Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (N = 15) were interviewed twice, using semi-structured in-depth interviews, analyzed by and the responses subject to interpretative-phenomenological analysis. Persons with firsthand experience of avoidant personality disorder were included in the research process. Results: The superordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering (...) the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, Ttheese findings highlight the importance, importance of being met intersubjectively as a person with intentionality and agency, even when one does not feel like one.as an agentive intentional being, even when one does not feel like one, of being met intersubjectively by a therapist. The importance of establishing an emotional bond and emergent trust for open therapeutic communication, collaboration, learning, and becoming able to build courage to begin to approach that which one fears, is emphasized. (shrink)

In _Plato on Democracy and Political technē_ Anders Dahl Sørensen offers an in-depth investigation of Plato’s discussions of democracy’s ‘epistemic potential’, arguing that this question is far more central to his political thought than is usually assumed.

In the young Henrik Ibsen's intellectual quarters, abroad as well as in his native Norway, Hegelianism was very much the philosophical systemde rigueur. Hegel's student Marcus Jacob Monrad taught phenomenology and aesthetics at the University of Christiania throughout the 1850s, and promoted a wider Hegelian way of thinking through frequent book reviews and newspaper articles. In Italy, soon to be his home away from home, Ibsen socialised with the art-historian Lorentz Dietrichson, whose views on the history of art were outspokenly (...) Hegelian. Ibsen was also in touch with the Hegelian circle gathering around the painter I. C. Dahl at the Academy of Art in Dresden. While Ibsen rarely engages in explicit philosophical discussion, he makes a significant exception when responding to the Danish translation of John Stuart Mill'sUtilitarianism. He admits that he has no professional expertise in this area but continues to observe that, insofar as ‘there are writers [like Mill] who lay down the law about philosophy without any knowledge of Hegel or German thought in general,’ it seems to him that ‘anything is allowed.’ To think philosophically without Hegel appears to Ibsen as tantamount to thinking without a reference point or standard. (shrink)

Moral Internalism proposes a necessary link between judging that an action is right/wrong and being motivated to perform/avoid that action. Internalism is central to many arguments within ethics, including the claim that moral judgments are not beliefs, and the claim that certain types of moral skepticism are incoherent. However, most of the basis for accepting Internalism rests on intuitions that have recently been called into question by empirical work. This paper further investigates the intuitions behind Internalism. Three experiments show not (...) only that these intuitions are not widespread, but that they are significantly influenced by normative evaluations of the situation in question. These results are taken to undermine Internalist intuitions, and contribute to the growing body of evidence showing that normative evaluations influence supposedly non-normative judgments. (shrink)

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

What is good sex? This question can be evaluated in multiple dimensions, the moral dimension being only one of them. My main thesis in this paper is that a criterion for good sex is whether the participants are on a par with each other. This can be understood as a moral ideal. In order to make this argument, I first explain what is meant by “sex”. This is, on the one hand, to delineate clearly which phenome-na are included in the (...) definition for the purposes of this argument. It is, on the other hand, to repel the problematic image of sex as something exclusively physical. In a second step I will address the issue of consent. Consent is, in my view, a minimal condition for the moral quality of sexual activities. It is only when consent is given by all participants that sexual activity is legitimized. Of course many related questions arise in this context, but without consent, we cannot speak of the moral quality of sexual activities at all. But why is consent so important? It is important to protect people. The protection is more successful if we take into account the attitude with which people engage with each other sexually. Sexual activities where people are on a par with each other are morally better than those where people are not. Being on par means that each participant’s desires and wishes are respected equally. I develop this thesis further by engaging with different objections. If we set out to question whether a sexual activity is morally good, we will also have to answer the question whether the participants who are engaged in this activity are on a par with each other. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

This paper investigates the acquisition of residual verb second (V2) in three corpora consisting of data from Norwegian-English bilinguals (Emma, Emily, and Sunniva) in order to determine to what extent these structures are affected by cross-linguistic influence (CLI) from Norwegian V2. The three girls exhibit three different patterns with regard to the relevant constructions. They are very target-like in their use of auxiliaries in the relevant structures. However, when it comes to do-support, Emily and Sunniva are equally target-like, while Emma (...) mainly produces non-target-like structures. These either involve the omission of do, or non-target-like movement of a lexical verb. Furthermore, Emma also allows verb movement across the subject with both lexical verbs and auxiliaries in topicalized structures, suggesting that she has overgeneralized residual V2 across verb types and clause types. Emily, on the other hand, is very target-like in structures involving residual V2 in English, but also allows auxiliaries and dummy-do to move across the subject in topicalized structures, overgeneralizing residual V2 to apply to non-subject-initial declaratives. Finally, Sunniva, is very precocious and very target-like in all the relevant structures, which may be an indication of acceleration due to CLI from Norwegian V2. We discuss these results with reference to language balance, finding that the measures available to us suggest that the differences between the children cannot straightforwardly be explained by language dominance. Instead, we suggest that these results can be accounted for by ambiguity in the English system, leaving the data open to several possible interpretations when acquired in contact with the consistent V2 system in Norwegian. This has several consequences: (i) the three girls’ parsers interpret the input differently, (ii) differences between the three children are qualitative rather than quantitative, and (iii) there has to be some mechanism that ensures that the children can ‘recover’ from these non-target-like grammars. In this paper, we will focus on the first two issues. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision‐making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real‐life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement‐based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

