Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO worksheet. A total of (...) 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted. (shrink)

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. Research (...) design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice (...) reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

Although Daniel Engster's “caring” human rights are, on the surface, a compelling way to bring the concept of care into the international political realm, I argue they actually serve to perpetuate some of the same problems of mainstream human-rights discourses. The problem is twofold. First, Engster's particular care theory relies on an uncritical acceptance of our dependence relations. It can, therefore, not only overlook how local and global institutions, norms, and the marketplace shape our relations of dependence, but also serve (...) to further naturalize our current dependence relations. Second, Engster's caring human rights are only minimally feminist, which means that they do not pay attention to the way in which women's full and equal political participation is a necessary component to challenging and overcoming the oppression, marginalization, and exploitation of women and their caring labor worldwide. Although I am sympathetic to Engster's goals and some of his proposed policy solutions, I argue that we should not abandon the critical, feminist lens of care ethics in favor of “caring” human rights that cannot overcome the care critique of mainstream human-rights discourses. (shrink)

This article considers how the metaphor of the vaccine line and the subjectivity of the line jumper came to frame COVID vaccination experiences. Drawing on analysis of interviews (n = 24) with self-identified vaccine line jumpers, this article reports on three narratives that arose across interviews: (1) vaccine line jumping is a necessary strategy of health-advocacy, (2) vaccines are personal healthcare tools earned through individual merit, and (3) vaccine refusal is a problem of belief rather than access. Findings advance research (...) about the personalization of vaccination and public health while contributing insights about the constrained subjectivities that people adopt in individualistic health landscapes. (shrink)

We introduce a new model of reduction inspired by Kemeny and Oppenheim’s model [Kemeny & Oppenheim 1956] and argue that this model is operative in a “ruthlessly reductive” part of current neuroscience. Kemeny and Oppenheim’s model was quickly rejected in mid-20th-century philosophy of science and replaced by models developed by Ernest Nagel and Kenneth Schaffner [Nagel 1961], [Schaffner 1967]. We think that Kemeny and Oppenheim’s model was correctly rejected, given what a “theory of reduction” was supposed to account for at (...) that time. But their guiding insights about what constitutes scientific reduction—increases in explanatory scope and systematization—reflect actual practices of current reductionistic neuroscience. The key rehabilitative step to make their insights fit current scientific details is to restate them using resources from recent work on causal-mechanistic explanation. We begin with a scientific case study, drawn from the relatively new field of “molecular and cellular cognition”. It provides an explanation of the well-known Ebbinghaus spacing effect on learning and memory in terms of interactions between a transcriptional enhancer protein and its inhibiting phosphatase in neurons recruited into the memory trace. Next we briefly describe some popular models of reduction from mid-20th-century philosophy of science. We point out how these models fail to illuminate key features of our scientific case study. Finally we present our causal-mechanistically updated Kemeny and Oppenheim-inspired model and argue that it nicely accounts for the details of our scientific case study. We close with a remark that will hopefully undercut the surprise many may feel to learn that a long-rejected philosophical account of reduction actually is at work in one of the most prominent reductionistic endeavors in current science. (shrink)

This article examines narratives, images, and stories that give insight to everyday experimentation and ethical self‐formation. I use the case of World Vision and its early leaders to unpack genealogies of American evangelical humanitarianism. Rather than seeking to identify American evangelicalism’s normative ethical stance, I aim to expand the discussion in anthropology of ethics on ethical self‐formation through examining the tensions, reflections, and processes of becoming among evangelical humanitarians. In doing so, I examine two focal areas of ethical self‐formation among (...) early World Vision leaders. The first is oscillation between and mixing of passion and compassion frameworks in the American evangelical imagination. Second, I identify a range of temporal frames that evangelicals draw on to make sense of and formulate ethical responses to human needs encountered abroad. (shrink)

An introduction to the seven principles for practicing critical hope.

Many have argued that sexualized banter is indicative of “masculine” culture, serving as a mechanism by which men construct masculine identity and dominance and create a climate of sexual harassment. While this claim has much empirical support, sexualized banter among women remains undertheorized. Furthermore, many contemporary scholars agree that the meaning of a sexual exchange may vary widely between cultural and material contexts, but this insight has only recently been applied to studies of workplace sexuality. This article considers the issues (...) of gender, sexuality, power, and context in light of ethnographic data collected in two service work establishments. Within these organizations, many workplace sexualized interactions emerge as facilitating camaraderie and empowerment between workers. The article concludes that the sexual particularities of a workplace should be interpreted as one of its many cultural features, reflective more of its organizational conditions than of a static sexual symbolism. (shrink)

