This essay characterizes a version of internal realism. In §1 I will argue that for semantical reasons we should be realists of a strong kind. In §2 I plead for an internalistic setting of realism starting from the thesis that truth is, at least, not a non-epistemic concept. We have to bear the consequences of this in form of a more complicated concept of truth. The ‘internal’ of ‘internal realism’ points to the justification aspect of truth. The ‘realism’ of ‘internal (...) realism’ points to the correspondence aspect. A thesis concerning the irreducibility of the two aspects will be established in §3. (shrink)

Haeusermann et al. (Citation2023) draw three overall conclusions from their study on closed loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. The first is that closed-loop neuromodulation devices did not substantially change epileptic patient’s personalities or self-perception postoperatively. The second is that some patients and caregivers attributed observed changes in personality and self-perception to the epilepsy itself and not to the DBS treatments. The third is that the devices provided participants with novel ways to make sense of their (...) illness. These findings further demonstrate a misalignment between some neuroethicists’ concerns about putative postoperative changes to personality, and the empirical evidence for such changes. Haeusermann et al. nonetheless concede that “neurotechnology directed at persisting rather than episodic clinical phenomena could have greater implications for personality or self-perception, either because they operate more continuously or are directed at clinical phenomena that are more stably integrated into patients’ self-concepts” (41). We acknowledge that the hypothesis that participants did not report changes because they were only episodically and not continually stimulated offers an interesting line for future investigation. Nonetheless, we would like to propose that potential postoperative personality changes might be correlated with the pathophysiology itself, rather than the stimulation effects of the technology. Generally, we advance the view that unintended effects solely induced by the technology cannot be excluded per se. Regardless, this comment aims to highlight that ethicists’ starting premise should be that patients suffering from diverse pathophysiology, or patients who are treated with stimulation in different brain regions and with differing parameters, would likely not react in the same way to treatment. (shrink)

In his recent paper in History and Philosophy of Logic, John Kearns argues for a solution of the Liar paradox using an illocutionary logic (Kearns 2007 ). Paraconsistent approaches, especially dialetheism, which accepts the Liar as being both true and false, are rejected by Kearns as making no ?clear sense? (p. 51). In this critical note, I want to highlight some shortcomings of Kearns' approach that concern a general difficulty for supposed solutions to (semantic) antinomies like the Liar. It is (...) not controversial that there are languages which avoid the Liar. For example, the language which consists of the single sentence ?Benedict XVI was born in Germany? lacks the resources to talk about semantics at all and thus avoids the Liar. Similarly, more interesting languages such as the propositional calculus avoid the Liar by lacking the power to express semantic concepts or to quantify over propositions. Kearns also agrees with the dialetheist claim that natural languages are semantically closed (i.e. are able to talk about their sentences and the semantic concepts and distinctions they employ). Without semantic closure, the Liar would be no real problem for us (speakers of natural languages). But given the claim, the expressive power of natural languages may lead to the semantic antinomies. The dialetheist argues for his position by proposing a general hypothesis (cf. Bremer 2005 , pp. 27?28): ?(Dilemma) A linguistic framework that solves some antinomies and is able to express its linguistic resources is confronted with strengthened versions of the antinomies?. Thus, the dialetheist claims that either some semantic concepts used in a supposed solution to a semantic antinomy are inexpressible in the framework used (and so, in view of the claim, violate the aim of being a model of natural language), or else old antinomies are exchanged for new ones. One horn of the dilemma is having inexpressible semantic properties. The other is having strengthened versions of the antinomies, once all semantic properties used are expressible. This dilemma applies, I claim, to Kearns' approach as well. (shrink)

. Computational chemistry grew in a new era of “desktop modeling,” which coincided with a growing demand for modeling software, especially from the pharmaceutical industry. Parameterization of models in computational chemistry is an arduous enterprise, and we argue that this activity leads, in this specific context, to tensions among scientists regarding the epistemic opacity transparency of parameterized methods and the software implementing them. We relate one flame war from the Computational Chemistry mailing List in order to assess in detail the (...) relationships between modeling methods, parameterization, software and the various forms of their enclosure or disclosure. Our claim is that parameterization issues are an important and often neglected source of epistemic opacity and that this opacity is entangled in methods and software alike. Models and software must be addressed together to understand the epistemological tensions at stake. (shrink)

