Aim:The purpose of this study was to explore how adolescent patients displaying developmental trauma experience and describe meaning in life. Schnell’s model of meaning in life is applied to explore meaningfulness, crises of meaning and sources of meaning. Method: The study has a qualitative design based on individual interviews with eight adolescents aged 14–18 years in treatment in an outpatient clinic for mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation. Results: The (...) adolescents related meaning in life to the experience of coherence, intrinsic values, progress and belonging, or the absence of these. Examples of sources of meaning among the informants were positive relations with meaningful others, structure and routines, moments of well-being, achieving goals related to education, work and family, and seeking something else outside oneself such as playing computer games, being engaged in politics, being with animals, having a belief in a god or being outdoors in natural surroundings. Conclusion: Although the topic of meaning in life was unknown to this group, they used sources of meaning intuitively. This group seems to have similar preferences to the general population. More knowledge is needed on how the topic of meaning in life can be useful in therapy for adolescents with development trauma. (shrink)

Bioethics: 50 Puzzles, Problems, and Thought Experiments collects 50 cases—both real and imaginary—that have been, or should be, of special interest and importance to philosophical bioethics. Cases are collected together under topical headings in a natural order for an introductory course in bioethics. Each case is described in a few pages, which includes bioethical context, a concise narrative of the case itself, and a discussion of its importance, both for broader philosophical issues and for practical problems in clinical ethics and (...) health policy. Each entry also contains a brief, annotated, list of suggested readings. In addition to the classic cases in bioethics, the book contains discussion of cases that involve several emerging bioethical issues: especially, issues around disability, social justice, and the practice of medicine in a diverse and globalized world. (shrink)

The article critically considers the role of NGOs at the US naval base in Guantánamo Bay, Cuba. On the basis of observation of pre-trial hearings for the case against Khalid Sheik Mohammed et al.—those allegedly responsible for the September 11 attacks—the article analyses NGOs as trial monitors of the US military commissions set up to deal with ‘alien unprivileged enemy belligerents’. In spite of continued efforts by human rights NGOs and incremental improvements in the military commissions’ institutional arrangements and practice, (...) the article shows how NGOs have become so much a part of the everyday operation of justice at ‘Gitmo’ that they legitimate the military commissions’ claim to be delivering fair and transparent justice. (shrink)

Objective: Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home patients with dementia.Materials and methods: Cross-sectional study with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the Mini-Mental State Examination from the COSMOS trial and the DEP.PAIN.DEM trial whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients (...) were included if they were ≥65 years of age and with life expectancy >6 months. In the DEP.PAIN.DEM trial, patients were included if they were ≥60 years and if they had depression according to the Cornell Scale for Depression in Dementia. In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale, and depression with CSDD. Sleep parameters were total sleep time, sleep efficiency, sleep onset latency, wake after sleep onset, early morning awakening, daytime total sleep time and time in bed. We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses.Results: Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE, less WASO and more DTS. More severe dementia was associated with more WASO and TiB. More severe depression was associated with less TST, less DTS and less TiB. Use of sedative medications was associated with less TiB.Conclusion: When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results. (shrink)

This paper investigates how people conceive and evaluate nature through language, in a climate change context. With material consisting of 1,200 answers to open-ended questions in nationally representative surveys in Norway, we explore what semantic roles and values the respondents attribute to nature as well as to how they interact with the public debate about climate change. We observe that different conceptions and valuations of nature are tied to different perspectives on the climate change issue: some address the responsibilities of (...) causing climate change, others its consequences, and others yet its potential solutions. The study provides knowledge about the variety of conceptions of nature that can be mobilised by individuals and suggests that policy measures and public communication could benefit by taking this diversity into account. (shrink)

The paper discusses Rawls’ and Habermas’ theories of deliberative democracy, focusing on the question of religious reasons in political discourse. Whereas Rawls as well as Habermas defend a fully inclusivist position on the use of religious reasons in the ‘background culture’ or ‘informal public sphere’, we defend a moderately inclusivist position. Moderate inclusivism welcomes religiously inspired contributions to public debate, but it also makes normative demands on public argumentation beyond the ‘public forum’ or ‘formal public sphere’. In particular, moderate inclusivism (...) implies what we call a ‘conversational translation proviso’ according to which citizens have a duty to supplement religious with proper political arguments if – but only if – they are asked to do so by their co-discussants. This position, we argue, is more in line with the deeper intuitions behind Rawls’ political liberalism and Habermas’ deliberative model than is the fully inclusivist alternative. _Keywords_: conversational translation proviso, deliberative democracy, ethics of citizenship, Habermas, moderate inclusivism, public reason, Rawls. (shrink)

In this paper I develop an account of member obligation: the obligations that fall on the members of an obligated collective in virtue of that collective obligation. I use this account to argue that unorganized collections of individuals can constitute obligated agents. I argue first that, to know when a collective obligation entails obligations on that collective’s members, we have to know not just what it would take for each member to do their part in satisfying the collective obligation, but (...) also what they should do if they cannot do their part because others will not do theirs. I go on to argue (contra recent proposals) that it is not good enough for members in this situation to reasonably believe that others will not do their part. Rather, for a member of an obligated collective to permissibly escape doing her part in a collective obligation, she must both reasonably doubt that others will do their part and stand ready to act in case others do as well. -/- This necessary condition for collective obligation points the way to plausible sufficient conditions – conditions that, I argue, allow unstructured collectives to bear obligations. For (a) if a collective’s members are individually obligated to be ready to do their part, in a given collective action, and (b) if that individual readiness makes it sufficiently likely that the collective will in fact act, then it is hard to see what could block an attribution of collective obligation. In particular, in that case there ought to be no additional objection that there is no existing, organized “agent” on which the obligation might fall. For agents are, simply, things that can act. To be able to act is just to be able to succeed by trying. Unstructured collectives try to do something, I argue, when each member acts on their willingness to do their part in that thing if others do theirs; sometimes they succeed, producing a collective action. Some unstructured collectives, therefore, can succeed by trying; therefore, they can act; therefore they are agents. (shrink)

