Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

The aim of the SI is to bring to the fore the places in which cross-sector partnerships (CSPs) are formed; how place shapes the dynamics of CSPs, and how CSPs shape the specific settings in which they develop. The papers demonstrate that partnerships and place are intrinsically reciprocal: the morality and materiality inherent in places repeatedly reset the reference points for partners, trigger epiphanies, shift identities, and redistribute capacities to act. Place thus becomes generative of partnerships in the most profound (...) sense: by developing an awareness of their emplacement, CSPs commit to place, and through their place-based commitments produce three intertwined modalities of place-specific ethics that bind CSPs and place: ethic of recognition, an ethic of care, and an ethic of resilience. Our authors have found vivid examples of how emplaced CSPs embody these ethics, signaling hope for the sustainability of our (always hyper-local) life-worlds. (shrink)

Th is paper uncovers how demolition has served as a collective way of forgetting violent pasts. It explores several examples in Canada, including the 1992 demolition of the notorious Mount Cashel Orphanage in St. John’s, Newfoundland, a building we claim was purposefully razed to the ground in order to forget egregious crimes of sexual abuse that had taken place on the site. We contend that as with other sites associated with difficult memories, this was a valiant effort to forget by (...) removing all traces of the setting. We note that even when buildings are not demolished following violent events, echoes of their architectural forms are often recast in the forms of memorials, both real and virtual. (shrink)

Although using different labels, genre theorists from different traditions have generally given privilege to the communicative purpose, in this article referred to as rhetorical objective, as genre determinant. Genre analysts who have studied press releases in particular tend to share this view, but nevertheless categorize communicative events conveyed through the press release as belonging to one genre despite variation in rhetorical objectives. This article argues that although the press release may be seen as a genre on the basis of textual (...) form, it does not qualify for the genre label if analysed in terms of content and rhetorical objective. To substantiate my claim, I shall discuss a small corpus of press releases, all focusing on a specific biotechnological issue. In my analyses I shall discuss staging in terms of content as well as logico-semantic relations between stages, patterns of stage combinations and their linguistic realizations with the aim of identifying variation in rhetorical objective. (shrink)

ABSTRACTRecent years have seen an increase in the influx of asylum-seekers in Scandinavia, and in Denmark this has led to ever-tighter immigration control. This article discusses emerging practices of refugee solidarity and resistance to migration policy in Danish civil society in the wake of what has been referred to as the European refugee crisis. To accomplish this purpose, I analyse how participants in Facebook discussions construe topoi and attitudes when facing the ethical dilemma of respecting the law versus showing concern (...) for humans in need, in line with what Foucault, Michel Foucault: Beyond Structuralism and Hermeneutics. Chicago: The University of Chicago Press) has referred to as ‘ethical self-formation’. This is illustrated through a case study of an incident from September 2015, when a member of a Danish City Council offered private shelter to immigrants on their way to Norway. The incident led to legal proceedings in August 2016 for what the defendant referred to as ‘the offense of helping fellow human beings in need’. The study is informed by Critical Discourse Analysis. Analysing Discourse. Textual analysis for social research. London and New York: Routledge; Wodak, R.. The politics of fear. London and New York: Sage) and governmentality theory. The subject and Power. In H. Dreyfus & P. Rabinow, Michel Foucault: Beyond Structuralism and Hermeneutics. Chicago: The University of Chicago Press; Foucault, M.. Security, Territory, Population: Lectures at the Collège de France 1977–78.. New York: Palgrave Macmillan; McIlvenny, P., Klausen, J. Z., & Lindegaard, L. B.. Studies of Discourse and Governmentality. Amsterdam and Philadelphia: Benjamins). Data include media representations and facebook comments published during 2016. The analytical approach combines topos analysis.. Methods of Critical Discourse Analysis. London: Sage; Wodak, R.. The politics of fear. London and New York: Sage) and appraisal analysis to tease out evaluative meaning. (shrink)

