The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted (...) differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted (...) differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of (...) communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

The main objective of this study is to eliminate the obstacles that the stylistic, structural, and methodological aspects of the text place in the way of reading and understanding Ludwig Wittgenstein's later work. The characteristic features of these elements are developed and discussed in the context of a close reading of the short section on reading in the Philosophical Investigations. Wittgenstein's aim in this section is the negative one of completely undermining explanatory accounts of the meaning of reading in terms (...) of mental states, experiences, or neurophysiological functions of the brain. In this respect the section on reading forms a clearing ground and a propaedeutic to Wittgenstein's conception of understanding as a rule-following activity. ;The signature of Wittgenstein's style is characterized by a dialogic terseness, an economy of expressions manifest in the brevity of numbered remarks, and a number of strategically indirect rhetorical devices. The structure of the text is shown to be discontinuous and multidirectional. The textual organization forms an overlapping and complex network that mirrors the complexity and multifaceted structure of language. The discontinuity easily inhibits following Wittgenstein's thought, and results in a judgment and dismissal of the text as being fragmented, frayed, and thus lacking structure. ;Wittgenstein's method is contrasted to the application of the scientific method to solving philosophical problems and to the phenomenological method of examining experiences. The argument for the existence of a method at all consists in focussing on and developing three methodological principles: recalling the course of philosophical nonsense; reminding ourselves of what we already know; and arranging and rearranging what already lies open to view. ;Bringing philosophical problems to an end by exposing them as pseudo-problems that often are caused by the forms of our expressions, is reached by an Ubersicht, an overview, of the multiple facets of language. Such an overview is gained by an application of Wittingenstein's method. An analysis of the section on reading in terms of its philosophical purpose and point illuminates the complex interplay of the methodological aspects, the unconventional structure of the text, and the profile of Wittgenstein's unique philosophical style. (shrink)

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A (...) hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence. (shrink)

Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection (...) from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient’s dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient’s wishes and needs are the starting point. (shrink)

The patient’s home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative care. (...) The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person‐centered approach. (shrink)

This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18—24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of (...) meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize. (shrink)

Today, societal decisions in areas of complexity are often dominated by one of three alternative ways: (a) by scientists, nowadays often in combination with commercial interest; (b) by politicians alone; and (c) by simply “laissez-faire,” or “the tyranny of small steps.” None of these three ways of decision making is fully democratic because they do not create enough awareness among the politicians and the general public. One reason is that the decision making basis becomes too narrowly framed and fragmented. Biotechnology (...) will continue to feed society with new democratic challenges for many years, perhaps decades, to come. The initially promising ideas of participative and deliberative democracy do not seem to solve the awareness problem. Instead, the authors propose an approach with more structured efforts for awareness building with transparency and participation taking place within the framework of representative democracy. (shrink)

From an aging research and life-course perspective, the transition to retirement marks a significant life-event and provides a unique opportunity to study psychological health and coping during a period of substantial change in everyday life. The aim of the present paper is to: (a) outline the rationale of the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) study, (b) describe the study sample, and (c) to present some initial results from the two first waves regarding the association between retirement status (...) and psychological health. The HEARTS study is designed to annually study psychological health in the years before and following retirement, and to examine change and stability patterns related to the retirement event. Among a representative Swedish population-based sample of 14 990 individuals aged 60 to 66 years, 5 913 completed the baseline questionnaire in 2015. The majority of the participants (69%) completed a web-based survey, and the rest (31%) completed a paper version. The baseline HEARTS sample represents the general population well in terms of gender and age, but is more highly educated. Cross-sectional findings from the first wave showed that retired individuals demonstrated better psychological health compared to those who were still working. Longitudinal results from the first and second waves showed that individuals who retired between waves showed more positive changes in psychological health compared with those still working or previously retired. (shrink)

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is (...) needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice. (shrink)

The counterfactual comparative account of harm has counterintuitive implications in cases involving overdetermination and preemption. A popular strategy for dealing with these problems appeals to plural harm—several events being jointly harmful. Björn Petersson criticizes this strategy on the grounds that it conflicts with a strong intuition that helps to motivate the counterfactual comparative account, namely, that harming someone essentially involves making a difference for the worse for her. In this paper, I argue that Petersson’s argument is unconvincing.

