The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can provide in rehabilitating (...) patients, and therefore also affect patients’ feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to ‘lose themselves’. Independence and autonomy are associated with dignity, but their lack is contrary to it. (shrink)

Existence value refers to the value humans ascribe to the existence of something, regard­less of whether it is or will be of any particular use to them. This existence value based on preference satisfaction should be taken into account in evaluating activities that come with a risk of species extinction. There are two main objections. The first is that on the preference satisfaction interpretation, the concept lacks moral importance because satisfying people’s preferences may involve no good or well-being for them. (...) However, existence value can be based on a restricted version of the preference satisfaction theory, which is not vulnerable to the skeptical arguments about the link between preference satisfaction and well-being. The second objection is that even if preference satisfaction can be linked to well-being, understanding existence value in terms of individual preference satisfaction is incoherent, because existence value reflects disinterested preferences that involve no benefits to the individual. However, the fact that existence value may involve disinterested preferences does not threaten the coherence of the concept, but suggests that it does not fit smoothly into the “utilitarian” or “welfarist” framework it is commonly considered within. A pluralistic normative approach based on prima facie duties can be an alternative to standard utilitarian-style approaches for considering existence value in concrete cases involving a risk of species extinction, such as through deep sea mining. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), (...) aged 33–66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues.Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians , aged 33–66 years, (...) residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner.Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position.Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

With regard to any natural resource, we can ask whether we should obtain (more of) it. For instance, we may ask whether we, as a society, should seek to obtain more minerals, or more oil. Furthermo...

While there is an extensive literature on how the precautionary principle should be interpreted and when precautions should be taken, relatively little discussion exists about the fair distribution of costs of taking precautions. We address this issue by proposing a general framework for deciding how costs of precautions should be shared, which consists of a series of default principles that are triggered according to desert, rights, and ability to pay. The framework is developed with close attention to the pragmatics of (...) how distributions will affect actual behaviours. It is intended to help decision-makers think more systematically about distributional consequences of taking precautionary measures, thereby to improve decision-making. Two case studies—one about a ban on turtle fishing in Costa Rica, and one about a deep-sea mining project in Papua New Guinea—are given to show how the framework can be applied. (shrink)

The value of nature has been extensively debated in environmental ethics. There has been less discussion, however, about how one should understand the relation between this value and normativity, or reasons: if something in nature is seen as valuable, how should we understand the relation between this fact and claims about reasons to, for example, protect it or promote its existence? The “commonsense” view is that value gives rise to reasons. The buck-passing account of value, on the other hand, implies (...) that for an entity or state of affairs in nature to be valuable just is for it to have properties that provide reasons to promote or have a pro-attitude towards it. BPA has been extensively debated, but has received little attention in environmental philosophy. In this paper, it is argued that the view suggests a “reasons first” approach to environmental ethics, and that it should be preferred to competing accounts of value in the context of environmental ethics. (shrink)

In decision-making based on multiple criteria, situations may arise where agents find their options to be neither better than, worse than nor equal to each other with respect to the relevant criteria. How, if at all, can a justified choice be made between such options? Are the options incomparable? This article explores a hypothetical case that illustrates how such a situation can arise in an environmental context; more specifically, it considers the deliberations of an imagined 'ethics committee' as it struggles (...) to decide whether or not a deep-sea mining project should be allowed to proceed. I argue that the case is best understood as involving options that are comparable in the sense of being 'on a par'. Working out from a discussion of Ruth Chang's 'self-governance' theory of choice in cases of parity, I suggest that, in the environmental context, the idea of choices expressing a moral identity may lead us in the direction of a plausible solution to these particularly challenging cases. (shrink)

Eric Katz (1992) influentially argued that ecological restoration involves the ‘big lie’ that a successful restoration re-establishes or re-creates all of what was lost through human degradation, a...

_Taking issue with sustainable governance involves careful consideration of social, economic, and environmental dimensions of sustainability, and the interplay of those dimensions in political processes and decision-making. The current issue of Etikk i Praksis contributes to this task by offering analysis of central concepts in the discourse of sustainability, as well as examinations of political and moral issues raised by pressing environmental challenges such as climate change._.

This book propels the study of American revolutionary and radical Thomas Paine into the twenty-first century by engaging an interdisciplinary and international group of scholars in an exploration of Paine's role in politics, literature, and the invention of the global.

The Danish health care sector currently undergoes changes that imply a gradual transition from an evidence‐based activity model to a value‐based quality model centered on patient involvement and value‐based governance. The patient naturally occupies a central position in health care, and the transition therefore raises important questions about health care quality and how successive national health quality strategies value quality and ascribe roles and agency to patients. To explore the complexity of these quality strategies, we analyze and discuss how political (...) discourse moments influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicates discursive struggle in Danish national health care policy. Underlying theoretical concepts are informed by New Public Management, the welfare state, health communication, and discourse theory. Our analytical approach is inspired by Critical Discourse Analysis and combines content analysis with linguistic analysis. (shrink)

This open issue of the Nordic Journal of Applied Ethics consists of four papers that discuss the topics covering vaccination, sustainability, development ethics research and family ethics. It also includes a book review.

