In Sweden, efforts to govern end-of-life care through policies have been ongoing since the 1970s. The aim of this study is to analyse how policy narratives on palliative care in Sweden have been formulated and have changed over time since the 1970s up to 2018. We have analysed 65 different policy-documents. After having analysed the empirical material, three policy episodes were identified. In Episode 1, focus was on the need for norms, standards and a psychological end-of-life care with the main (...) goal of solving the alleged deficiencies within end-of-life care in hospital settings. Episode 2 was characterised by an emphasis on prioritising end-of-life care and dying at home, and on the fact that the hospice care philosophy should serve as inspiration. In Episode 3, the need for a palliative care philosophy that transcended all palliative care and the importance of systematic follow-ups and indicators was endorsed. Furthermore, human value and freedom of choice were emphasised. In conclusion, the increase of policy-documents produced by the welfare-state illustrate that death and dying have become matters of public concern and responsibility. Furthermore, significant shifts in policy narratives display how notions of good palliative care change, which in turn may affect both the practice and the content of care at the end of life. (shrink)

In Sweden, palliative care has, over the past decades, been object to policies and guidelines with focus on how to achieve “good palliative care”. The aim of this study has been to analyse how experts make sense of the development and the current state of palliative care. Departing from this aim, focus has been on identifying how personal experiences of ‘the self’ are intertwined with culturally available meta-level concepts and how experts contribute to construct new scripts on palliative care. Twelve (...) qualitative interviews were conducted. Four scripts were identified after analysing the empirical material: 1. script of paths towards working within palliative care; 2. script of desirable and deterrent reference points; 3. script of tensions between improvement and bureaucracy; and 4. script of low status and uncertain definitions. The findings of this study illustrate how experts in complex ways intertwine experiences of ‘the self’ with meta-levels concepts in order to make sense of the field of palliative care. The participants did not endorse one “right way” of “good” deaths. Instead, palliative care was considered to be located in a complex state where the historical development, consisting of both desirable ideals, death denials and lack of guidelines, and more recent developments of strives towards universal concepts, “improvement” and increased bureaucracy altogether played a significant role for how palliative care has developed and is organised and conducted today. (shrink)

Hamilton’s Rule, named after the evolutionary biologist Bill Hamilton, and the related concepts of inclusive fitness and kin selection, have been the bedrock of the study of social evolution for the past half century. In ’The Philosophy of Social Evolution’, Jonathan Birch provides a comprehensive introduction to the conceptual foundations of the Hamiltonian view of social evolution, and a passionate defence of its enduring value in face of the recent high profile criticism. In this review essay, I first outline the (...) version of Hamilton’s Rule defended by Birch, dubbed Hamilton’s Rule General, and its derivation. With this in place, I then navigate through the fierce disagreements that Hamilton’s Rule generates among social evolution researchers and evaluate Birch’s central argument of the book that HRG serves as an organizing framework for social evolution research under which we can compare and interpret more detailed causal models. I then spend the remainder of the review discussing what I take to be three of the most exciting implications of Hamilton’s thinking raised by Birch: the extension of Hamilton’s Rule to mobile genetic elements, maximization of inclusive fitness models and the idea of adaptation as organism design, and the relationship between Hamilton’s approaches to social behaviour and the gene’s-eye view of evolution. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...) deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life. (shrink)

Moral imagination, according to John Kekes, is indispensable to a fulfilling and responsible life.

I revisit my article, “Why Immortality Is Not So Bad,” in which I argued that Bernard Williams’s thesis that immortality would necessarily be boring for any human being is false. Here I point out various ways in which Williams’s treatment of the issues has tilted and distorted the subsequent debates.

For this second edition, the editors have returned to Austin's original lecture notes, amending the printed text where it seemed necessary.