Traditional approaches to computer ethics regard computers as tools, andfocus, therefore, on the ethics of their use. Alternatively, computer ethicsmight instead be understood as a study of the ethics of computationalagents, exploring, for example, the different characteristics and behaviorsthat might benefit such an agent in accomplishing its goals. In this paper,I identify a list of characteristics of computational agents that facilitatetheir pursuit of their end, and claim that these characteristics can beunderstood as virtues within a framework of virtue ethics. This (...) frameworkincludes four broad categories – agentive, social, environmental, and moral– each of which can be understood as a spectrum of virtues rangingbetween two extreme subcategories. Although the use of a virtue frameworkis metaphorical rather than literal, I argue that by providing a frameworkfor identifying and critiquing assumptions about what a `good' computer is,a study of android arete provides focus and direction to the developmentof future computational agents. (shrink)

The current antireductionist consensus rests in part on the indefensibility of the deductive-nomological model of explanation, on which classical reductionism depends. I argue that the DN model is inessential to the reductionist program and that mechanism provides a better framework for thinking about reductionism. This runs counter to the contemporary mechanists’ claim that mechanism is an alternative to reductionism. I demonstrate that mechanists are committed to reductionism, as evidenced by the historical roots of the contemporary mechanist program. This view shares (...) certain core commitments with reductionism. It is these shared commitments that constitute the essential elements of the reductionist program. (shrink)

Most of us create and use a panoply of non-sentential representations throughout our ordinary lives: we regularly use maps to navigate, charts to keep track of complex patterns of data, and diagrams to visualize logical and causal relations among states of affairs. But philosophers typically pay little attention to such representations, focusing almost exclusively on language instead. In particular, when theorizing about the mind, many philosophers assume that there is a very tight mapping between language and thought. Some analyze utterances (...) as the outer vocalizations of inner thoughts (e.g. Grice 1957, Devitt 2005), while others treat thought as a form of inner speech (e.g. Sellars 1956/1997, Carruthers 2002). But even philosophers who take no stand on the relative priority of language and thought still tend to individuate mental states in terms of the sentences we use to ascribe them. Indeed, Dummett (1993) claims that it is constitutive of analytic philosophy that it approaches the mind by way of language. In many ways, this linguistic model is salutary. Our thoughts are often intimately intertwined with their linguistic expression, and public language does provide a comparatively tractable proxy for, and a window into, the messier realm of thought. However, an exclusive focus on thought as it is expressed in language threatens to leave other sorts of thought unexplained, or even to blind us to their possibility. In particular, many cognitive ethologists and psychologists find it useful to talk about humans, chimpanzees, birds, rats, and even bees as employing cognitive maps. We need to make sense of this way of talking about minds as well as more familiar sentential descriptions. In what follows, I investigate the theoretical and practical possibility of non-sentential thought. Ultimately, I am most interested in the contours of distinctively human thought: what forms does human thought take, and how do those different forms interact? How does human thought compare with that of other animals? In this essay, however, I focus on a narrower and more basic theoretical question: could thought occur in maps? Many philosophers are convinced that in some important sense, thought per se must be language-like.. (shrink)

Recently, some mechanists have embraced reductionism and some reductionists have endorsed mechanism. However, the two camps disagree sharply about the extent to which mechanistic explanation is a reductionistic enterprise. Reductionists maintain that cellular and molecular mechanisms can explain mental phenomena without necessary appeal to higher-level mechanisms. Mechanists deny this claim. I argue that this dispute turns on whether reduction is a transitive relation. I show that it is. Therefore, mechanistic explanations at the cellular and molecular level explain mental phenomena. I (...) make my case in part by noting that mechanisms at higher levels are composed of mechanisms at lower levels. Compositional relations are transitive. In addition, they are explanatory. I conclude that there are explanatory linkages from cellular and molecular mechanisms to mental phenomena within a hierarchy of nested mechanisms. (shrink)

I take up three puzzles about our emotional and evaluative responses to fiction. First, how can we even have emotional responses to characters and events that we know not to exist, if emotions are as intimately connected to belief and action as they seem to be? One solution to this puzzle claims that we merely imagine having such emotional responses. But this raises the puzzle of why we would ever refuse to follow an author’s instructions to imagine such responses, since (...) we happily imagine many other implausible things. A natural response to this second puzzle is that our responses to fiction are real, and so can’t just be conjured up in response to an author’s demands. However, this simple response is inadequate, because we often respond differently to people and events in fiction than we would if we encountered them in real life. Solving these three puzzles in a consistent way requires the notion of a “perspective” on a fictional world. I sketch an account of this intuitive but frustratingly amorphous notion: perspectives are tools for organizing our thinking, which can in turn alter our emotional and evaluative responses. Cultivating a perspective can be illuminating, entertaining, or corrupting — or all three at once. (shrink)

