Det er en utbredt oppfatning at det økende prestasjonskravet i toppfotball fører til en svekkelse av moral og fair play-holdninger. Men hvordan tenker toppfotballspillere i forhold til ulike dilemmaer som oppstår på banen, og er det forskjeller mellom toppfotballspillere og spillere på lavere nivå? For å avklare dette gjennomførte vi en empirisk undersøkelse der vi intervjuet spillere og trener i én toppklubb og én breddeklubb. Vi var interessert i to hovedproblemstillinger: 1) Hva tenker fotballspillere på ulike prestasjonsnivå om etikk og (...) moralske dilemmaer i fotball? 2) Hvilke faktorer påvirker spillerne, direkte og indirekte, i deres vurderinger og handlinger? Resultatene fra undersøkelsen viser at det er store forskjeller mellom de to prestasjonsnivåene. Spillerne på breddenivået føler generelt et større ansvar for å opptre ærlig på banen enn hva som er tilfelle på toppnivået. Vi fant 4 spesifikke faktorer i toppfotballen som bidrar til umoralsk opptreden. For det første opplever spillerne en forventning om at de prioriterer resultat foran fair play. For det andre bidrar tilstedeværelsen av supportere på kamper til en slik prioritering. For det tredje vil handlinger som er i strid med fair play signaliseres som akseptable internt i miljøet, selv om de ofte signaliseres som uakseptable overfor media og omverdenen. For det fjerde kan spillere oppleve det som vanskelig å gå i mot trenerens oppfordringer til en pragmatisk og resultatfokusert opptreden.Nøkkelord: moral, etikk, fair play, footballEnglish summary: How morally do football players think? – an empirical study of moral dilemmas in elite footballIt is a common view that the increasing focus on achievement and success in elite football leads to a weakening of moral and fair play attitudes. But how do elite players think and what do they think about different dilemmas that appear on the field, and is there a difference between elite players and lower division players? To answer these questions we conducted an empirical investigation in which we interviewed the players and manager in an elite club and in a lower division club. We were interested in two main problems: 1) How do football players at different performance levels think about ethics and moral dilemmas in football? 2) Which factors influence the players, directly and indirectly, in their evaluations and actions? The results from the investigation show that there are important differences between the players at the two performance levels. The lower division players felt in general a higher responsibility to behave honestly on the field than the elite players. We identified four specific factors in elite football that contribute to unsportsmanlike behavior. First, elite players feel more pressure to prioritize results more than fair play. Second, the presence of the supporters contributes to the priority of results. Third, unsportsmanlike behavior is often signaled as unacceptable to the media and the surroundings. Internally, however, such behavior is considered acceptable among the manager and the players. Fourth, the players may find it hard to go against the manager’s insistence on a pragmatic and result-oriented focus.Keywords: morals, ethics, fair play, football. (shrink)

This paper provides an existential analysis of humour as a social virtue in invasion games at the elite sport level. The main argument is that humour in this particular context can be valuable both in the competitive social training environment and in game performance. This is investigated through philosophical and psychological conceptualisations of humour that are used to reveal and analyse the appearance and possible value of a humorous approach in various social situations experienced during invasion games and the associated (...) training situations. It is concluded that humour can help balance and structure the social training environment as well as facilitate creative game performance. On this basis it is suggested that the existential perspectives on humour presented could make a fruitful contribution to talent development in the domain of invasion games. (shrink)

The aim of this paper is to investigate whether or not ethical conflicts can be identified, analysed and solved using ethical principles. The relation between the physician and the patient with ischemic heart disease (IHD) as life style changes are recommended in a secondary prevention program is used as an example. The principal persons affected (the patient and his or her spouse) and the ethical principles (respect for autonomy, non-maleficence, beneficence and justice) are combined in a two dimensional model. The (...) most important person affected by the recommendations is the patient. His or her autonomy is challenged by the suggested life style changes, the purpose of which is to promote the future wellbeing and health of the patient. The spouse is indirectly involved in and affected by the process. He or she often feels neglected by caregivers. Ethical conflicts can both be identified and analysed using ethical principles, but often no solution is implied. Most (if not all) physicians would strongly encourage life style changes, but surprisingly there is no uncontroversial justification for this conclusion using principles. (shrink)

