BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

This article is a response to Thomas David Riisfeldt’s paper entitled ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’. It is shown that as far as euthanasia and palliative sedation are concerned, Riisfeldt has not established that a common ground, or a similarity, between the two is the relief of suffering. Quite the contrary, this is not characteristic of euthanasia, neither by definition nor from a clinical point of view. Hence, the argument hinges on a conceptually (...) and empirically erroneous premise and is accordingly a non-starter. (shrink)

This article gives brief results of a Norwegian empirical project where the main purpose has been to study the burial rite versus bereavement and the role of religiousness in relation to the disposing of the dead. The theoretical perspective is that loss of a significant close, as well as religiousness are primary life experiences which flow together in the bereaved person's grieving conduct during the burial rite. 70 bereaved persons who had lost a close relative during a certain time period (...) have filled in questionnaires with information about the death, the funeral, religiousness and bereavement. The sample is treated statistically by means of indexes for grieving conduct during the burial week, religiousness, and grief. The sample is coherent and unambiguous, and shows that those who let the burial rite be a time to mourn experienced more benefit from the funeral service and had less anxiety, depression and intrusive experiences during the first year of bereavement. But sadness was independent of the grieving conduct during the burial rite, a result which makes sadness an aspect of mourning which qualitatively differs from the other aspects described. External conditions as urbanity and institutionalizing, as well as internal matters as the dramatical character of the loss, and personal religiousness affected the bereaved person's grieving conduct during the burial rite. (shrink)

Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make (...) oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience. (shrink)

BackgroundSurveys on attitudes towards assisted dying play an important role in informing public debate, policy and legislation. Unfortunately, surveys are often designed with insufficient attention to framing effects; that is, effects on the respondents’ stated attitudes caused by question wording and context. The purpose of this study was to demonstrate and measure such framing effects.MethodsSurvey experiment in which an eight-question survey on attitudes towards assisted dying was distributed to Norwegian citizens through a web-based panel. Two variations of question wording as (...) well as two variations of question order were employed. Respondents were randomized to receive one of four questionnaire versions.ResultsThree thousand and fifty responses were received. There were moderate to large question wording and question order effects. A majority of Norwegian citizens favour the legalization of assisted dying for patients with terminal or chronic disease.ConclusionsStakeholders in the assisted dying debate need to acknowledge potential framing effects, and accordingly should interpret survey results with caution. The same holds for researchers who conduct attitude surveys in the field of bioethics. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

The aim of this study was to explore which group-based emotion regulation goals and strategies are offered in the group culture of Jehovah's Witnesses (JWS). Based on interviews with 29 group-active JWS in Norway, a thematic analysis was conducted in which an overall pattern of cognition taking precedence over emotions was found. Due to endtime expectations and a long-term goal of eternal life in Paradise, future emotions were prioritized. The emotion regulation strategies identified among JWS were social sharing and the (...) interconnected cognitive reappraisal. A new concept, emotional forecasting, was introduced, describing a reappraisal tactic of regulation using prospects of future emotions to regulate the here and now. It was concluded that the prospection of the future is a strong regulator of emotions of the here and now and should be included in psychological models of emotion regulation. (shrink)

_ Source: _Page Count 32 The aim of this study was to explore which group-based emotion regulation goals and strategies are offered in the group culture of Jehovah’s Witnesses. Based on interviews with 29 group-active JW s in Norway, a thematic analysis was conducted in which an overall pattern of cognition taking precedence over emotions was found. Due to end-time expectations and a long-term goal of eternal life in Paradise, future emotions were prioritized. The emotion regulation strategies identified among JW (...) s were _social sharing_ and the interconnected _cognitive reappraisal_. A new concept, _emotional forecasting_, was introduced, describing a reappraisal tactic of regulation using prospects of future emotions to regulate the here and now. It was concluded that the prospection of the future is a strong regulator of emotions of the _here and now_ and should be included in psychological models of emotion regulation. (shrink)

_ Source: _Volume 39, Issue 3, pp 312 - 343 The aim of this study was to explore which group-based emotion regulation goals and strategies are offered in the group culture of Jehovah’s Witnesses. Based on interviews with 29 group-active JW s in Norway, a thematic analysis was conducted in which an overall pattern of cognition taking precedence over emotions was found. Due to end-time expectations and a long-term goal of eternal life in Paradise, future emotions were prioritized. The emotion (...) regulation strategies identified among JW s were _social sharing_ and the interconnected _cognitive reappraisal_. A new concept, _emotional forecasting_, was introduced, describing a reappraisal tactic of regulation using prospects of future emotions to regulate the here and now. It was concluded that the prospection of the future is a strong regulator of emotions of the _here and now_ and should be included in psychological models of emotion regulation. (shrink)