Giving the foundation of his doctrine of the “Umwelten” v.Uexküll considersKants idealism as the best starting point. The present essay, to the contrary, tries to demonstrate, that the peculiarity of his problems rather corresponds to the logical and metaphysical position ofLeibniz's “monadology” and so shares its philosophical profundity as well as its ontological difficulties. Cardinal points of this correspondence are the following: 1) There is a plurality of subjective worlds=“Umwelten”=“monads”. 2) They are completely isolated one from another. 3) The subject (...) bilds up its reality quite autonomically according to an ideal and specific law=plan=conception. 4) The individual vital laws harmonize according to an optimal general plan. 5) The objective space is denied and regarded as the formalized system of living subjective centres=points of view. 6) Therefrom results the difficulty of explaining a causality of inconscious nature, which is independent from the subject. 7) From this follows the necessity of speculatively amplifying the conception of “subject” or “monad” as well as finally displacing the problem of reality into the metaphysical-religious sphere of a supreme monad or subject.En donnant les raisonnements de sa doctrine des „Umwelten”, M. v.Uexküll considère l'idéalisme deKant comme le meilleur point de départ. Par contre le présent essai cherche à démontrer que la disposition du problème effectivement en question le met plutÔt en parallèle, du point de vue du criticisme et de la métaphysique, avec la „monadologie” deLeibniz, à l'ampleur philosophique de laquelle elle participe aussi bien qu'à ses difficultés ontologiques. Les points cardinaux de cette concordance sont les suivants: 1) la pluralité des mondes subjectifs=„Umwelten” =„monades”; 2) leur intégral isolement réciproque; 3) l'autonomie du sujet quant à la construction de sa réalité, suivant une loi idéelle et spécifique; 4) l'harmonie de toutes les lois vitales et individuelles suivant un plan d'ensemble tendant à un optimum; s) le reniement de la réalité absolue de l'espace objectif et son interprétation comme système formalisé de centres subjectifs vivants ; 6) la difficulté qui en résulte pour l'admissibilité d'une causalité de la nature inconsciente, indépendante du sujet; 7) la nécessité, en découlant, d'une amplification spéculative de l'idée du „sujet” ou de la „monade”, ainsi que, finalement, le renvoi du problème de la réalité dans la sphère métaphysico-religieuse d'une monade suprÊme ou d'un suprÊme sujet. (shrink)

Departing from the view that genres are regulative as well as constitutive of social action, this article explores the interconnectedness of genres and Discourses that transit generic boundaries. Situating the study in a local energy transition project in Denmark and exploring what happens in a series of citizen meetings without a narrowly defined agenda, I argue that the meetings may be seen as a nexus of genres constituted by a tissue of interwoven Discourses with a lifespan that extends beyond the (...) specific communicative moment. I understand a nexus of genres as a point where genres in a wider sense meet and interact. Relating the Discourses initiated by the participating citizens to the ideational, the interpersonal and the textual metafunctions in systemic functional linguistics, I analyse topics made salient by actors participating in the citizen meetings. By following these topics intertextually across generic boundaries, I identify Discourses that are mutually entangled and genres that are taken up in the process. These include anticipatory Discourse, Discourse of legitimation, Discourse of motivation, Discourse about technology and Discourse about energy saving initiatives or in other words Discourses that exceed the boundaries of the specific genre in which they are realized. (shrink)

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)

Background: Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures, complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the values (...) underlying informed consent. Methods: Over a 2-week period in April 2014 we conducted semistructured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute’s requirements for consent, and the researchers’ strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. Results: Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors’ accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. Conclusions: We argue that while building and maintaining trusting relationships in research is important—not least in developing countries—strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out. (shrink)

To clarify concerns that the public has with genetic technologies, the article presents the results of focus group interviews conducted in Denmark in 2000. The concerns of the public are divided into three ideal-typical categories: social, economic, and cultural. Following a general discussion of why it is important to take these discourses of concern seriously, each discursive category is discussed with examples taken from the focus group interviews.