This paper begins with the decisive moment of the 2010 Champions League final, as Diego Milito dribbles past van Buyten to settle the score. By taking a closer look at this situation we witness a complex and ambiguous movement phenomenon that seems to transcend established phenomenological accounts of performance, as a creative performance such as this cannot be reduced to bodily self-awareness or absorbed skilful coping. Instead, the phenomenon of the feint points to a central question we need to ask (...) when investigating performance in football: ?How can one intentionally transcend the expectations of others?? In order to clarify this, the paper will conduct a contextual analysis of a feint drawing on existential philosophy and phenomenology. The main argument is that the feint incarnates a fundamental and indispensable strategy in the game context of football and the analysis of it throws light on central existential phenomena involved in game creativity, with appearance, seduction, commitment and value being the focal ones. The analysis suggests a broader notion of expertise by pointing to the need of stressing the dynamic and social game context. What the feint explicates is that in football it is not enough to be aware of your own body or rely on your embodied habits. In order to cope in the game situation it is also necessary to be absorbed in the other and transcend his or her expectations. (shrink)

We respond to the comments provided on our paper `Principles help to analyse but often give no solution-secondary prevention after a cardiac event’ by Simon Waltho, and highlight points of clarification.

The welfare of farmed fish is often regarded with less concern than the welfare of other husbandry animals, as fish are not universally classified as sentient beings. In Norway, farmed fish and other husbandry animals are legally protected under the same laws. Additionally, the legislature has defined a number of aquaculture-specific amendments, including mandatory welfare courses for fish farmers who have a key role in securing animal welfare, also with regards to noting welfare challenges in the production process. This article (...) uses fish welfare courses as a site from which to inquire about the common-sense understanding of fish welfare in Norwegian fish farming. The focus is specifically on fish farm employees, their experiences of welfare-related issues and contradictions in their daily work, and the struggle to act responsibly in aquaculture settings. Through participant observation at welfare courses, as well as interviews and conversations with fish farm workers, the article details how challenges are experienced ‘on the ground’, and suggests how fish farm workers’ own experiential knowledge might be mobilized to improve the general welfare of farmed fish. (shrink)

systematicity is. Until systematicity is adequately systematicity. Most contributors to these debates have clarified, we cannot know whether classical paid little or no attention to the alleged empirical.

Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support int...

BackgroundInvoluntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.MethodsIn-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.ResultsThe answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable (...) to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish Mental Care Act, healthcare organisation and the care environment.ConclusionsInvoluntary treatment was generally seen as an unwanted exception to standard care. The respondents’ judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation. (shrink)

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment withN=1379 German participants, we investigated whether the public’s vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred exclusive (...) allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations. (shrink)

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic. In a series of scenarios, participants were asked (...) to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions. (shrink)

Hans Skjervheim har hatt stor betydning for norsk åndsliv og offentlig ordskifte. Han hadde en unik evne til å vise hvordan tidløse filosofiske problemstillinger ikke bare angår fagfilosofer, men også er til stede i den politiske debatt og i hverdagens små og store utfordringer. Mange forbinder nok Skjervheim særlig med ±positivismestriden? på 1960- og 1970-tallet. Denne antologien viser bredden i virksomheten hans, og at mange av Skjervheims tekster har noe betydelig å si om også vår egen tids utfordringer - blant (...) annet om tiltroen til vitenskapen, filosofiens rolle, forvitringen av den liberale orden, økologisk krise, algoritmestyrte sosiale medier, ±fake news? og identitetspolitikk. Forfatterne er en blanding av en eldre garde, som skrev og virket samtidig med Skjervheim, og en yngre garde bestående av toneangivende fagpersoner fra ulike fagområder i dag. De tar alle for seg en eller flere sentrale tekster av Skjervheim og leser dem inn i samtidige problemstillinger. Disse nylesningene aktualiserer og bruker av Skjervheims filosofiske og litterære arv, men peker også på blindflekker og svakheter i hans tenkning - helt i tråd med slik Skjervheim ønsket å bli lest. (shrink)

