The importance of patient involvement is increasing in healthcare, and initiatives are constantly implemented to reach the ideal of involved and educated patients. This secondary analysis was initially embedded in a randomized controlled study where the aim was to gain insight into perceptions and experiences within a group of women undergoing fertility treatment through two focus group interviews. In this secondary analysis, we investigated how patient involvement was strived for in both clinical practice and research. During the analysis, it became (...) apparent that the women exercised and maintained a clear perspective on their hope for a child, Project Child, while the interviewer pursued a treatment perspective, Project Treatment. Despite different perspectives, the conversation during the interviews seemed effortless, and it became apparent how the interviewer and the participants were actually focusing partly on the same, but primarily on different issues but without addressing or acknowledging this. Knowledge and awareness of the difference in perspectives is important when healthcare professionals seek to involve patients both in clinical practice and in research. Patient involvement in both research and clinical practice has shown to be a challenge and entails that pathways are organized and decisions shared by healthcare professionals. (shrink)

ABSTRACT In this survey we have investigated the experiences and attitudes of Danish physicians regarding end‐of life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non‐resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made (...) and found acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self‐determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death. (shrink)

In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non-resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made and found (...) acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self-determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death. (shrink)

It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely (...) available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty. (shrink)

We discuss the variety of sorts of sympathy Hume recognizes, the extent to which he thinks our sympathy with others’ feelings depends on inferences from the other’s expression, and from her perceived situation, and consider also whether he later changed his views about the nature and role of sympathy, in particular its role in morals.

In this chapter, I argue that one can articulate a historically attuned and analytically rich model for understanding jazz in its various inflections. That is, on the one hand, such a model permits us to affirm jazz as a historically conditioned, dynamic hybridity. On the other hand, to acknowledge jazz’s open and multiple character in no way negates our ability to identify discernible features of various styles and aesthetic traditions. Additionally, my model affirms the sociopolitical, legal (Jim Crow and copyright (...) laws), and economic structures that shaped jazz. Consequently, my articulation of bebop as an inflection of Afromodernism highlights the sociopolitical, and highly racialized context in which this music was created. Without a recognition of the sociopolitical import of bebop, one’s understanding of the music is impoverished, as one fails to grasp the strategic uses to which the music and discourses about the music were put. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that results as part of a social process that systematically (...) gives rise to racial injustice, and is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

Cheyne and Girard characterize felt presence during sleep paralysis attacks as a pre-hallucinatory expression of a threat-activated vigilance system. While their results may be consistent with this interpretation, they are nonetheless correlational and do not address a parsimonious alternative explanation. This alternative stipulates that FP is a purely spatial, hallucinatory form of a common cognitive phenomenon—social imagery—that is often, but not necessarily, linked with threat and fear and that may induce distress among susceptible individuals. The occurrence of both fearful and (...) non-fearful FPs in a multiplicity of situations other than sleep paralysis attacks supports the notion that FPs are hallucinatory variants of social imagery and that they are not necessarily bound to threat-activated vigilance. Evidence linking FPs with anxiety disorders supports the notion that the distress they evoke may be mediated by a more general affective distress personality factor. To illustrate the predominantly spatial character of FP hallucinations, similarities between FP and phantom limbs are summarized and the possibility that these two phenomena are parallel expressions of a mirror neuron system is considered. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that (1) results as part of a social process that (...) systematically gives rise to racial injustice, and (2) is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

Name der Zeitschrift: Kierkegaard Studies Yearbook Jahrgang: 2016 Heft: 1 Seiten: 39-50.

We show that a popular class of connectionist models (which we label 'first order connectionism') looks unlikely to provide the kind of resources required by the hypothesis. We examine some alternative hybrid models that seem more promising. Finally, we raise a more purely philosophical issue concerning the conditions under which a being can count as a genuine believer or cognizer.".

The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the semantic content of the terms “health” and “disease.” In the first section, four meta-theoretical assumptions of the traditional debate are identified and alternative approaches to the problems are presented. Afterwards, the view that health and disease are constituted by a dynamic relation between demands imposed on an organism (...) and individual presuppositions for adequate response is developed. In the last section, the paper takes stock of three possible objections to and clarifies some implications of this approach to the notions of health and disease. (shrink)

Kaum ein Zeitabschnitt war von solch grundlegenden technischen, politischen und philosophischen Umbruchen gepragt wie die 100 Jahre bis zur Jahrtausendwende - vom Kaiserreich zur globalen Weltgesellschaft, vom Idealismus zum Werterelativismus. Die juristische Grundlagenforschung - auch die Rechtsphilosophie - ist gegenwartig in keiner guten Verfassung: Ihr fehlt die gesellschaftliche Resonanz, und damit einhergehend der qualifizierte wissenschaftliche Nachwuchs. Der Band mochte einen Anstoss geben, durch eine Ruckbesinnung auf die grossen Leistungen in der Rechtsphilosophie des letzten Jahrhunderts an diese anzuknupfen, Problemlosungen fur die (...) Zukunft zu suchen und die Unverzichtbarkeit der Rechtsphilosophie dabei wieder ernst zu nehmen. (shrink)