For many years, the downtown in Clarksdale, with a municipal population of 17,960 and located in the northern part of the Mississippi Delta, had lost its role as the centre providing a wide range of jobs and services to those living in the surrounding region. For many cities and towns in America, downtown decline has been associated with the flight to the suburbs and the growth in shopping malls serving flourishing gated communities. In Clarksdale’s case, downtown decline has been due (...) largely to the advent of big box retailing and the location of new retail and commercial developments along the state highway on the edge of town, combined with the loss of jobs and population associated with agricultural restructuring. Today, however, Clarksdale has taken up the challenge to ‘revitalize’ the downtown in the face of economic adversity. Recovery is under way, and much of this is associated with blues music and Delta culture: Clarksdale is situated at the fabled ‘crossroads’ of Highways 49 and 61 and is also the home to national icons in literature, art and other cultural pursuits. These are key elements around which the downtown revitalization effort is focused. This paper charts the process by which the Clarksdale community has embarked on the road to downtown recovery, and highlights the town’s indelible links with the blues, borne out of years of toil, hardship and social deprivation. The paper emphasizes the importance of ‘champions’ and ‘creative people’, drawing on community support, in achieving downtown revitalization. Positive results are becoming evident with new businesses and jobs, improved levels of service, refurbishment of derelict buildings, a renewed sense of place, and an uplift in community confidence. The significance of cultural tourism to downtown revitalization is highlighted, with particular emphasis on the global appeal of blues, but with its roots firmly established in Clarksdale and the Delta. (shrink)

When a collective is blamed, the responsibility does not escape individuals. Spheres of influence are designed to determine the scale of blame; namely, by proximity and ability to influence a different result. Agents in the respective role types will be responsible upon our examining their extent of influence. Although you may be inclined to say that the responsibility lies with those who have access to policy-making, this doesn't allow for the deviants we expect at appropriate times. Here we are compelled (...) to seek a new moral outlook that maintains our perception of ourself: “what is not worthy of me must not be confused with special requirements of my ‘station and its duties’.”This essay offers a direction to assuage Lewis's fears toward collective responsibility. The challenges to individual responsibility behind such an ascription is complex but need not obliterate it. The delineation of roles by spheres of influence and activity gives some markers to the culpable agents. (shrink)

""This book covers an extensive range of traditional and 'new' ideologies, and organizes its complex subject matter extremely clearly.

The following lectures were really given, in substance, at a girls' school (far in the country); which, in the course of various experiments on the possibility of introducing some better practice of drawing into the modern scheme of female education, I visited frequently enough to enable the children to regard me as a friend. The Lectures always fell more or less into the form of fragmentary answers to questions; and they are allowed to retain that form, as, on the whole, (...) likely to be more interesting than the symmetries of a continuous treatise. Many children (for the school was large) took part, at different times, in the conversations; but I have endeavored, without confusedly multiplying the number of imaginary speakers, to represent, as far as I could, the general tone of comment and inquiry among young people. (shrink)

The influence of J. L. Austin on contemporary philosophy was substantial during his lifetime, and has grown greatly since his death, at the height of his powers, in 1960. Philosophical Papers, first published in 1961, was the first of three volumes of Austin's work to be edited by J. O. Urmson and G. J. Warnock. Together with Sense and Sensibilia and How to do things with Words, it has extended Austin's influence far beyond the circle who knew him or read (...) the handful of papers he published in journals. (shrink)

The human cognitive architecture consists of a set of largely independent modules associated with different brain regions. This book discusses in detail how these various modules can combine to produce behaviours as varied as driving a car and solving an algebraic equation.

One of the central problems in the philosophy of psychology is an updated version of the old mind-body problem: how levels of theories in the behavioral and brain sciences relate to one another. Many contemporary philosophers of mind believe that cognitive-psychological theories are not reducible to neurological theories. However, this antireductionism has not spawned a revival of dualism. Instead, most nonreductive physicalists prefer the idea of a one-way dependence of the mental on the physical.In Psychoneural Reduction, John Bickle presents (...) a new type of reductionism, one that is stronger than one-way dependency yet sidesteps the arguments that sank classical reductionism. Although he makes some concessions to classical antireductionism, he argues for a relationship between psychology and neurobiology that shares some of the key aims, features, and consequences of classical reductionism. Parts of Bickle's "new wave" reductionism have emerged piecemeal over the past two decades; this is his first comprehensive statement and defense of it to appear. (shrink)

The Province of Jurisprudence Determined (1832) is a classic of nineteenth-century English jurisprudence, a subject on which Austin had a profound impact. His book is primarily concerned with a meticulous explanation of most of the core concepts of his legal philosophy, including his conception of law, his separation of law and morality, and his theory of sovereignty. Almost a quarter of it consists of an interpretation and defence of the principle of utility. This edition includes the complete and unabridged text (...) of the fifth (1885) and last edition. The comprehensive introduction discusses Austin's life, the main themes of his book, leading criticisms of his ideas, and recent interpretations of his legal philosophy. The edition also includes an up-to-date bibliography and biographical synopses of the principal figures mentioned in the text. (shrink)