Corporate sustainability is an important strategy and value orientation for marketing, but scarce research addresses the organizational drivers and barriers to including it in companies’ marketing strategies and processes. The purpose of this study is to determine levels of commitment to corporate sustainability in marketing, processes associated with sustainability marketing commitment, drivers of sustainability marketing at the functional level of marketing, and its organizational context. Using survey data from 269 managers in marketing, covering a broad range of industries in Sweden (...) and Denmark, we took a structural modelling approach to examine construct relationships, mediation, and moderation effects. Overall, the findings show that marketing capabilities associated with the innovation of new products, services, and business models constitute a strong driver to leverage sustainability marketing commitment. In conjunction with insights into processes related to the enactment of sustainability marketing, this result indicates that companies’ marketing departments have a propensity to drive corporate sustainability. The study provides substance to the idea of aligning substantive marketing capabilities closer to dynamic capabilities. Accordingly, the study reveals that reliance on market orientation alone does not lead to greater sustainability commitment. (shrink)

A speed-accuracy trade-off (SAT) in behavioural decisions is known to occur in a wide range of vertebrate and invertebrate taxa. Accurate decisions often take longer for a given condition, while fast decisions can be inaccurate in some tasks. Speed-accuracy tactics are known to vary consistently among individuals, and show a degree of flexibility during colour discrimination tasks in bees. Such individual flexibility in speed-accuracy tactics is likely to be advantageous for animals exposed to fluctuating environments, such as changes in predation (...) threat. We therefore test whether individual speed-accuracy tactics are fixed or flexible under different levels of predation threat in a model invertebrate, the bumblebee Bombus terrestris. The flexibility of speed-accuracy tactics in a foraging context was tested in the laboratory using a ‘meadow’ of artificial flowers harbouring ‘robotic’ crab spider predators. We found that while the ranking of bees along the speed and accuracy continuums was consistent across two levels of predation threat, there was some flexibility in the tactics used by individual bees – most bees became less accurate at colour discrimination when exposed to predation threat when flower types were rewarding. The relationship between decision speed and accuracy was influenced by predator detectability and the risk associated with making incorrect choices during the colour discrimination task. Predator crypsis resulted in a breakdown in the relationship between speed and accuracy, especially when making an incorrect floral choice incurred a distasteful quinine punishment. No single speed-accuracy tactic was found to be optimal in terms of foraging efficiency under either predation threat situation. However, bees that made faster decisions achieved higher nectar collection rates in predator free situations, while accurate bees achieved higher foraging rates under predation threat. Our findings show that while individual bees remain relatively consistent in terms of whether they place greater emphasis on speed or accuracy under predation threat, they can respond flexibly to the additional time costs of detecting predators. (shrink)

By comparing alternative evolutionary models, the International Sexuality Description Project marks the transition of evolutionary psychology to the next level of scientific maturation. The lack of final conclusions might partly be a result of the composition of the Sociosexual Orientation Inventory and the sampled populations. Our own data suggest that correcting for both gives further support to the strategic pluralism model.

Cognitive models propose that both, negative interpretations of ambiguous social situations and ruminative thoughts about social events contribute to the maintenance of social anxiety disorder. It has further been postulated that ruminative thoughts fuel biased negative interpretations, however, evidence is rare. The present study used a multi-method approach to assess ruminative processing following a social interaction and negative interpretation bias in a student sample screened for high and low social anxiety. Results support the hypothesis that group differences in negative interpretations (...) of ambiguous social situations in HSAs vs. LSAs are mediated by higher levels of post-event processing assessed in the questionnaire. Exploratory analyses highlight the potential role of comorbid depressive symptoms. The current findings help to advance the understanding of the association between two cognitive processes involved in social anxiety and stress the importance of ruminative post-event processing. (shrink)

Der Band Bildung als Kunst beleuchtet die Bildungskonzepte Fichtes, Schillers, Humboldts und Nietzsches.

Wenn es um „den Kapitalismus“ geht, regieren schnell die Gefühle. Die Philosophen Sabine Döring und Lars Neth appellieren an die Vernunft. -/- Interview: Wolf Lotter.