What makes something a part of my body, for moral purposes? Is the body defined naturalistically: by biological relations, or psychological relations, or some combination of the two? This paper approaches this question by considering a borderline case: the status of prostheses. I argue that extant accounts of the body fail to capture prostheses as genuine body parts. Nor, however, do they provide plausible grounds for excluding prostheses, without excluding some paradigm organic parts in the process. I conclude by suggesting (...) that embodiment is moralized all the way down: to be a body part is to be the sort of thing that ought to be protected, in a certain way, by social practices. (shrink)

This paper argues that disabled people can be healthy. I argue, first, following the well-known ‘social model of disability’, that we should prefer a usage of ‘disabled’ which does not imply any kind of impairment that is essentially inconsistent with health. This is because one can be disabled only because limited by false social perception of impairment and one can be, if impaired, disabled not because of the impairment but rather only because of the social response to it. Second, I (...) argue that it is often wrong to use the term ‘healthy’ in a way that makes health inconsistent with any degree whatsoever of health-relevant bodily dysfunction. Whether someone is ‘healthy’ properly-so-called depends on standards of health presupposed in conversational context. Sometimes, I argue, these standards are or ought to be lax enough to allow some people with some health deficits still to count as ‘healthy’ per se. Taking inspiration from David Lewis and Mary Kate Mcgowan, I go on to argue that denying that someone is ‘healthy’ in a context typically succeeds in shifting going presuppositions to require standards strict enough to make that denial acceptable. And this, I conclude by arguing, often constitutes an abuse of conversational power. (shrink)

In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them—and sometimes, permissibly doing so. Stopping a patient’s heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases (...) at the boundary—procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it—particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively “bodily” rights and restrictions in at least some implantable devices. (shrink)

In The Minority Body, Elizabeth Barnes rejects prevailing social constructionist accounts of disability for two reasons. First, because they understand disability in terms of oppressive social responses to bodily impairment, they cannot make sense of disability pride. Second, they maintain a problematic distinction between impairment and disability. In response to these challenges, this paper defends a version of the social model of disability, which we call the Social Exclusion Model. On our account, to be disabled is to be in a (...) bodily or psychological state that is represented as an impairment in the prevailing ideology of one’s society, and to be excluded from valuable activities on the basis of this representation. While this model refers to a distinction between disability and impairment, it makes no presuppositions about which bodies function ‘normally’ and which do not. It is the ideology of impairment rather than impairment itself that does any work to determine whether a person is disabled. We argue that this model answers some of the important objections that Barnes raises against prevailing social constructionist accounts of disability, and that it’s focus on the oppressive social positioning of disabled people gives it explanatory power that Barnes’s own account lacks. (shrink)

This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare (...) burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness. (shrink)

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification (...) of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation. (shrink)

Technological measures meant to change sexual orientation are, we have argued elsewhere, deeply alarming, even and indeed especially if they are safe and effective. Here we point out that this in part because they produce a distinctive kind of ‘clinical collective action problem’, a sort of dilemma for individual clinicians and researchers: a treatment which evidently relieves the suffering of particular patients, but in the process contributes to a practice that substantially worsens the conditions that produce this suffering in the (...) first place. We argue that the role obligations of clinicians to relieve the suffering of their patients put them in a poor position to solve this problem, though they can take measures to avoid complicity in the harms that would result from widespread use of individually safe and effective reorientation biotechnology. But in the end the medical community as a whole still seems obligated to provide these measures, if they become technologically feasible. Medical researchers are in a better position to prevent the harms that would result if reorientation techniques were safe, effective and widely available. We argue that the harms attendant on the development of safe and effective re-orientation techniques give researchers reason to avoid ‘applied‘ research aimed at developing these techniques, and to be careful in the conduct of basic orientation research which might be applied in this way. (shrink)

This paper argues for Serious Distributive Egalitarianism – the view that some material inequalities are seriously objectionable as such; not merely, say, because such inequalities tend to generate inequalities in status. Social justice requires equality, I argue, because basic social institutions produce important goods and are produced in turn by the relevantly equal contributions of all those that comply with them. E.g., basic social institutions make it much easier to produce cooperatively than it would be in their absence; therefore, these (...) institutions produce, among other things, opportunities to participate in particular productive enterprises. But basic social institutions are themselves produced, in large part, by the compliance of those subject to them; these subjects, therefore, contribute to the production of the goods that basic institutions produce. This gives (at least) every compliant subject of basic social institutions a claim on these goods. And, I argue that, though some do contribute more to the maintenance of basic institutions than others, those who contribute more are too responsible for the fact that others contribute less to point to the consequences of this difference as a reason they should get greater returns. I conclude that all subjects of basic social institutions have equally forceful and forcefully equal claims on the goods these institutions produce; claims that render inequalities in the Distribution of these goods Seriously objectionable as such. (shrink)