This special issue of Etikk i Praksis – Nordic Journal of Applied Ethics features four articles that address a number of urgent ethical issues that arise in the COVID-19 pandemic.

The editorial introduces original articles, a commentary and book review.

This open issue of the Nordic Journal of Applied Ethics consists of four papers that discuss topics covering fetal diagnostics ethics, value conflicts in the use of artificial intelligence, abortion and population ethics.

Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. The dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This gives rise to delay (...) aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to “inhibit” responses (“disinhibition”). A hypofunctioning mesocortical dopamine branch will cause attention response deficiencies (deficient orienting responses, impaired saccadic eye movements, and poorer attention responses toward a target) and poor behavioral planning (poor executive functions). A hypofunctioning nigrostriatal dopamine branch will cause impaired modulation of motor functions and deficient nondeclarative habit learning and memory. These impairments will give rise to apparent developmental delay, clumsiness, neurological “soft signs,” and a “failure to inhibit” responses when quick reactions are required. Hypofunctioning dopamine branches represent the main individual predispositions in the present theory. The theory predicts that behavior and symptoms in ADHD result from the interplay between individual predispositions and the surroundings. The exact ADHD symptoms at a particular time in life will vary and be influenced by factors having positive or negative effects on symptom development. Altered or deficient learning and motor functions will produce special needs for optimal parenting and societal styles. Medication will to some degree normalize the underlying dopamine dysfunction and reduce the special needs of these children. The theory describes how individual predispositions interact with these conditions to produce behavioral, emotional, and cognitive effects that can turn into relatively stable behavioral patterns. Key Words: catecholamine; clumsiness; dopamine; hyperkinesis; hyperkinetic disorder; impulsivity; monoamine; neuromodulator; overactivity; pollutants; reinforcement; reward; verbally governed behavior; soft signs; variability. (shrink)

The dynamic developmental theory (DDT) has benefited from the insights of the commentators, particularly in terms of the implications for the proposed steepened delay gradients in attention-deficit/hyperactivity disorder (ADHD). The introduction of modified memory processes as a basis for the delay gradients improved the links to aspects of ADHD. However, it remains unclear whether the hyperactive-impulsive and inattentive subtypes are separate subgroups or may be explained as different outcomes of the same genetic factors and thus explicable by the same principles. (...) The DDT suggests that altered reinforcement and extinction processes define an endophenotype in ADHD that can be related dimensionally to inattention, hyperactivity, and impulsivity. The relation between the suggested endophenotype, characterized by changes in basic learning mechanisms, and other endophenotypes characterized by delay aversion or response disinhibition, needs to be tested in future studies. (shrink)

Sagvolden, Johansen, Aase, and Russell (Sagvolden et al.) examine attention-deficit/hyperactivity disorder (ADHD) at levels of analysis ranging from neurotransmitters to behavior. At the behavioral level they attribute aspects of ADHD to anomalies of delay-of-reinforcement gradients. With a normal gradient, responses followed after a long delay by a reinforcer may share in the effects of that reinforcer; with a diminished or steepened gradient they may fail to do so. Steepened gradients differentially select rapidly emitted responses (hyperactivity), and they limit the (...) effectiveness with which extended stimuli become conditioned reinforcers, so that observing behavior is less well maintained (attention deficit). Impulsiveness also follows from steepened gradients, which increase the effectiveness of smaller, more immediate consequences relative to larger, more delayed ones. Individuals who vary in the degree to which their delay gradients are steepened will show different balances between hyperactivity and attention deficit. Given the range of ADHD phenomena addressed, it may be unnecessary to appeal to additional behavioral processes such as extinction deficit. Extinction deficit is more likely a derivative of attention deficit, in that failure to attend to stimuli differentially correlated with extinction should slow its progress. The account suggests how relatively small differences in delay gradients early in development might engender behavioral interactions leading to very large differences later on. The steepened gradients presumably originate in properties of neurotransmitter function, but behavioral interventions that use consistently short delays of reinforcement to build higher-order behavioral units as a scaffolding to support complex cognitive and social skills may nonetheless be feasible. Key Words: ADHD; attention deficit; delay gradient; exponential decay; extinction deficit; hyperactivity; impulsiveness; intervention; observing responses; self-control. Footnotes1000 Jeffrey Gray was the BBS Editor for this treatment. When he accepted Sagvolden et al. for publication, he invited Catania, who was one of the reviewers of the original submission, to prepare a precommentary. Com-mentators were then invited to respond to the Sagvolden et al. article, to the Catania precommentary, or to both. (shrink)