One INTRODUCTION 1. Background The theory of the nature of health and disease, or of the concepts of health and disease, has been central in modem ...

The aim of this study was to explore the ethical foundations for a caring conversation. The analysis is based on the ethics of Paul Ricoeur and deals with questions such as what kind of person the nurse ought to be and how she or he engages in caring conversations with suffering others. According to Ricoeur, ethics (the aim of an accomplished life) has primacy over morality (the articulation of aims in norms). At the ethical level, self-esteem and autonomy were shown (...) to be essential for a person (nurse) to act with respect and responsibility. The ethical relationship of a caring conversation was found to be asymmetrical, because of the passivity inflicted by suffering. This asymmetry was found to be potentially unethical if not balanced with reciprocity. In the ethical context, the caring conversation is one in which the nurse makes room through the ethos of caritas for a suffering person to regain his or her self-esteem, and thus makes a good life possible. (shrink)

Bengt Brülde in his article ``The Goals of Medicine. Towards a Unified Theory'' has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. In Brülde's analysis, however, the very concept of medicine is deliberately left quite vague and it is therefore difficult to see how the goals of medicine are related to the goals of closely allied enterprises such as health promotion and social welfare. In this reply I (...) therefore propose an analysis of these related conceptual areas. I do this mainly in two respects. Following the nomenclature in a previously published article I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between – as well as the common properties of – these different enterprises. (shrink)

As a part of a research project on Dignity and Older Europeans Programme) I explore in this paper a set of notions of human dignity. The general concept of dignity is introduced and characterized as a position on a value scale and it is further specified through its relations to the notions of right, respect and self-respect. I present four kinds of dignity and spell out their differences: the dignity of merit, the dignity of moral or existential stature, the dignity (...) of identity and the universal human dignity. Menschenwürde pertains to all human beings to the same extent and cannot be lost as long as the persons exist. The dignity of merit depends on social rank and position. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go. The dignity of moral stature is the result of the moral deeds of the subject; likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed. The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, also dependent on the subject's self-image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind. (shrink)

The paper presents an infinite hierarchy of sound and complete axiomatic systems for Two-Dimensional Modal Tense Logic with Historical Necessity, Agents and Acts. A main novelty of these logics is their capacity to represent formally (i) basic action-sentences asserting that such and such an act is performed/omitted by an agent, as well as (ii) causative action-sentences asserting that by performing/omitting a certain act, an agent causes that such and such a state-of-affairs is realized (e.g. comes about/ceases/remains/remains absent). We illustrate how (...) the formal machinery of our systems can be used to reconstruct a number of interesting ideas in the Logic of Agency and Action that have been proposed by authors like von Wright, von Kutschera, Belnap and Segerberg. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Concepts and Theories of AddictionLennart Nordenfelt (bio)Keywordsaddiction, disease, will power, autonomy, holistic view of healthThe article "A Liberal Account of Addiction" is a good piece of analytic philosophy applied to psychiatry. It is well-informed both with regard to empirical matters and philosophical conceptualization. The arguments are often—but, as I will show, not always—quite convincing. The conclusions of the paper also have crucial consequences for practice, for the treatment (...) of patients, and for social policy.The authors argue that current scientific understandings of the problem of addiction are fundamentally flawed. They distinguish between two main positions in science: The Disease View and the Willpower View. According to the Disease View, drug-seeking behavior is the direct result of some physiological change in the drug seeker's brain. According to the Willpower View, the addict is no longer rational; he or she uses drugs as a result of a fundamentally non-voluntary process.The authors dismiss the Disease View in the following way. They first note that drug addicts are in many ways rational planners. The addicts may have to think a lot to find the best ways to find the heroin, cigarettes, or alcohol, and they normally act according to this planning. They are not in any simple sense "caused" to act in a particular way. Moreover, referring to recent neurological literature, the authors note that the changes caused by drug addiction—which have to do with activating reward pathways in the brain—are identical with the outcomes of many other human activities that we do not call addiction. "In fact, any pleasurable experience causes dopamine to be released within the brain, activating these reward pathways" (Foddy and Savulescu 2010, 4). These experiences can be the result of coffee drinking, sexual activity, and physical exercise. Thus, the physical changes in the brain are not effects peculiar to the pharmacology of the drugs; they are instead the effects of the pleasure that the subject has experienced.The argument against the Willpower View is lengthy and more involved. The proponent of the Willpower View must argue that there is some flaw in the subject's autonomy. The drug addict is in some sense unable to avoid taking the drug. The authors of the present article scrutinize this idea on the basis of distinguishing between different senses of autonomy: Substantive autonomy and procedural autonomy. They state that we must here be talking about procedural autonomy, namely, autonomy regarded as dependent only on our capacity to process information and make choices in accordance with our preferences. We cannot, as in the case of substantive autonomy, require that the preferences themselves be reasonable. [End Page 27] In such a case, many of our ordinary actions would be judged non-autonomous.The most reasonable Willpower accounts rely on the idea that addicted people in some sense lack self-control. The authors cite different interpretations of the concept of lacking self- control and they conclude that "none of these … theories can say that addicts are necessarily lacking in self-control unless they also make unreasonable normative or false factual claims about the nature of drug- or pleasure-oriented choices" (Foddy and Savulescu 2010, 10). For instance, according to one interpretation the subject does not endorse his own desire for drugs, but takes the drug anyway. According to another interpretation, the addict regrets taking the drug after having done so. Against such claims the authors claim that many addicts indeed endorse their desires for drugs and many addicts do not regret their addictive behavior.So what is the positive account proposed by the authors? They put forward what they call a Liberal View. It contains three claims about addiction: First, we do not know whether an addict values anything more than the satisfaction of his addictive desires; second, we do not know whether an addict behaves autonomously when he uses drugs; and third, addictive desires are just strong regular desires.According to the Liberal View, one has to accept that the addicts may have drug taking as their highest priority and that they do not have any reduced procedural autonomy. The authors say: "Once we abandon normative bias, we must accept... (shrink)