The rapid change of values in the latter half of the 2Qth century required new ethical answers and considerations in all areas of society (family, corporate world, medicine, biotechnology, etc.). The need for a new »Christian Ethics« in Germany permeated all of society after the collapse of Nazi-ideology and valuesystems. The article shows how Protestant ethics in and around Germany have failed to adress this need. There are two main reasons for the inadequate response. First, the mainstream of Protestant ethics (...) widely refused to offer specifically »Christian« contributions to the moral reconstruction of society, based on a fear that core of Christianity would yet again be utilized as a lable of legitimacy. Secondly, theological ethics were focused on the discourse of principle to an extent that the laboraus work of application was left more or less undone. Protestant ethics did not succeed in making ethical commitments and considerations relevant for specific questions and needs for example in the area of medicine and biotechnological research or in the realm of corporate action and interaction. The lack of applicability and immediate relevance calls for a discourse and collaboration that integrates the ethical disciplines with those members and institutions in society that are confronted with and confronting the ethical challenge. (shrink)

Karl-Wilhelm Dahm examines in his study a certain pattern of the theological criticism of marktet economy. In this pattern the market economy appears as in principal unethical. Dahm asks specifically about the theological arguments, which the criticism of market ecomomy underlie. The questions are put in a second part in an effort, to come to a constructive appreciation of the basic principles of »Soziale Marktwirtschaft«.

In the year ending March 2020, an estimated 773,000 people in England and Wales were sexually assaulted. These types of crimes have lasting effects on victims’ mental health, including depression, anxiety, and post-traumatic stress disorder. There is a large body of literature which identifies several factors associated with the likelihood of the victim reporting a sexual assault to the police, and these differences may be due to rape myth stereotypes which perpetuate the belief that rape is only “real” under certain (...) conditions. Less is known, however, about the effect these rape myths and stereotypes have on the investigation process itself and the subsequent police outcomes assigned to sex offences. This study aimed to address this gap, providing a profile of all RASSO committed over a 3-year period in one English police force, the police outcomes of these offences, and whether any offences, suspect, or victim variables were associated with different outcomes, in particular the decision to charge or cases where victims decline to prosecute. In line with previous research, the majority of victims were female while the majority of suspects were male, and the most frequent victim–suspect relationship was acquaintance, followed by partner/ex-partner. Charge outcomes were more likely in SSOs and less in rape offences, more likely with stranger offences and less likely than offences committed by partners/ex-partners and relatives, and some non-white suspects were more likely to be charged than suspects of other ethnicities, including white suspects. Victim attrition was more likely in cases where the suspect was a partner or ex-partner and least likely where the suspect was a stranger, more likely in SSOs than in rape cases, and more likely when the victim ethnicity was “other”. Law enforcement should be aware of the potential biases, both relating to rape myths and stereotypes and to the biased treatment of victims and suspects based on demographic characteristics, and work to eliminate these to ensure a fairer and more effective RASSO investigative process. (shrink)

On a familiar and prima facie plausible view of metaphor, speakers who speak metaphorically say one thing in order to mean another. A variety of theorists have recently challenged this view; they offer criteria for distinguishing what is said from what is merely meant, and argue that these support classifying metaphor within 'what is said'. I consider four such criteria, and argue that when properly understood, they support the traditional classification instead. I conclude by sketching how we might extract a (...) workable notion of 'what is said' from ordinary intuitions about saying. (shrink)

In the majority of research, resettled immigrant and refugee parents are often considered to be less involved with their children’s schooling than majority parents. This study challenges such research positions, based on narrative interviews about parenting in exile conducted with refugee parents resettled in Norway. Cultural psychology and positioning theory have inspired the analyses. The choice of methodology and conceptualisations have brought forth a rich vein of material, which illuminated agency and active positions in the parents’ narratives about involvement with (...) their children’s education. Involvement narratives of success achieved by parents taking action are presented as well as narratives of thwarted agency. Parents’ narrated action includes also involvement outside officialdom, such as informal contact with teachers. It is assumed that the latter involvement forms have become invisible in the majority of earlier research on refugee parents’ school involvement due to methodological choices, and may have contributed to deficit positioning of refugee parents as passive in school involvement. This article’s agency narratives form a sharp contrast to such deficit positioning. (shrink)