Limiting intensive care is paid increasing attention. In the echoing call for physicians’ ethical self‐restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, (...) but only draw conclusions from defined premises, the premises may or may not be true. Their intertwined descriptive and normative evidence is endorsed in an academic and political discourse. There will necessarily be various demands for rationality in prudent decisions between physicians, their patients and society. These demands are formulated dialogically through critical questions and justified answers. A good argument is the convincing one that, finally and ideally, leads to the absence of open objections. Thus, in the end the rightness of a given decision does not depend on axiomatic moral principles, but is comparative and conditional, as it is given in an omnilateral argument. Neither is it the democratic process of shared decision making that we should evaluate, but rather the argumentative state itself, when we judge the morality of health politics and clinical practice. (shrink)

Standard tools used in societal risk management such as probabilistic risk analysis or cost–benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor’s list to argue that the alternative (...) ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost–benefit analysis. (shrink)

This paper asks what it would mean for epistemic practices to take irreducible perspectivity into account. It starts with the premise that such perspectivity cannot be explained on the basis of conceptual logic alone, but only by virtue of the logic of sensual perception. Following Merleau-Ponty’s phenomenology of perception, four requirements are developed that irreducible perspectivity demands from epistemic practice: interminable movement, broadening horizons, bearing disharmonies and the presupposition of different horizons. As soon as truth-oriented practice is detached from the (...) traditional idea of final insights into ›things themselves‹, as it survives in the concepts of epistemology, it emerges as a concrete, mundane endeavour that continuously has to deal with the possibility that the world might be understood better, deeper or differently. (shrink)

Peter Winch, following Wittgenstein, was critical of the notion that philosophy could pass judgment on matters like the sense of words, the rationality of actions, or the validity of arguments. His critique had both what we might call a local strand – the insight that criteria of thought and action are not universal but vary between cultures and between practices – and a personal strand – the insight that those local criteria are ultimately given shape through the particular applications made (...) of them by individuals. These strands are prominent, for instance, in Winch’s discussion of cross-cultural understanding as well as his treatment of the distinction between valid reasoning and illicit persuasion. (shrink)

Although the use of new health technologies in healthcare and medicine is generally seen as beneficial, there has been little analysis of the impact of such technologies on people's lives and understandings of health and illness. This book explores how new technologies not only provide hope for cure and well-being, but also introduce new ethical dilemmas and raise questions about the "natural" body. Focusing on the ways new health technologies intervene into our lives and affect our ideas about normalcy, the (...) body and identity, New Health Technologies explores: how new health technologies are understood by lay people and patients how the outcomes of these technologies are communicated in various clinical settings how these technologies can alter our notions of health and illness and create "new illness." Written by authors with differing backgrounds in phenomenology, social psychology, social anthropology, communication studies and the nursing sciences, this book is essential reading for students andacademics of medical sociology, health and allied studies, and anyone with an interest in new health technologies. (shrink)

Der Ubergang von der Ideenwelt des Veda zu derjenigen der Upanisaden wird in der Regel als Beginn der indischen Philosophie angesehen. Lars Gohler zeigt in seiner Monographie zur fruhen Philosophie in Indien, dass es neben den Upanisaden hingegen noch eine weitere Traditionslinie in der Entstehung der indischen Philosophie gegeben hat: Sie fuhrt von der Opferritualistik des Veda zu der ihr nachfolgenden Ritualwissenschaft und Hermeneutik der Mimamsa. Ein Grossteil der Begriffe der indischen Philosophie, die ursprunglich aus dem Bereich der Opferritualistik (...) stammen, wurden in der Mimamsa von ihrem engeren rituellen Gebrauch gelost und erhielten eine philosophische Dimension. Ebenso haben die Diskurslogik, Sprachphilosophie und Hermeneutik der Mimamsa in methodischer Hinsicht wichtige Ausgangspunkte fur die klassische Philosophie Indiens dargestellt. Gohler beleuchtet in seiner Studie detailliert diese weitgehend unbekannte Traditionslinie und zeigt ihren entscheidenden Einfluss auf die Entwicklung der indischen Philosophie auf. (shrink)

