correspondence theory, coherentism, pragmatism, verificationism, and instrumentalism diverge in many ways, they converge in at least one fundamental respect. They are all monist theories of truth. They incorporate the thesis that there is one property—and one property only—in virtue of which propositions can be true. The truth pluralist, on the other hand, rejects this idea. There are several properties in virtue of which propositions can be true. This article offers a survey (...) of recent work on alethic pluralism—presenting various incarnations of the view, objections leveled against them, and various lines of response available to pluralists. (shrink)

What is truth? Philosophers are interested in a range of issues involving the concept of truth beginning with what sorts of things can be true. This is a collection of eighteen new and original research papers on truth and other alethic phenomena by twenty of the most promising young scholars working on truth today.

Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? In (...) this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project ‘Bioethics in Theory and Practice’. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

A common objection to paternalism concerns its expressive content. Many reject paternalistic policies and actions on the ground that they arguably involve insulting expressions of disrespect toward those subjected to them. The paper challenges this view. It argues that refraining from acting paternalistically can be disrespectful. Specifically, the paper argues that there is a relevant way in which A disregards the moral worth of B if A stands idly by when B is about to act very imprudently. If true, treating (...) others with equal respect and concern, as relational egalitarians and others rightly ask us to do, will somewhat surprisingly sometimes involve treating them paternalistically. (shrink)

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.

Friedrich Schleiermacher is often considered the Father of Modern Theology, known for his attempt to reconcile traditional Christian doctrines with philosophical criticisms and scientific discoveries. Despite the influence of his work on significant figures like Karl Barth, he has been largely ignored by contemporary theologians. Focussing on Schleiermacher's doctrine of sin, this book demonstrates how Schleiermacher has not only been misinterpreted, but also underestimated, and deserves a critical re-examination. The book approaches Schleiermacher on sin with respect to three themes: one, (...) its power to transcend an intractable metaethical dilemma at the heart of modern debates over sin; two, its intended compatibility with natural science; and three, to re-evaluating its place, and so Schleiermacher's place, in the history of theology. It solves and dissolves problems arising simultaneously from natural science, confessional theology, ethics, and metaphysics in a single, integrated account using Schleiermacher's understudied thought from his dogmatics The Christian Faith. In contrast to the account sometimes given of modern theology as marked by a break with "Greek metaphysics," Schleiermacher's account is shown to stand in stark contrast by retrieving, not excising, ancient thought in service of an account of sin adequate to natural science. This is a vital rediscovery of a foundational voice in theology. As such, it will greatly appeal to scholars of Modern Theology, theological ethics, and the history of Modern Christianity. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

How may clinical ethics committees inspire ethical reflection among healthcare professionals? How may they deal with organizational ethics issues? In recent years, Norwegian CECs have attempted different activites that stretch or go beyond the standard trio of education, consultation, and policy work. We studied the novel activities of Norwegian CECs by examining annual reports and interviewing CEC members. Through qualitative analysis we identified nine categories of novel CEC activities, which we describe by way of examples. In light of the findings, (...) we argue that some novel working methods may be well suited to promote ethical reflection among clinicians, and that the CEC may be a suitable venue for discussing issues of organizational ethics. (shrink)

Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated. This article presents a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: formal coercion, informal coercion, uncertainty related to the Norwegian legislation on coercion (...) and professional role and identity. Some ethical challenges did not fit into these categories. Only 36% of the ethical challenges were related to the use of formal coercion or the interpretation of the health law. Conclusion Even within coercion regulated by law, weighing different moral values remains important to reflect upon the appropriateness of the possible use of coercion. (shrink)

Sustainability challenges typically occur across sectoral boundaries, calling the state, market, and civil society to action. Although consensus exists on the merits of cross-sector collaboration, our understanding of whether and how it can create value for various, collaborating stakeholders is still limited. This special issue focuses on how new combined knowledge on cross-sector collaboration and business models for sustainability can inform the academic and practitioner debates about sustainability challenges and solutions. We discuss how cross-sector collaboration can play an important role (...) for the transition to new and potentially sustainability-driven business models given that value creation, delivery, and capture of organizations are intimately related to the collaborative ties with their stakeholders. Sustainable alternatives to conventional business models tend to adopt a more holistic perspective of business by broadening the spectrum of solutions and stakeholders and, when aligned with cross-sector collaboration, can contribute new ways of addressing the wicked sustainability problems humanity faces. (shrink)

I introduce a mathematical account of expectation based on a qualitative criterion of coherence for qualitative comparisons between gambles (or random quantities). The qualitative comparisons may be interpreted as an agent’s comparative preference judgments over options or more directly as an agent’s comparative expectation judgments over random quantities. The criterion of coherence is reminiscent of de Finetti’s quantitative criterion of coherence for betting, yet it does not impose an Archimedean condition on an agent’s comparative judgments, it does not require the (...) binary relation reflecting an agent’s comparative judgments to be reflexive, complete or even transitive, and it applies to an absolutely arbitrary collection of gambles, free of structural conditions (e.g., closure, measurability, etc.). Moreover, unlike de Finetti’s criterion of coherence, the qualitative criterion respects the principle of weak dominance, a standard of rational decision making that obliges an agent to reject a gamble that is possibly worse and certainly no better than another gamble available for choice. Despite these weak assumptions, I establish a qualitative analogue of de Finetti’s Fundamental Theorem of Prevision, from which it follows that any coherent system of comparative expectations can be extended to a weakly ordered coherent system of comparative expectations over any collection of gambles containing the initial set of gambles of interest. The extended weakly ordered coherent system of comparative expectations satisfies familiar additivity and scale invariance postulates (i.e., independence) when the extended collection forms a linear space. In the course of these developments, I recast de Finetti’s quantitative account of coherent prevision in the qualitative framework adopted in this article. I show that comparative previsions satisfy qualitative analogues of de Finetti’s famous bookmaking theorem and his Fundamental Theorem of Prevision.The results of this article complement those of another article (Pedersen, Strictly coherent preferences, no holds barred, Manuscript, 2013). I explain how those results entail that any coherent weakly ordered system of comparative expectations over a unital linear space can be represented by an expectation function taking values in a (possibly non-Archimedean) totally ordered field extension of the system of real numbers. The ordered field extension consists of formal power series in a single infinitesimal, a natural and economical representation that provides a relief map tracing numerical non-Archimedean features to qualitative non-Archimedean features. (shrink)

Background The aim was to explore how the clinical ethics committees in Norway have worked and functioned within mental health care and addiction treatment services. Methods Analysis of 256 annual reports from clinical ethics committees from 2003 to 2012 and a survey to clinicians who had used a clinical ethics committee. Results Dilemmas related to coercion, confidentiality, information, and patient autonomy dominated. The committees established only for psychiatric hospitals, had received more cases from mental health and addiction services than the (...) committees also serving somatic services. Many of the case discussions involved both somatic and mental health care, complicated legal issues as well as ethical dilemmas. Mental health care professionals that have used the clinical ethics committees evaluated the clinical ethics committees deliberation as useful. Conclusion Given the many difficult ethical dilemmas in mental health care ethics work need to be strengthened. The complexity of the cases requires varied and interdisciplinary competence and training among the clinical ethics committee members. (shrink)