This is an essay at the intersection of metaethics and the history of contemporary analytic philosophy. It explores the relationships between Allan Gibbard’s mature quasi-realist expressivism and (i) three non-naturalistic varieties of what I call “non-inflationary realism” and (ii) moral fictionalism. Moral or normative realism is frequently (if mistakenly) taken to involve certain existence-affirming external assumptions about the metaphysical status of substantive normative thought and discourse. The non-inflationary realists seek to embrace moral or normative objectivity and truth without any distinctly—as (...) they see it, “inflated”—moral or normative ontology. This position, along with a shared emphasis on the primacy of substantive moral or normative thought and discourse, brings them very close to Gibbard, and so to what it is tempting to treat as a strikingly different metaethical account. Focusing on the non-inflationary realists Ronald Dworkin, T.M. Scanlon, and Derek Parfit, I examine similarities among their views, and between each of these views and Gibbard’s. I argue that the non-inflationary realist project should be understood as including the work not only of these figures, characteristically seen as among its paradigmatic representatives, but also, crucially, that of Gibbard. They all agree that our moral or normative claims purport to state normative truths and that such claims are capable of being true or false and that when true they do not depend on the particular standpoint anyone happens to take. Our moral or normative thoughts can be characterized as beliefs. We can have moral knowledge. There are substantive moral and normative facts. These facts are not reducible to non-normative facts. Normative concepts cannot be analyzed in purely naturalistic terms; and normative facts do not depend on any robustly existent truth-makers. Focusing on these shared commitments enables me to home in on the apparent differences that nonetheless remain. They differ in significant respects, for instance, about whether—and, if so, to what extent—we can make any meaningful external (non-substantive) judgments about the moral or normative and about whether there is a role for property-based explanations that minimalism about the normative fails to capture. By investigating these and other differences, I shed light on what is at stake in giving an adequate account of our moral and normative thought and talk. I pursue this aim further by considering why it might seem that quasi-realist expressivism was a form of normative fictionalism or error theory—though it is not. I attempt here to clear up confusions stemming from common assumptions associated with terms like “realism,” “cognitivism,” or “fictionalism” with respect to morality or normativity. I distinguish some differences in the ways in which normative properties can be understood by non-inflationary realists and the roles they can play in explaining normativity. I underscore the implausibility of treating the moral domain as completely autonomous. And I attempt to offer suggestions regarding some conceptual options that remain to be further explored. I maintain that Gibbard makes explicit otherwise unacknowledged implications of Scanlon’s or Dworkin’s accounts, implications regarding deep differences between normative or moral and other domains, implications which might help explain the uneasiness that prompts Scanlon and Dworkin to resist Gibbard’s account and that pushes Parfit toward what seems to be a sort of intermediate position between non-inflationary and more ontologically committed realism. Non-inflationary realism forces us to rethink metaethics in interesting and promising ways. (shrink)

The democratic boundary problem raises the question of who has democratic participation rights in a given polity and why. One possible solution to this problem is the all-affected principle, according to which a polity ought to enfranchise all persons whose interests are affected by the polity’s decisions in a morally significant way. While AAP offers a plausible principle of democratic enfranchisement, its supporters have so far not paid sufficient attention to economic participation rights. I argue that if one commits oneself (...) to AAP, one must also commit oneself to the view that political participation rights are not necessarily the only, and not necessarily the best, way to protect morally weighty interests. I also argue that economic participation rights raise important worries about democratic accountability, which is why their exercise must be constrained by a number of moral duties. (shrink)

The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

Disagreement persists about when, if at all, disenfranchisement is a fitting response to criminal wrongdoing of type X. Positive retributivists endorse a permissive view of fittingness: on this view, disenfranchising a remarkably wide range of morally serious criminal wrongdoers is justified. But defining fittingness in the context of criminal disenfranchisement in such broad terms is implausible, since many crimes sanctioned via disenfranchisement have little to do with democratic participation in the first place: the link between the nature of a criminal (...) act X (the ‘desert basis’) and a fitting sanction Y is insufficiently direct in such cases. I define a new, much narrower account of the kind of criminal wrongdoing which is a more plausible desert basis for disenfranchisement: ‘political wrongdoing’, such as electioneering, corruption, or conspiracy with foreign powers. I conclude that widespread blanket and post-incarceration disenfranchisement policies are overinclusive, because they disenfranchise persons guilty of serious, but non-political, criminal wrongdoing. While such overinclusiveness is objectionable in any context, it is particularly objectionable in circumstances in which it has additional large-scale collateral consequences, for instance by perpetuating existing structures of racial injustice. At the same time, current policies are underinclusive, thus hindering the aim of holding political wrongdoers accountable. (shrink)