Confusion surrounds Catholic teaching on the use of assisted nutrition and hydration, specifically the question of when, if ever, its refusal or removal is ethical. This paper focuses on two often-neglected considerations: the relationship between means and mechanism, and an assessment of proportionality of the mechanism from the patient’s perspective. The authors draw on two critical principles of Catholic moral teaching: only ordinary means are required, and proportionality is subject to the perspective of the patient, not just that of experts (...) or the culture. The mechanisms that provide food and water have distinct benefits and burdens. Their proportionality is properly subject to analysis by the patient or surrogate, who determines which mechanism is acceptable in the patient’s situation. (shrink)

Over recent decades, public participation in technology assessment has spread internationally as an attempt to overcome or prevent societal conflicts over controversial technologies. One outcome of this new surge in public consultation initiatives has been the increased use of participatory consensus conferences in a number of countries. Existing evaluations of consensus conferences tend to focus on the modes of organization, as well as the outcomes, both procedural and substantial, of the conferences they examine. Such evaluations seem to rest on the (...) assumption that this type of procedure has universally agreed goals and meanings, and that therefore consensus conferences can readily be interpreted and applied across national boundaries. This article challenges this approach to consensus conferences. The core of the article is a study of national differences in ideas about what constitutes legitimate goals for participatory arrangements. The study looks at three consensus conferences on GMOs, which took place in France, Norway, and Denmark. Drawing on this study, the article discusses the ways in which interpretations of the concept of participation; the value attributed to lay knowledge vs. technical expertise; as well as ideas about the role of the layperson, are all questions that prompt entirely different answers from country to country. Further, the article analyses these national differences within a theoretical framework of notions of democratic legitimacy. (shrink)

The interview revolves around the idea that Al Qaeda is a distinctively modern phenomenon dependent upon modern and Western ideas of transformation of the human condition through mass violence. Meanwhile, the USA and Europe are deeply superstitious about their own unique position in the world. Professor John Gray outlines a clash of modernisms, the one not less ambitious or global in nature than the other. He applies an analysis of modernity upon present phenomena such as the war in Iraq, the (...) failed EU constitution, the debate about Muslims and more broadly religion in secular societies, etc., and sketches an alternative path for the West than the present liberal revolutionary; a path informed by an awareness of limitations. (shrink)

Participatory methods aim to address controversy over new technologies through public consultation. This paper first describes the emergence of participatory methods within the framework of technology assessment, then provides an overview of the landscape of participatory arrangements; and, finally, discusses participatory methods in relation to different democratic ideals. The article challenges the widespread assumption that participatory methods can function as normatively neutral tools, which can readily be employed in various social and political settings. Through a case study of consensus conferences (...) on GMOs in three European countries, the article investigates the interpretive processes that take place when participatory procedures are applied in new national political settings. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

In public debate GMPs are oftenreferred to as being unnatural or a violationof nature. Some people have serious moralconcerns about departures from what is natural.Others are concerned about potential risks tothe environment arising from the combination ofhereditary material moving across naturalboundaries and the limits of scientificforesight of long-term consequences. To addresssome of these concerns we propose that anadditional element in risk assessment based onthe concept of familiarity should beintroduced. The objective is to facilitatetransparency about uncertainties inherent inthe risk assessment of (...) the GMP. Familiarityconventionally involves data and experiencerelating to the plant species and the ecosystemin question. We would like to extend thisconcept to the molecular level of plantbreeding and suggest that GMP characteristicsshould be compared to a reference baselinedetermined by conventional breeding techniques.Three GMPs are ranked according to familiarityat the plant and ecosystem level and themolecular level. The approach may help tointegrate discussion of the scientificarguments and moral questions raised in thedebate about GMOs by providing an operationalscheme within which moral concerns are broughtwithin the framework of science-based riskassessment. (shrink)

A collection of essays on philosophy and politics on the occasion of the 65th birthday of the radical philosopher Frieder Otto Wolf.

In Europe the use of genetically modified (GM) crops in food production has so far failed to gain wide public approval. Ordinary people are concerned about issues not covered by the existing regulation, including usefulness and unnaturalness. In response, particularly to worries about unnaturalness, biotechnologists have suggested that inserted genes should derive only from the plant itself, or from close relatives. This paper examines public perceptions of these so-called ‘cisgenic crops’ and asks whether the public shares the idea that they (...) are less unnatural and thus more acceptable than transgenic plants. Using five focus group interviews, we identified five lines of argument about naturalness with a bearing on the assessment of cisgenic crops as well as GM crops in general. The paper concludes that, depending on perceptions of naturalness, some people would agree that cisgenic crops are more acceptable than their transgenic counterparts. The finding that ordinary people value different aspects of naturalness may be relevant to a broader audience than just those interested in gene technology. It cautions against a simplistic interpretation of what counts as ‘natural’. (shrink)