The link between nature and the spiritual life has been a mainstay in Christianity going back to the beginning of Scripture. However, our modern context has veered toward a humancentric emphasis in the use of nature for spiritual purposes. This article seeks to recover a framework for connecting nature and the spiritual life by analyzing and applying the writings of the hymn-writer Isaac Watts. Influenced by the English Puritans and the eighteenth-century English naturalists, Watts leverages the empirical and the spiritual (...) to employ a theocentric natural theology in his hymnody, psalmody, and spiritual prose. Examining these writings of Watts, in turn, aid in recovering a faithful use of nature in spiritual formation within our modern Christian context. (shrink)

In this article I argue for an empiricist view on laws. Some laws are fundamental in the sense that they are the result of inductive generalisations of observed regularities and at the same time in their formulation contain a new theoretical predicate. The inductive generalisations simul- taneously function as implicit definitions of these new predicates. Other laws are either explicit definitions or consequences of other previously established laws. I discuss the laws of classical mechanics, relativity theory and electromagnetism in detail. (...) Laws are necessary, whereas acciden- tal generalisations are not. But necessity here is not a modal concept, but rather interpreted as short for the semantic predicate “... is necessarily true”. Thus no modal logic is needed. The neces- sity attributed to law sentences is in turn interpreted as “necessary condition for the rest of the the- ory”, which is true since fundamental laws are implicit definitions of theoretical predicates use in the theory. (shrink)

BÄCKSTRÖM B, ASPLUND K and SUNDIN K.Nursing Inquiry2010;17: 257–268 The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischargeStroke consequences present a great long‐term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle‐aged female spouses’ lived experience of their relationship with a partner who has suffered a stroke, during the first year (...) postdischarge. Four middle‐aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio‐taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners’ cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge. (shrink)

"Postsecular Benjamin"explicates Benjamin's engagements with religious traditions as resources for contemporary debates on secularism, conflict, and identity.".

Examines the historical, cultural, and religious context of the life and work of German Jewish philosopher Walter Benjamin (1892-1940).

Newtonian mechanics has a container conception of space. Space is regarded as an empty receptacle in which all material bodies exist. For a long time, most defenders of this view claimed that it must be mind-dependent. Anton Marty is the first modern philosopher to argue both that physical space is mind-independent and that it has the features characteristic of Newtonian physical space. Moreover, he works out a number of metaphysical implications of this view. Therefore, Marty ought to be given a (...) prominent place in the history of conceptions of space. As shown by Graham Nerlich, a container conception can be defended even after the twentieth-century revolutions in physics. By bringing Marty and Nerlich together, the paper claims that a container conception of space/space-time should even today be taken seriously in the philosophy of physics. (shrink)

Electromagnetism is usually understood as a theory describing how charged particles and eletromagnetic fields interact. In this paper I argue that a double ontology comprising both particles and fields is problematic. Either we should think of electromagnetism as a theory about charged particles directly interacting with each other, or as theory of fields whose local interactions are manifested as field quanta, called "particles." From a purely theoretical point of view the choice between a particle and a field interpretation does not (...) matter much when it concerns classical electromagnetism; both interpretations are possible and, as shown by Quine, there is a general method for translating a theory about one kind of objects into a theory assuming another kind of objects, provided these theories are empirically equivalent. From an empiricist point of view, however, the particle interpretation is the choice, since some particles are directly observable. Testable predictions of electromagnetism are predictions of the motion of charged bodies, in theory represented as particles, so this must be the empiricists' choice of ontology. In quantum electrodynamics one is however forced to chose a field ontology, since a particle ontology for this theory is impossible. So called "quantum particles" are field quanta, which cannot be treated as individuals making up a domain of quantification. There is thus a tension regarding ontology between classical and quantum electrodynamics. But this tension is nothing else than the much debated measurement problem of quantum mechanics. (shrink)

We have argued that the counterfactual comparative account of harm and benefit (CCA) violates the plausible adequacy condition that an act that would harm an agent cannot leave her much better off than an alternative act that would benefit her. In a recent paper in this journal, however, Neil Feit objects that our argument presupposes questionable counterfactual backtracking. He also argues that CCA proponents can justifiably reject the condition by invoking so-called plural harm and benefit. In this reply, we argue (...) that Feit’s lines of criticism are both unsuccessful. (shrink)

In this paper, we put forward two novel arguments against the counterfactual comparative account (CCA) of harm and benefit. In both arguments, the central theme is that CCA conflicts with plausible judgements about benefit and prudence.