This book is a unique introductory overview of decision theory. It is completely non-technical, without a single formula in the book. Written in a crisp and clear style it succinctly covers the full range of philosophical issues of rationality and decision theory, including game theory, social choice theory, prisoner's dilemma and much else. The book aims to expand the scope and enrich the foundations of decision theory. By addressing such issues as ambivalence, inner conflict, and the constraints imposed upon us (...) by our attachments to others, Frederic Schick reveals that our thinking is often more subtle than standard theories of rationality allow. Only a theory that respects that subtlety can illumine what is otherwise puzzling. The book contains many examples drawn from history and literature dealing with subjects such as love, war, friendship, and crime. (shrink)

This is _the_ leading introduction 200to professional values and ethics in social work. Frederic G. Reamer provides social workers with a succinct and comprehensive overview of the most critical issues relating to professional values and ethics, including the nature of social work values, ethical dilemmas, and professional misconduct. Conceptually rich and attuned to the complexities of ethical decision making, _Social Work Values and Ethics_ is unique in striking the right balance between history, theory, and practical application. For the third (...) edition, Reamer has updated the content and strengthened the relevance of the case material. Also new to the third edition: o Discussion of the moral dialogue between practitioner and cliento Coverage of virtue ethicso Practical discussion of concepts underlying social work ethicso Expanded application of the National Association of Social Workers Code of Ethics to ethical dilemmas in the professiono A look at the historical evolution of ethical standards in social worko New vignettes, illustrating difficult ethical decisionso More guidance on informed consent and termination of serviceso Discussion questions at the end of each chaptero A section on how to conduct a social work ethics audit. (shrink)

In narrative style, Plato and the Founding of the Academy illustrates how the dialogue usually known as the Republic is constructed on the basis of simple but technical mathematical and harmonical principles, or numbers.

One important concern regarding implantable Brain Computer Interfaces is the fear that the intervention will negatively change a patient’s sense of identity or agency. In particular, there is concern that the user will be psychologically worse-off following treatment despite postoperative functional improvements. Clinical observations from similar implantable brain technologies, such as deep brain stimulation, show a small but significant proportion of patients report feelings of strangeness or difficulty adjusting to a new concept of themselves characterized by a maladaptive je ne (...) sais quoi despite clear motor improvement. Despite the growing number of cases in the DBS literature, there is currently no accepted or standardized tool in neuroethics specifically designed to capture the phenomenological postoperative experience of patients implanted with DBS or BCI devices. Given potential risks of postoperative maladaptation, it is important for the field of neuroethics to develop a qualitative instrument that can serve as a shared method for capturing postoperative variations in patient experience of identity and agency. The goal of this article is to introduce an instrument we have developed for this purpose and call for further neuroethical efforts to assess the phenomenology of implantable brain device use. (shrink)

Before the Darwinian revolution species were thought to be universals. Since then, numerous attempts have been made to propose new definitions. The twentieth-century German philosopher Nicolai Hartmann defined 'species' as an individual system of processes and a process of life of a higher-order. To provide a clear understanding of Hartmann's conception of species, I first present his method of definition. Then I look at Hartmann's Philosophie der Natur (1950) to present his concepts of "organism" and "species." And I end the (...) paper by pointing out two possible systematic inconsistencies. (shrink)

Brief, accessible, and affordable, these pocket-sized volumes offer the essential introductions to the great philosophers of the Western tradition-from Plato to Wittgenstein.

Introduction -- 1e Intermed consid -- Marx -- Simmel -- Weber -- Lukács -- 2e intermed consid -- Horkheimer -- Adorno -- 3e intermed consid -- Habermas I -- Habermas II -- Habermas III -- Conclusion -- Postscript -- Bibliography.