The article critically examines the ideas of the Dutch philosopher and ethnologist Annemarie Mol. Her main work, “The Body Multiple: Ontology in Medical Practice”, is mainly subjected to analysis. According to the author of the article, A. Mol managed to offer his own version of the “ontological turn” and, perhaps, change the accents in the entire theoretical repertoire of actor-network theory (ANT). She, carrying out a “police investigation” in hospital Z, was able to show the multiplicity of ontologies of the (...) body and its disease / illness. What is called the illness is represented by a large number of actors – people, their relationships, tools, diagnostic methods, etc. – which together can be represented as an assembly or assemblage. The “choreography of the ontology” of such an assembly is contingent, since it may be different. (shrink)

Die rationalen Vermögen sind bewusst im Hinblick auf den Begriff des zu bewirkenden Zustands oder Gegenstands erworben. Dank dieses Logos oder Wissens um die Definition des zu bewirkenden Ziels können sie nicht bloß wie die angeborenen naturalen Vermögen angewandt werden oder nicht, sondern sind für inhaltlich gegensätzliche Resultate offen. Bei den rationalen Vermögen im engeren Sinne, den Kunstfertigkeiten, erwerben wir durch Einübung wertneutrale operative Fähigkeiten, so dass erst eine hinzukommende Entscheidung eine eindeutige Verwirklichung erlaubt. Bei den Tugenden üben wir uns (...) in ein Vermögen ein, dem eine sittliche Ausrichtung der Entscheidungen integriert ist, das dennoch prinzipiell offen bleibt. Um in einer Situation die Handlung herauszufinden, die äußerlich die Merkmale einer Tugend hat, muss die Naturanlage zum rationalen Vermögen entfaltet sein. Dieses ist in der Tugend zur Disposition weiterentwickelt, sich für diese Handlungsweise stets und um ihrer selbst willen zu entscheiden.Unlike innate natural potencies, acquired rational potencies by virtue of the logos of the goal to be realised not only can be exercised or not, but even are open to results of opposite contents. In the case of rational potencies in the narrower sense , we acquire, by habituation, operational abilities which are morally neutral so that a decision is required for an unequivocal result to be achieved. In the case of virtues, the acquired potency has a moral orientation for our decisions integrated in itself and nevertheless remains, in principle, open. In order to find out in a certain situation which action has the external characteristics of a virtue, the natural faculty must be developed to be a rational potency. In the virtue, the latter is further developed to be the disposition to choose this type of action always and for its own sake. - This new systematic reconstruction is meant to explore in how far Aristotelian virtues may be regarded as rational potencies. (shrink)

During his lifetime, he saw his works translated into German, Swedish, English, French, Hungarian and Dutch. These works were widely read and frequently reprinted in numerous editions throughout the second half of the century.

Name der Zeitschrift: Kierkegaard Studies Yearbook Jahrgang: 2017 Heft: 1 Seiten: 423-437.

The paper examines whether a perspective, which posits political communities as relative unchanging groups, can adequately capture a possible reinterpretation of liberal ideals. It also analyses whether statist measures designed to rectify structural inequality can be one motivating factor in the reinterpretation of these ideals. -/- .

The strategy of deterrence suffers from at least 8 deficiencies: 1. The deterrence threat may be underestimated or overestimated. 2. The efficacy of deterrence is conditioned by o variety of factors. 3. Deterrence is highly questionable inasmuch as it represents the principle of revenge. 4. Deterrence may lead to self-deterrence. 5. Extended deterrence may have a low degree of credibility. 6. The stability of the deterrence system is constantly jeopardized. 7. Deterrence may lead to accidental nuclear war. 8. Moral acceptability (...) of deterrence is decreasing. Attempts to overcome these deficiencies by upgraded deterrence postures, arms control, unilateral disarmament and defensive systems have been futile. Therefore mankind will have to live with deterrence; efforts ought to be undertaken, however, to prevent a ‘nuclear Sarajevo’ by appropriate measures stabilizing the strategic system. (shrink)