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)

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)

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)

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 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)

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)

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)

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)

This book reveals the sense in which our postmodern societies are characterized by the obscene absence of the intellectual. The modern intellectual--who had once been associated with humanism and enlightenment—has in our day been replaced by media stars, talking heads, and technical experts. At issue is the ongoing crisis of democracy, under the aegis of the société du spectacle and its vast networks of politically-induced idiocy, industrially-produced biocide, and militarily-provoked genocide. Spectacle fills the resulting moral and intellectual vacuum with electronic (...) technologies of control, punishment, and destruction. This postmodern tyranny reduces intelligence to mechanistic, positivist, and grammatological models of inquiry, while increasing the segmentation, fragmentation, and dissolution of human existence. The apotheosis of the spectacle explains the intellectual void that lies at the heart of our postmodern decadence; it also accounts for the need to recuperate the humanist values of enlightenment promoted by the modern intellectual tradition. (shrink)

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)

Some commentators have condemned Kant’s moral project from a feminist perspective based on Kant’s apparently dim view of women as being innately morally deficient. Here I will argue that although his remarks concerning women are unsettling at first glance, a more detailed and closer examination shows that Kant’s view of women is actually far more complex and less unsettling than that attributed to him by various feminist critics. My argument, then, undercuts the justification for the severe feminist critique of Kant’s (...) moral project. (shrink)

The lesion and transplantation data cited by Sinden et al., when considered in tandem, seem to harbor an internal inconsistency, raising questions of false localization of function. The extrapolation of such data to cognitive impairment and potential treatment strategies in Alzheimer's disease is problematic. Patients with focal basal forebrain lesions (e.g., anterior communicating artery aneurysm rupture) might be a more appropriate target population.

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)

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)

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 myside bias in written argumentation entails excluding other side information from essays. To determine the locus of the bias, 86 Experiment 1 participants were assigned to argue either for or against their preferred side of a proposal. Participants were given either balanced or unrestricted research instructions. Balanced research instructions significantly increased the use of other side information. Participants' notes, rather than search patterns, predicted the myside bias. Participants who defined good arguments as those that can be “proved by facts” (...) were more prone towards the myside bias. In Experiment 2, 84 participants of high and low argumentation ability read a text called “More Than Just the Facts” designed to contradict this fact-based argumentation schema. For high argumentation ability participants, the intervention reduced the myside bias, but for low ability participants it increased. The roots of the myside bias are underdeveloped argumentation schemata leading to misconceptions about research and argumentation. (shrink)

The Internet was conceptualized as a technology that would be capable of bringing about a better future, but recent literature in science and technology studies and adjacent fields provides numerous examples of how this pervasive sociotechnical system has been shaped and used to dystopic ends. This article examines different future imaginaries present in Future Internet Architecture projects funded by the National Science Foundation from 2006 to 2016, whose goal was to incorporate social values while building new protocols to replace Transmission (...) Control Protocol and Internet Protocol to transfer and route information across the ever-expanding Internet. I examine the findings from two of the NSF’s FIA projects—Mobility First and eXpressive Internet Architecture—to understand the projects’ trajectories and values directives through their funding cycle and their projections into the future. I discuss how project documentation and participant articulations fall into the following three distinct themes about past experience and speculation: understanding the public, negotiating resources, and carrying project values into the future. I conclude that if the future Internet is to promote positive sociotechnical relationships, its architects must recognize that complex social and political decisions pervade each step of technical work and do more to honor this fact. (shrink)

Through a close reading of Plato’s Euthyphro, I reopen an old question: what would it look like to think piously? Although the dialogue itself is aporetic with regard to the definition of piety as such, I show that a specifically philosophical piety emerges: namely, the capacity to deal well with sameness and difference. A look at central features of the dialogues that provide the Euthyphro’s dramatic context confirms this claim.

Genetic engineering techniques (e.g., CRISPR-Cas) have led to an increase in biotechnological developments, possibly leading to uncertain risks. The European Union aims to anticipate these by embedding the Precautionary Principle in its regulation for risk management. This principle revolves around taking preventive action in the face of uncertainty and provides guidelines to take precautionary measures when dealing with important values such as health or environmental safety. However, when dealing with ‘new’ technologies, it can be hard for risk managers to estimate (...) the societal or environmental consequences of a biotechnology that might arise once introduced or embedded in society due to that these sometimes do not comply with the established norms within risk assessment. When there is insufficient knowledge, stakeholders active in early developmental stages (e.g., researchers) could provide necessary knowledge by conducting research specifically devoted to what these unknown risks could entail. In theory, the Safe-by-Design (SbD) approach could enable such a controlled learning environment to gradually identify what these uncertain risks are, to which we refer as responsible learning. In this paper, we argue that three conditions need to be present to enable such an environment: (1) regulatory flexibility, (2) co-responsibility between researchers and regulators, and (3) openness towards all stakeholders. If one of these conditions would not be present, the SbD approach cannot be implemented to its fullest potential, thereby limiting an environment for responsible learning and possibly leaving current policy behind to anticipate uncertain risks. (shrink)