The Russian philosopher Nikolai Onufrievich Lossky adhered to an evolutionary metaphysics of reincarnation according to which the world is constituted of immortal souls or monads, which he calls ‘substantival agents.’ These substantival agents can evolve or devolve depending on the goodness or badness of their behavior. Such evolution requires the possibility for monads to reincarnate into the bodies of creatures of a higher or of a lower level on the scala perfectionis. According to this theory, a substantival agent can evolve (...) by being gradually reincarnated multiple times through a sort of process of metamorphosis from the level of the most elementary particles all the way up to the level of human beings or even higher. In ‘Ученiе Лейбница о перевоплощенiи какъ метаморфозѣ’, Lossky argues that the works of Leibniz contain scattered elements of such a systematic evolutionary doctrine of reincarnation as metamorphosis and he attempts to reconstitute this doctrine. The present article is intended as an historical introduction to the translation of Lossky’s ‘Leibniz’s Doctrine of Reincarnation as Metamorphosis.’. (shrink)

Philosophy is one of the most intimidating and difficult of disciplines, as any of its students can attest. This book is an important entry in a distinctive new series from Routledge: The Great Philosophers . Breaking down obstacles to understanding the ideas of history's greatest thinkers, these brief, accessible, and affordable volumes offer essential introductions to the great philosophers of the Western tradition from Plato to Wittgenstein. In just 64 pages, each author, a specialist on his subject, places the philosopher (...) and his ideas into historical perspective. Each volume explains, in simple terms, the basic concepts, enriching the narrative through the effective use of biographical detail. And instead of attempting to explain the philosopher's entire intellectual history, which can be daunting, this series takes one central theme in each philosopher's work, using it to unfold the philosopher's thoughts. (shrink)

We argue that a fashionable interpretation of the theory of natural selection as a claim exclusively about populations is mistaken. The interpretation rests on adopting an analysis of fitness as a probabilistic propensity which cannot be substantiated, draws parallels with thermodynamics which are without foundations, and fails to do justice to the fundamental distinction between drift and selection. This distinction requires a notion of fitness as a pairwise comparison between individuals taken two at a time, and so vitiates the interpretation (...) of the theory as one about populations exclusively. (shrink)

Intentional explanation, according to Elster, seeks to elucidate an action by showing that it was intentionally conducted, in order to bring about certain goals . Intentional actions furthermore, are rational actions: they imply that agents establish a connection between the goals they target and the means that are appropriate to reach them, by way of different beliefs about the means, the goals and the environment. But how should we understand intentional actions in the light of philosophical research on emotions, rationality, (...) and normativity? This question is the departure point of this article. Various philosophers have analyzed the relationships between rationality and emotion, those between emotion and normativity, and those between emotion and intentional action. Nonetheless, their theses are scattered and do not offer an integrative view on how rationality, normativity and emotions work from the standpoint of intentional explanation. By using de Sousa’s distinction between the epistemic and the strategic modes of rationality as a theoretical framework, this article proposes therefore to remedy this deficit by unifying these philosophical insights with the goal of elaborating a theory of intentional explanation which brings together rationality, normativity and emotions. (shrink)

When developing phylogenetic systematics, the entomologist Willi Hennig adopted elements from Nicolai Hartmann’s ontology. In this historical essay I take on the task of documenting this adoption. I argue that in order to build a metaphysical foundation for phylogenetic systematics, Hennig adopted from Hartmann four main metaphysical theses. These are (1) that what is real is what is temporal; (2) that the criterion of individuality is to have duration; (3) that species are supra-individuals; and (4) that there are levels of (...) reality, each of which may be subject to different kinds of law. Reliance on Hartmann’s metaphysics allowed Hennig to ground some of the main theoretical principles of phylogenetic systematics, namely that the biological categories—from the semaphoront to the highest rank—have reality and individuality despite not being universals, and that they form a hierarchy of levels, each of which may require different kinds of explanation. Hartmann’s metaphysics thereby provided a philosophical justification for Hennig’s phylogenetic systematics, both as a theory and as a method of classification. (shrink)

This book, originally released in 1919, contains five lectures given by the author while he was Professor to the Inns of Court during the late 1800s. The lectures were revised to include notes & annotations by A.H.F. LeFroy.