ZusammenfassungDie aktuellen Entwicklungen und Anforderungen in der pflegeberuflichen Bildung, das Ausbildungsziel im Pflegeberufegesetz vom 17. Juli 2017 und die Explikationen in der dazugehörigen Ausbildungs- und Prüfungsverordnung für die Pflegeberufe fordern eine stärkere Ausrichtung auf die Entwicklung ethischer Kompetenzen explizit ein. Bislang liegen tendenziell übergreifende Definitionen und Darlegungen zu ethischen Kompetenzen in der Pflege vor, deren Verdienst es ist, das Spezifische der Pflegeethik zu konturieren und erstmals ethische Kompetenzen für das Feld zu konkretisieren. In methodischer und didaktischer Hinsicht ist indes eine (...) spezifische Differenzierung gemäß unterschiedlicher Bildungsniveaus relevant. Lehrende werden ihre Lehre nicht mehr nur im Sinne einer allgemeinen Förderung ethischer Kompetenz entwickeln können, sondern müssen dabei den jeweiligen Verantwortungsbereich und das angezielte Qualifikationsniveau der Lernenden berücksichtigen. Ziel der Darlegungen ist es, konkrete Kompetenzniveaus für die Anbahnung professionsethischer Kompetenzen zu operationalisieren, die einerseits die Anforderungen aus dem zukünftigen Pflegeberufegesetz aufgreifen und andererseits anstehende curriculare Entwicklungsprozesse unterstützen. (shrink)

Norman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the (...) latter claim. Does accountability for reasonableness result in fair limit-setting decisions? It is argued that the answer to this question is not a clear yes. Daniels is remarkably unclear about the criterion of fairness that accountability for reasonableness satisfies. The paper discusses different options for resolving this lack of clarity and examines how they apply to Daniels’ accountability for reasonableness framework. It is concluded, first, that accountability for reasonableness is not a paradigm case of any of the classic notions of procedural justice; second, that what might be called "constrained pure procedural justice" best reflects how accountability for reasonableness results in fair limit-setting decisions; and third, that the procedural conditions of accountability for reasonableness must be further specified and amended to better achieve a fair process, and hence fair limit-setting decisions. (shrink)

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions (...) for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

In these Carus Lectures, Annette Baier looks at the relation between individual and shared reasoning, intending, and moral reflection. In each case she emphasizes the interdependence of minds and the role of social practices in setting the norms governing these activities.

The Cautious Jealous Virtue is an illuminating meditation that will interest not only Hume scholars but also those interested in the issues of justice and in ...

At the heart of any theoretical problem of justice lies the problem of motivation: Even if we could conceive of a way to develop a comprehensive system of just laws, and even if we could rationally believe in the justice of these laws, how could we ever ensure that we—or anyone else—would be motivated to abide by them? By unearthing how the problem of motivation sways canonical discussions of justice, the article brings forth intrinsic similarities and differences in these discussions (...) that are often overlooked in the literature. In particular, the article highlights intrinsic similarities in the analysis of the concept of justice in two central works that belong to the continental and the analytic tradition respectively and are otherwise rarely discussed together: Hegel’s Outlines of the Philosophy of Right and Rawls’s Theory of Justice. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

" By the end, we can see the cause to which Hume has been true throughout the work.

The past decade has seen an explosion of work on the history of the human sciences during the Cold War. This work, however, does not engage with one of the leading human sciences of the period: linguistics. This article begins to rectify this knowledge gap by investigating the influence of linguistics and its concept of study, language, on American public, political and intellectual life during the postwar and early Cold War years. I show that language emerged in three frameworks in (...) this period: language as tool, language as weapon, and language as knowledge. As America stepped onto the international stage, language and linguistics were at the forefront: the military poured millions of dollars into machine translation, American diplomats were required to master scores of foreign languages, and schoolchildren were exposed to language-learning on a scale never before seen in the United States. Together, I argue, language and linguistics formed a critical part of the rise of American leadership in the new world order — one that provided communities as dispersed as the military, the diplomatic corps, scientists and language teachers with a powerful way of tackling the problems they faced. To date, linguistics has not been integrated into the broader framework of Cold War human sciences. In this article, I aim to bring both language, as concept, and linguistics, as discipline, into this framework. In doing so, I pave the way for future work on the history of linguistics as a human science. (shrink)

One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks to (...) subjects” be “reasonable in relation to anticipated benefits, if any, to subjects and the importance of the knowledge” to be gained from the .. (shrink)