Our contribution takes shape as reflections on Object Lessons (Wiegman, 2012) from the perspective of three scholars of race, gender and sexuality who were also graduate students of Robyn Wiegman in the mid-2000s at Duke University. All three of us took Introduction to Feminist Theory with her and all three of us received graduate certificates in Feminist Studies. Our educational and career trajectories also share this similarity: we received PhDs in the disciplines (English, Comparative Literature and French), but went on (...) to jobs that are either completely or partially housed in departments invested in studying what Wiegman calls ‘identity knowledges' (namely, African American Studies and Gender Studies). In these essays, we reflect on how Wiegman's course helped shaped our approaches to academic knowledge production and how her reflexive pedagogy animates not only Object Lessons but also our own critiques of identity’s institutionalized forms. (shrink)

A Cinematic Humanist approach to film is committed inter alia to the following tenet: Some fiction films illuminate the human condition thereby enriching our understanding of ourselves, each other and our world. As such, Cinematic Humanism might reasonably be regarded as an example of what one might call ‘Cinematic Cognitivism’. This assumption would, however, be mistaken. For Cinematic Humanism is an alternative, indeed a corrective, to Cinematic Cognitivism. Motivating the need for such a corrective is a genuine scepticism about the (...) very notion of the cognitive. Using historical reconstruction, I reveal how ‘cognitive’ has become a multiply ambiguous, theory-laden term in the wake of, indeed as a consequence of, Noam Chomsky’s original stipulative definition. This generates a constitutive problem for cognitivism as both a research programme and a set of claims, and as such poses a trilemma for philosophers of film, art and beyond. I propose a Cinematic Humanist solution to the problematic commitments of cognitive film theorising and, in so doing, gesture towards a methodology I am calling ‘philosophy of film without theory’. (shrink)

This book is about the ways in which modern enlightenment, rather than liberating humanity from tyranny, has subjected us to new servitude imposed by systems of mass manipulation, electronic vigilance, compulsive consumerism, and the horrors of a seemingly unending global war on terror. The main intellectual aims of this title are the following: the analysis of spectacle, the criticism of providential enlightenment, and the examination of positive dialectics. The spectacle, in this case, is the apotheosis of the culture industries, a (...) total inversion of reality and of our existences. Providential enlightenment is not only a critique of the failure of enlightenment, but of the mutilation of historical enlightenments. Positive dialectics signal a new era of intellectual engagement in the construction of our historical future. During a time in which national democracies seem an imperial farce, it is not enough for intellectuals faced with all this destruction to blithely recommend resistance. The book thus ties American, British, French and German theoretical traditions into a reflexive challenge to the notion of intellectual as critic, and argues instead for a trespassive tradition of cultural leadership. (shrink)

Three years after John Haugeland’s passing, we are privileged to take up the manuscript he labored over but was not granted the time to finish. That manuscript, from which this book as a whole gets its title, has been carefully edited for continuity by Joseph Rouse, who also provides us with plenty of context for making sense of it. Rouse’s lengthy Editor’s Introduction outlines the central peculiarities of Haugeland’s reading of Martin Heidegger and argues for the relevance of that reading (...) for contemporary philosophical thought, broadly construed. Rouse’s editorial footnotes, in addition to their usual role of clarifying textual matters, extend the work of his introduction by tracking substantive changes in Haugeland’s thinking across 30 years of work, and by flagging for the reader Haugeland’s more unusual interpretations. Furthermore, Rouse has included nine other texts of Haugeland’s that either directly or indirectly elucidate Heidegger’s work in the late 1920s, the last of which .. (shrink)

The paper works out an account of the piety proper to philosophical thought. The investigation proceeds as a critical interpretation of three enigmatic claims made by Martin Heidegger about ‘the piety of thinking,’ but the paper is not simply exegetical; the interpretive work is constantly in service of an attempt to think through the phenomenon independently. Plato’s Euthyphro and Nietzsche’s critique of scientific piety both hover in the background of Heidegger’s pronouncements, and they are given special attention here. Through the (...) investigation, philosophical piety is shown to be a virtuous capacity to respond with fitting submission to the truth as what is insurmountably prior to us. To respond fittingly is, at least, to deal well with sameness and difference, which in the case of piety means to recognize two features of our situation: that philosophical questioning necessarily arises out of a fundamental listening, or affirmation, and that we always belong to being but only ever across a gap. (shrink)