Meaning in life has become an important topic in empirical research in the psychology of religion. Although it has been studied and found applicable in many different contexts, research on meaning in life and sources of meaning in African countries is scarce. This study qualitatively investigates understandings and experiences of meaning in life and sources of meaning among urban and village dwellers with different educational backgrounds in Zambia. Seven focus group interviews (total N = 52) were conducted and analysed, drawing (...) on Schnell’s model of meaning in life and sources of meaning. The results indicate that the concept of meaning in life is relevant to both urban and village dwellers in Zambia. Meaning experiences and sources of meaning are associated with certain life domains: relationships; religion; education and work; leisure activities; and health and survival. Each life domain includes several fundamental sources of meaning, which can be related to Schnell’s four dimensions of sources of meaning: self-transcendence, self-actualisation, order and well-being and relatedness. The results are discussed in light of extant studies on meaning and cultural characteristics in Africa. (shrink)

Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews (...) with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life. (shrink)

_ Source: _Volume 39, Issue 2, pp 139 - 164 The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often (...) contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy. (shrink)

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational (...) and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference. (shrink)

This paper examines the effectiveness of public enforcement by studying the effects of regulatory intervention to curb tunneling through intercorporate loans in China. Specifically, we explore whether public enforcement efforts in 2006 resulted in less tunneling, and ultimately in increased performance for tunneling firms. We show that tunneling is among the dominant factors increasing the likelihood of becoming blacklisted. We also find that firms’ tunneling mechanisms decreased significantly after the regulatory shock, and that their performance increased significantly compared to non-tunneling (...) firms after the regulatory shock. Finally, we find a positive market reaction to the public announcement of tunneling both for firms that have been blacklisted and other tunneling firms that are not blacklisted. Collectively, these results suggest that public enforcement in the presence of a credible threat succeeds in deterring the effect on tunneling behavior in China. (shrink)

This paper examines the relationship between performance persistence and corporate governance. We document systematic differences in performance persistence across listed companies in China during 2001–2011, and empirically demonstrate that firms with better corporate governance show higher performance persistence. The results are robust over both the short and long terms. We also find that performance persistence is an important factor in refinancing, and it can lower companies’ costs of borrowing. Overall, our findings offer important implications for business ethics, as we demonstrate (...) how corporate governance can lower companies’ costs of debt. (shrink)

In Parkinson’s disease, the fronto-striatal network is involved in motor and cognitive symptoms. Working memory updating training engages this network in healthy populations, as observed by improved cognitive performance and increased striatal BOLD signal. This two-part study aimed to assess the feasibility of WM updating training in PD and measure change in cognition, movement and functional brain response in one individual with PD after WM updating training. A feasibility and single-subject study were performed in which patients with PD completed computerized (...) WM updating training. The outcome measures were the pre-post changes in criterion and transfer cognitive tests; cognitive complaints; psychological health; movement kinematics; and task-related BOLD signal. Participants in the feasibility study showed improvements on the criterion tests at post-test. FL displayed the largest improvements on the criterion tests and smaller improvements on transfer tests. Furthermore, FL reported improved cognitive performance in everyday life. A shorter onset latency and smoother upper-limb goal-directed movements were measured at post-test, as well as increased activation within the striatum and decreased activation throughout the fronto-parietal WM network. This two-part study demonstrated that WM updating training is feasible to complete for PD patients and that change occurred in FL at post-test in the domains of cognition, movement and functional brain response. (shrink)

One important distinction in psychology is between inferences based on associative memory and inferences based on analysis and rules. Much previous empirical work conceive of associative and analytical processes as two exclusive ways of addressing a judgment task, where only one process is selected and engaged at a time, in an either-or fashion. However, related work indicate that the processes are better understood as being in interplay and simultaneously engaged. Based on computational modeling and brain imaging of spontaneously adopted judgment (...) strategies together with analyses of brain activity elicited in tasks where participants were explicitly instructed to perform similarity-based associative judgments or rule-based judgments (n = 74), we identified brain regions related to the two types of processes. We observed considerable overlap in activity patterns. The precuneus was activated for both types of judgments, and its activity predicted how well a similarity-based model fit the judgments. Activity in the superior frontal gyrus predicted the fit of a rule-based judgment model. The results suggest the precuneus as a key node for similarity-based judgments, engaged both when overt responses are guided by similarity-based and rule-based processes. These results are interpreted such that similarity-based processes are engaged in parallel to rule-based-processes, a finding with direct implications for cognitive theories of judgment. (shrink)