Inductive thinking is a universal human habit; we generalise from our experiences the best we can. The induction problem is to identify which observed regularities provide reasonable justification for inductive conclusions. In the natural sciences, we can often use strict laws in making successful inferences about unobserved states of affairs. In the social sciences, by contrast, we have no strict laws, only regularities which most often are conditioned on ceteris paribus clauses. This makes it much more difficult to make reliable (...) inferences in the social sciences. In particular, we want knowledge about general causal relations in order to be able to determine what to do in order to achieve a certain state of affairs. Knowledge about causal relations that are also valid in the future requires experiments or so called ‘natural experiments’. Only knowledge derived from such experiences enable us to draw reasonably reliable inferences about how to act in order to achieve our goals. (shrink)

Everyday resistance is about the many ways people undermine power and domination through their routine and everyday actions. Unlike open rebellions or demonstrations, it is typically hidden, not politically articulated, and often ingenious. But because of its disguised nature, it is often poorly understood as a form of politics and its potential underestimated. Conceptualizing Everyday Resistance presents an analytical framework and theoretical tools to understand the entanglements of everyday power and resistance. These are applied to diverse empirical cases including queer (...) relationships in the context of heteronormativity, Palestinian daily life under military occupation, workplace behaviors under office surveillance, and the tactics of fat acceptance bloggers facing the War against obesity. Johansson and Vinthagen argue that everyday resistance is best understood by accounting for different repertoires of tactics, relations between actors, and struggles around constructions of time and space. Through a critical dialogue with the work of James C. Scott, Michel de Certeau, and Asef Bayat, they aim to reconstruct the field of resistance studies, expanding what counts as resistance and building systematic analysis. Conceptualizing Everyday Resistance offers researchers and students from different theoretical and empirical backgrounds, an essential overview of the field and a creative framework that illuminates the potential of all people to transform society. (shrink)

This study investigates how allomaternal care impacts human development outside of energetics by evaluating relations between important qualitative and quantitative aspects of AMC and developmental outcomes in a Western population. This study seeks to determine whether there are measurable differences in cognitive and language outcomes as predicted by differences in exposure to AMC via formal and informal networks. Data were collected from 102 mothers and their typically developing infants aged 13–18 months. AMC predictor data were collected using questionnaires, structured daily (...) diaries, and longitudinal interviews. Developmental outcomes were assessed using the Cognitive, Receptive Language, and Expressive Language subtests of the Bayley III Screening Test. Additional demographic covariates were also evaluated. Akaike Information Criterion -informed model selection was used to identify the best-fitting model for each outcome across three working linear regression models. Although AMC variables had no significant effects on Receptive and Expressive Language subtest scores, highly involved familial AMC had a significant medium effect on Cognitive subtest score. Formal childcare had no effect on any outcome. This study provides preliminary evidence that there is a measurable connection between AMC and cognitive development in some populations and provides a methodological base from which to assess these connections cross-culturally through future studies. As these effects are attributable to AMC interactions with networks of mostly related individuals, these findings present an area for further investigation regarding the kin selection hypothesis for AMC. (shrink)

The meaning of being a middle‐aged close relative of a person who has suffered a stroke, 1 month after discharge from a rehabilitation clinicThe sudden and unexpected impact of stroke may have a stressful affect on close relatives. To illuminate the essential meaning in the lived experience of a middle‐aged close relative of a person who has suffered a stroke, narrative interviews were conducted with 10 close relatives of people who had suffered their first stroke where both parties were aged (...) over 18 and under 65. A phenomenological‐hermeneutic interpretation of the narratives was then conducted. Three intimately intertwined themes emerged during the analysis: ‘being called to mission’, ‘feeling lost and set adrift’ and ‘struggling to keep going’. The middle‐aged close relatives felt unreflectively duty bound. There was a struggle with suffering and enduring the process of coping with life and overcoming a feeling of helplessness. Life turned out to be a struggle with overwhelming feelings. They felt alienated in a restricted life situation, disconnected from themselves and others, and from a world that supports feelings of being lost and set adrift (i.e. feeling homeless). Strength was found in moments when the situation improved, in being related to oneself and others, and when feelings of normality were regained. (shrink)