This book is a guide to working with social science concepts. Concepts are the prisms through which we see the social world. They are foundational to the social science enterprise, and the quality of investigations hinges in part on how well researchers make use of them. Most social science concepts are drawn from ordinary language used in everyday ways; however, many social scientists "reconfigure" ordinary words to meet their research needs. They tinker with the meanings of words to fit their (...) theoretical aims and make them precise, useful tools of measurement and comparison. This book examines social science concepts through an interpretivist lens with the aim of providing concrete conceptual guidance for future research. Specifically, this book seeks to: 1) identify characteristic dangers that attend the making and use of reconfigured concepts; 2) lay out ways in which a select number of interpretivist approaches have been used to mitigate these dangers; 3) introduce practical tools that rework these interpretivist approaches into explicit and useable research methods; 4) show concretely how these elucidation tools can be gainfully used by social scientists working both within and outside of the interpretivist tradition. It will be an essential guide for social science research. (shrink)

What are the motivational bases that help explain the various normative judgements that social agents make, and the normative reasoning they employ? Answering this question leads us to consider the relationships between thoughts and emotions. Emotions will be described as thought-dependent and thought-directing, and as being intimately related to normativity. They are conceived as the grounds that motivate social agents to articulate their reasoning with respect to the values and norms they face and/or share in their social collective. It is (...) argued that because they are modes of thinking, emotions generate cognitive activities that relate to the making of evaluative and deontic judgements, the utterance of speech acts, the mastering of normative concepts and the building of arguments. Furthermore, each type of emotion generates its own constitutive judgements and structures normative thinking according to its own logic. The main thesis is that emotions provide sociological explanations for social agents’ thinking and speech, for emotions are precisely what motivate and, especially, structure normative reasoning and language. Being observable in language, emotions allow us to explain a) how social subjects reason and argue through norms and values, and b) how social subjects through their speech acts can contribute to the (un-)making of the social world. (shrink)

Background The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim The aim of the study was to explore ambulance (...) nurses’ experiences of relationships with patients in urgent and emergency situations. Methods Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results Relationships with patients during urgent and emergency assignments emerged as three themes: “ Ambiguous silence,” “ Professional competence” and “ Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses. (shrink)

The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics (...) that mention putative DBS-induced changes to patients’ postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probablyin lieuof robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS. (shrink)

The author attempts to encompass the self, or a self, that, while at some times appears to be his own, at other times not, thus encompassing and continually morphing. It is a mixture of poetry and prose.

Le présent dossier est issu d’une collaboration de plusieurs années entre le directeur, Frédéric Gabriel, et les différents auteurs des articles. Il répond à un programme de recherche qui avait été présenté comme suit : La revue ThéoRèmes entend se concentrer sur l’expérience comme vecteur de compréhension des religions, dans toute la richesse des disciplines que son texte de présentation mentionne : sociologie, histoire, anthropologie, psychologie ou sciences cognitives. Qu’en est-il du droi...

This is _the_ leading introduction 200to professional values and ethics in social work. Frederic G. Reamer provides social workers with a succinct and comprehensive overview of the most critical issues relating to professional values and ethics, including the nature of social work values, ethical dilemmas, and professional misconduct. Conceptually rich and attuned to the complexities of ethical decision making, _Social Work Values and Ethics_ is unique in striking the right balance between history, theory, and practical application. For the third (...) edition, Reamer has updated the content and strengthened the relevance of the case material. Also new to the third edition: o Discussion of the moral dialogue between practitioner and cliento Coverage of virtue ethicso Practical discussion of concepts underlying social work ethicso Expanded application of the National Association of Social Workers Code of Ethics to ethical dilemmas in the professiono A look at the historical evolution of ethical standards in social worko New vignettes, illustrating difficult ethical decisionso More guidance on informed consent and termination of serviceso Discussion questions at the end of each chaptero A section on how to conduct a social work ethics audit. (shrink)

resumo Trata-se aqui de mostrar como a filosofia de Bergson decorre da constatação da passagem do tempo enquanto fato primordial e originário; nessa medida, as suas obras podem ser consideradas como diferentes tentativas de esclarecer tal experiência da temporalidade que, filosoficamente considerada, consiste na intuição da duração. Para isso, examina-se a forma pela qual o tratamento dado a problemas filosóficos distintos e discutidos em cada um de suas obras efetiva-se como meditação sobre o fato primitivo e seu esclarecimento progressivo. Em (...) primeiro lugar, acompanhamos o percurso de dedução das principais características da duração, sucessão, conservação e ato, sublinhando algumas de suas conseqüências filosóficas. A seguir, examinamos a dimensão crítica da filosofia de Bergson pela análise do pensamento do instante, aquele que desfigura a experiência do tempo e origina a via equivocada da metafísica tradicional; nesse exame procuramos diferenciar tal pensamento da experiência da simultaneidade, que é constitutiva de nossa relação concreta com as coisas. palavras-chave duração, sucessão, simultaneidade, criação, experiência, instante. (shrink)