In the 1960’s, Lars Bergström and Hector-Neri Castañeda noticed a problem with alternative acts and consequentialism. The source of the problem is that some performable acts are versions of other performable acts and the versions need not have the same consequences as the originals. Therefore, if all performable acts are among the agent’s alternatives, act consequentialism yields deontic paradoxes. A standard response is to restrict the application of act consequentialism to certain relevant alternative sets. Many proposals are based on (...) some variation of maximalism, that is, the view that act consequentialism should only be applied to maximally specific acts. In this paper, I argue that maximalism cannot yield the right prescriptions in some cases where one can either (i) form at once the intention to do an immediate act and form at a later time the intention to do a succeeding act or (ii) form at once the intention to do both acts and where the consequences of (i) and (ii) differ in value. Maximalism also violates normative invariance, that is, the condition that if an act is performable in a situation, then the normative status of the act does not depend on what acts are performed in the situation. Instead of maximalism, I propose that the relevant alternatives should be the exhaustive combinations of acts the agent can jointly perform without performing any other act in the situation. In this way, one avoids the problem of act versions without violating normative invariance. Another advantage is that one can adequately differentiate between possibilities like (i) and (ii). (shrink)

Ontology and theology cannot be combined if ontology excludes non physical causes. This paper examines some possibilities for ontology to be combined with theology in so far as non physical causes are permitted. The paper builds on metaphysical findings that shows that separate ontological domains can interact causally indirectly via interfaces. As interfaces are not universes a first universe is allowed to be caused by an interface without violating the principle of causal closure of any universe. Formal theology can therefore (...) be based on the assumption that the (first) universe is caused by God if God is defined as the first cause. Given this, formal theology and science can have the same ontological base. (shrink)

Many logical systems today describe intelligent interacting agents over time. Frameworks include Interpreted Systems (IS, Fagin et al. [8]), Epistemic-Temporal Logic (ETL, Parikh & Ramanujam [22]), STIT (Belnap et al. [5]), Process Algebra and Game Semantics (Abramsky [1]). This variety is an asset, as different modeling tools can be fine-tuned to specific applications. But it may also be an obstacle, when barriers between paradigms and schools go up. This paper takes a closer look at one particular interface, between two systems (...) that both address the dynamics of knowledge and information flow in multi-agent systems. One is IS/ETL (IS and ETL are, from a technical point of view, the same up to model transformations, cf. [20]), which uses linear or branching time models with added epistemic structure induced by agents’ different capabilities for observing events. These models provide a Grand Stage where histories of some process unfold constrained by a protocol, and a matching epistemic-temporal language describes what happens. The other framework is Dynamic Epistemic Logic (DEL, [10, 4, 34]) that describes interactive processes in terms of epistemic event models which may occur inside modalities of the language. Temporal evolution is then computed from some initial epistemic model through a process of successive ‘product updates’. It has long been unclear how to best compare IS/ETL and DEL. Various aspects have been investigated in [10, 30, 32], but in this paper, we study the interface in a more systematic way. Often, DEL and ETL are presented as alternative ways of adding dynamics to multi-agent epistemic models. In this paper, we rather focus on how merging the two different modeling choices leads to interesting new questions. Our leading interest here will be a view of informational processes as evolving over time. To see what we mean, consider the simplest version of DEL, viz. the logic of public announcements PAL ([23]) which adds a very specific type of communicative 1 action to epistemic models: a public announcement.. (shrink)

Standard definitions of causal closure focus on where the causes in question are. In this paper, the focus is changed to where they are not. Causal closure is linked to the principle that no cause of another universe causes an event in a particular universe. This view permits the one universe to be affected by the other via an interface. An interface between universes can be seen as a domain that violates the suggested account of causal closure, suggesting a view (...) in which universes are causally closed whereas interfaces are not. On this basis, universes are not affected by other universes directly but rather indirectly. (shrink)

Lars Løvlie, Paul Standish; Introduction: Bildung and the idea of a liberal education, Journal of Philosophy of Education, Volume 36, Issue 3, 16 December 2002.