Macroeconomic fluctuations in interest rates, exchange rates, and inflation can be considered sources of good or bad “luck” for corporate performance if management is unable to adjust operations to these fluctuations. Based on a sample of 2,091 US firms, we decompose the impacts of macroeconomic fluctuations on three measures of CEO compensation. Our study provides empirical support for the importance of considering macroeconomic fluctuations in designing CEO incentive schemes. It adds to the managerial power literature on moral hazard and CEO (...) compensation by pinpointing the obvious risk that the CEO in an asymmetric and non-linear reward system will be inclined to prioritize his/her own cash flow at the expense of fulfilling an assumed agency role. The policy conclusion for remuneration committees and board of directors is to filter out macroeconomic influences on performance to be rewarded whenever an asymmetric compensation scheme has been opted for. (shrink)

The role of intentions in motor planning is heavily weighted in classical psychological theories, but their role in generating eye movements, and our awareness of these oculomotor intentions, has not been investigated explicitly. In this study, the extent to which we monitor oculomotor intentions, i.e. the intentions to shift one’s gaze towards a specific location, and whether they can be expressed in conscious experience, is investigated. A forced-choice decision task was developed where a pair of faces moved systematically across a (...) screen. In some trials, the pair of faces moved additionally as soon as the participants attempted to gaze at one of the faces, preventing them from ever viewing it. The results of the experiment suggest that humans in general do not monitor their eye movement intentions in a way that allows for mismatches between planned gaze landing target and resulting gaze landing target to be consciously experienced during decision-making. (shrink)

This essay examines contemporary liberal theory in light of the 12 cartoons of the Prophet Muhammad, first published in the Danish newspaper Jyllands-Posten. The objective is both to show the limits of liberal theory, in particular with regard to constituents who do not share liberalism's view of acceptable harm, and to discuss how these limits give us reason to supplement liberal theory with other recourses from critical theory and phenomenology. The essay warns against a bifurcation of law and harm, and (...) instead argues for a pluralization of the possible links between them. To this end, the essay foregrounds what T.M. Scanlon dubs a certain ‘creative instability’, which works to energize liberalism's practice of free speech. The essay tracks this possibility in relation to the plurality and energy intrinsic to the 12 Jyllands-Posten cartoons, and suggests that liberal theory can learn from thinkers such as Merleau-Ponty and Deleuze who focus on the variable impacts and framings of free speech. The upshot is a self-critical theory of free expression, one that links harmful speech to the affirmation of mutual contestation, social equality and respect for difference. (shrink)

This paper considers the politics of tolerance through the lens of Spinoza’s philosophy of immanence. The contention is that Spinoza’s philosophy of immanence provides us with a better conceptualization of the relationship between tolerance and power, and that it in so doing reinvigorates a theory of active tolerance that, for the most part, has been lost in contemporary democratic theory. Spinoza’s philosophy of immanence does so because it animates a sensorial orientation to politics, one that heightens our attention to the (...) affective components of political life, enabling us to better theorize how all modes of existence, including the so-called passive ones, harbor a degree of power that can be mobilized for purposes that go beyond the “non-practice” highlighted by advocates and critics of tolerance in contemporary democratic theory. The paper develops this argument with ongoing reference to Marcuse’s critique of tolerance. (shrink)

It is not unusual in real-life that one has to choose among finitely many alternatives when the merit of each alternative is not perfectly known. Instead of observing the actual utilities of the alternatives at hand, one typically observes more or less precise signals that are positively correlated with these utilities. In addition, the decision-maker may, at some cost or disutility of effort, choose to increase the precision of these signals, for example by way of a careful study or the (...) hiring of expertise. We here develop a model of such decision problems. We begin by showing that a version of the monotone likelihood-ratio property is sufficient, and also essentially necessary, for the optimality of the heuristic decision rule to always choose the alternative with the highest signal. Second, we show that it is not always advantageous to face alternatives with higher utilities, a non-monotonicity result that holds even if the decision-maker optimally chooses the signal precision. We finally establish an operational first-order condition for the optimal precision level in a canonical class of decision-problems, and we show that the optimal precision level may be discontinuous in the precision cost. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)