Rich with historical and cultural value, these works are published unaltered from the original University of Minnesota Press editions.

One staple of living in our information society is having access to the web. Web-connected devices interpret our queries and retrieve information from the web in response. Today’s web devices even purport to answer our queries directly without requiring us to comb through search results in order to find the information we want. How do we know whether a web device is trustworthy? One way to know is to learn why the device is trustworthy by inspecting its inner workings, 156–170 (...) 1995; Humphreys 2004, Episteme, 6, 221–229 2009). But ordinary users of web devices cannot inspect their inner workings because of their scale, complexity, and the corporate secrecy which enshrouds both the procedures by which the devices operate and the companies that make them. Further piling on this predicament, authors have criticized web technology on the grounds that the invisibility of the web devices’ inner workings prevents users from critically assessing the procedures that produce a given output, in some cases, barring users from fulfilling their epistemic responsibilities, 343–355 2010; Miller and Record Episteme, 10, 117–134 2013). I consider four broad kinds of reasons which we can acquire without inspecting the inner workings of black-boxed technology: individual understanding, expert testimony, testing through experience, and social vetting; and show how each is a viable method of appraising black-boxed technology. By deploying these methods, we can remain responsible inquirers while nonetheless benefitting from today’s epistemic resources on the web. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is at odds with this conceptualisation. (...) By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural arbitrariness’ (...) in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at least within (...) privately funded health care. (shrink)

Some fundamental aspects of the lived body only become evident when it breaks down through illness, weakness or pain. From a phenomenological point of view, various breakdowns are worth analyzing for their own sake, and discussing them also opens up overlooked dimensions of our bodily constitution. This book brings together different approaches that shed light on the phenomenology of the lived body—its normality and abnormality, health and sickness, its activity as well as its passivity. The contributors integrate phenomenological insights with (...) discussions about bodily brokenness in philosophy, theology, medical science and literary theory. Phenomenology of the Broken Body demonstrates how the broken body sheds fresh light on the nuances of embodied experience in ordinary life and ultimately questions phenomenology’s preunderstanding of the body. (shrink)

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)

Scholarship has tended to focus on the deleterious impacts of chronic exposure to violence, to the detriment of understanding how residents living in dangerous contexts care for themselves and one another. Drawing on 30 months of ethnographic fieldwork, this article examines two sets of practices that residents exercise in the name of protecting themselves and their loved ones. The first set (“making toast”) includes the mundane, “small acts,”—often embedded in routine—that residents draw on in an effort to form connections and (...) create order in a fundamentally chaotic and stressful environment. The second set (“splitting apples”) involves the teaching and exercise of violence in the name of protecting daughters and sons from further harm. Using interviews and field notes, we argue that both sets of practices, when viewed in situ, reveal an “ethics of care.” Resisting the urge to either romanticize or sanitize these efforts, we engage with the difficult question of what it means when an expression of “care” involves the (re)production of violence, especially against a loved one. (shrink)

A complement to _Researching Schools_ by the same authors, this book provides readers with a strong theoretical framework for school-based research as well as valuable advice on the ways in which networks of specialist groups can work together to create a broad-ranging approach to educational research. Through a critical examination of existing research and current thinking, the authors draw out implications for the effective policy and practice of school-based research. Illustrated throughout with case studies and including a full and detailed (...) literature review, this book will be a vital resource for all academics pursuing research into education. (shrink)

Presenting the work of a highly innovative partnership between the University of Cambridge Faculty of Education and eight secondary schools, this book explores this networked learning community which has helped to define the use and production of educational knowledge and research within and between various partners. This book examines the central questions and gives examples of the outcomes of the development that will assist any researchers, especially teachers undertaking research, to develop school-university partnerships. Stories and examples from practitioners and others (...) who worked directly in and with schools are presented throughout the book. It will appeal to a wide audience of practitioners and academics, and to all who are interested in how research and enquiry can be used to support the development of practice in schools. (shrink)