‘Bill Scheuerman’s ‘The End of Law’ offers a compelling case for the claim that Carl Schmitt’s constitutional theory is not authentically democratic. This does not entail, however, that Schmitt’s views are of no relevance for understanding the contemporary crisis of democracy. Schmitt’s arguments offer a blueprint for the populist-authoritarian subversion of democracy. Defenders of democracy are therefore well-advised to engage with Schmitt’s ideas.’.

In this dialogue a sceptic meets one that convinces him that he is safe from the void of Nothingness although it exists.

This is a conceptual attempt to integrate the major current psychotherapeutic methods via the introduction of Macro Psychology. The idea is fully philosophical, and the aim is to spur debate. Clinically, we land in the following picture: Scenarios with a maltreated dog, its owner, and a therapist. Conditioning: The therapist takes the dog to a safe environment. Behavioral therapy: The therapist instructs the owner to take regular long walks with the dog, to feed it regularly, to let it have access (...) to fresh water, and to stop hitting it. Cognitive behavioral therapy: The therapist instructs the owner to take regular long walks with the dog, to feed it regularly, to let it have access to fresh water, and to stop hitting it. The therapist also tells the owner why. Psychodynamically oriented therapy: The therapist tries to help the owner to reconnect to repressed parts that care for the dog. (shrink)

Samuel seeks out Kurt at a pub and initiates a discussion. Soon Kurt becomes engaged. What is it that is incomplete?

manuscript delves into the philosophical debate surrounding the Special Composition Question (SCQ), focusing on the causal relationships between objects and their constituent parts. By distinguishing between Weak and Strong Causal Composition, the article explores how causal mechanisms underpin the composition of objects. Theories from notable philosophers, including van Inwagen and Leibniz, are evaluated. This study seeks to bridge the gap between common sense perspectives and principled ontological theories by introducing the concepts of Weak and Strong Causal Composition. The analysis reveals (...) how a causal approach can offer insightful resolutions to longstanding debates in mereology and ontology, emphasizing the role of causality in understanding the essence of material composition. The proposed causal perspective encourages further philosophical inquiry into the foundational principles governing the composition of objects. (shrink)

We define a set of things of one singular kind as the set of all things that can causally affect one another. To enable causal interaction between such sets, we define a thing that is of a non-singular kind as consisting of more than one singular kind. Such a thing of a non-singular kind supervenes on things of singular kinds and is open to causally intervene between sets of things of different singular kinds without violating the definition of a set (...) of things of one singular kind. With the empty set as a set of things of one singular kind, we define Mem as ‘either the smallest element of intervening sets in the indefinite set of sets of things of a singular kind and the intermediate supervening sets, or, if nothing exists, the empty set’. Thus, Mem exists. Comment. The argument focuses on a definition of a supervening set of things of a non-singular kind. Besides that, it really only claims that if we define Mem as some set of existing things or the set without elements, Mem exists. That, though, is tautological. The argument, thus, can only be interesting if anything besides the empty set exists. That only the empty set would exist, however, is refuted by this very claim. (shrink)

In this dialogue Jeito and Immanuel K. tries to navigate in a sea filled with philosophy, God and Nothingness. They conclude that they are safe from the void of Nothingness.

In this dialogue P F and Jeito talk about nothing and something.

In this dialogue Zhuangzi and Jacob discuss nothing and something and their relation with God.

Here A, B, C, D, I, X and “Philosophy” discuss some features of the relation between identity and love.

The basic fault in the philosophy of science is simple enough to put in words and now it is time to do that. This basic fault puts the food on the table for philosophers and scientists, so it is hard to actually get the word out. That is not my problem, though. The basic fault is that we still assume that there is some kind of stuff that ‘everything’ consists of. My aim is to show how we can make it (...) right. (shrink)

The modal properties of the principle of the causal closure of the physical have traditionally been said to prevent anything outside the physical world from affecting the physical universe and vice versa. This idea has been shown to be relative to the definition of the principle. A traditional definition prevents the one universe from affecting any other universe, but with a modified definition, e.g., the causal closure of the physical can be consistent with the possibility of one universe affecting the (...) other universe. Gamper proved this modal property by implementing interfaces between universes. Interfaces are thus possible, but are they realistic? To answer this question, I propose a two-step process where the second step is scientific research. The first step, however, is to fill the gap between the principles or basic assumptions and science with a consistent theoretical framework that accommodates the modal properties of an ontology that matches the basic assumptions. (shrink)