Trata-se aqui de mostrar como a filosofia de Bergson decorre da constatação da passagem do tempo enquanto fato primordial e originário; nessa medida, as suas obras podem ser consideradas como diferentes tentativas de esclarecer tal experiência da temporalidade que, filosoficamente considerada, consiste na intuição da duração. Para isso, examina-se a forma pela qual o tratamento dado a problemas filosóficos distintos e discutidos em cada um de suas obras efetiva-se como meditação sobre o fato primitivo e seu esclarecimento progressivo. Em primeiro (...) lugar, acompanhamos o percurso de dedução das principais características da duração, sucessão, conservação e ato, sublinhando algumas de suas conseqüências filosóficas. A seguir, examinamos a dimensão crítica da filosofia de Bergson pela análise do pensamento do instante, aquele que desfigura a experiência do tempo e origina a via equivocada da metafísica tradicional; nesse exame procuramos diferenciar tal pensamento da experiência da simultaneidade, que é constitutiva de nossa relação concreta com as coisas.Duração. Sucessão. Simultaneidade. Criação. Experiência. Instante. The bergsonian Conception of Time AbstractThe aim of this article is to show how Bergson´s philosophy derives from the understanding of the passing of time as an original and primordial fact. In this way, his works can be considered to be different attempts to explain this experience of temporality which, philosophically considered, consist of the intuition of duration. Thus, we examine the way in which the treatment given to distinct philosophical problems discussed in each of his works takes place as a meditation on the primitive fact and its progressive clarification. Firstly, we follow the course of deduction of the main characteristics of duration, succession, conservation and act, emphasizing some of his philosophical consequences. We then examine the critical dimension of Bergson´s philosophy through the analysis of the thought of the instant, which distorts the experience of time and gives rise to an equivocal way of traditional metaphysics; in this examination we shall seek to differentiate this idea from the experience of simultaneity that constitutes our concrete relationship with things.Duration. Succcession. Simultaneity. Creation. Experience. Instant. (shrink)

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Building upon a non-standard understanding of evolutionary process focusing on variation and persistence, I will argue that communities and ecosystems can evolve by natural selection as emergent individuals. Evolutionary biology has relied ever increasingly on the modeling of population dynamics. Most have taken for granted that we all agree on what is a population. Recent work has reexamined this perceived consensus. I will argue that there are good reasons to restrict the term “population” to collections of monophyletically related replicators and (...) interactors, which explains why many existing models in population biology exclude by definition many genuine evolving biological individuals such as communities and ecosystems. By studying a case of community evolution, we will see that it is variation that is important to evolutionary processes, not populations. Variation within a population is only one of many types of variation that can lead to evolution by natural selection. The upshot of focusing on variation is that cases of community and ecosystem adaptive change become tractable in evolutionary terms. I will show that complex emergent individuals such as communities and ecosystems cannot be fully accommodated by conventional population/reproduction models but can be accommodated by variation/persistence models. (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that (...) promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

Ecological fitness has been suggested to provide a unifying definition of fitness. However, a metric for this notion of fitness was in most cases unavailable except by proxy with differential reproductive success. In this article, I show how differential persistence of lineages can be used as a way to assess ecological fitness. This view is inspired by a better understanding of the evolution of some clonal plants, colonial organisms, and ecosystems. Differential persistence shows the limitation of an ensemblist noncausal understanding (...) of evolution. Causal explanations are necessary to understand the evolution by natural selection of these biological systems. †To contact the author write to: Department of Philosophy, University of Montreal, P.O. Box 6128, Station Centre‐Ville, Montreal, Quebec, H3C 3J7 Canada; e‐mail: [email protected]. (shrink)

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative (...) design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous. (shrink)