The basic work for this book was carried out during the spring of 1989 in Edinburgh, where I had been granted a research position at The Institute for Advanced Studies in the Humanities. I should like to express here my indebtedness to the Institute for the opportunity thus afforded me. I should also like to say how very grateful I am for the stimulating conversations I had there with Professor Timothy Sprigge and Dr. Elizabeth Telfer. Dr. Telfers’s own treatise Happiness (...) has been a major influence on my view of the questions involved. The basic view of health and illness presented in this book is more fully set out in my On the Nature of Health. As in the case of my previous larger projects, I have received a great amount of support and may wise comments from Professor Ingmar Pörn, Helsinki. Three Danish experts – Anton Aggernaes, Erik Ostenfeld and Peter Sandøe – have made valuable comments. Professor Heng ten Have, Nijmegen, has improved my reading of the philosophy of Jeremy Bentham. I should also like to thank my colleagues at the Department of Health and Society, University of Linköping, for helping me to avoid a number of the pitfalls that can so easily stumble into when it comes to a treatise like this. Especially I should like to mentioned Per-Erik Liss, Ingemar Nordin and Bo Petersson, all three of whom have read and commented on the entire manuscript. A Swedish version of this book, Livskvalitet och hälsa, came out in 1991. I have been made quite a number of corrections and additions, one type of addition being replies to critical points made in reviews of the Swedish version. I should like to thank Malcolm Forbes for valuable help putting my English into publishable condition. Linköping, May 1993 Lennart Noredenfelt. (shrink)

Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe this person. On (...) the other hand it certainly does not preclude an additional evaluation of the state of affairs as undesirable or bad. The basic scientific description and the evaluation are, however, two independent matters, according to this kind of theory. Other philosophers claim that the concept of health, together with the other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. A statement that he or she is healthy does not merely imply certain scientific facts regarding the person’s body or mind but implies also a (positive) evaluation of the person’s bodily and mental state. My task in this paper will be, first, to present the two principal rival types of theories and present what I take to be the main kind of reasoning by which we could assess these theories, and second, to present a deeper characterization of the principal rival theories of health and illness. (shrink)

A great number of constructive suggestions for the analysis of the concepts and models treated are presented in this book, which mirrors a current debate within the theory of medicine by covering three central topics: the concepts of health and disease; definition and classification in medicine; and causal explanation in medicine. Among the issues dealt with are: How should the concepts of health and disease be characterized in order to be of relevance to clinical practice? Should we try to define (...) particular diseases in explicit terms? What should be the criteria for selecting causes when explaining disease or death? These problems are treated from various points of view, the contributors being drawn from the fields of clinical medicine, epidemiology, psychiatry, social medicine, philosophy, and history of medicine. (shrink)

This paper contains an attempt at constructing a semantic framework for the field of health enhancement. The latter is here conceived as an extremely general category covering the whole area of health care and health promotion. With this framework as a basis I attempt to define the place of medicine within the enterprise of health enhancement. I finally indicate some normative issues for the future, in particular problems and possible developments for medicine as a species of health enhancement.

In policy-making the consumption of specially labelled products, and its role in improving the welfare of livestock, has attracted considerable attention. There is in many countries a diverse market for animal welfare-friendly products which is potentially confusing and may lack transparency. We ask whether special quality labels that involve medium levels of animal welfare, as compared with labels promoting premium levels of animal welfare, have a role to play in promoting improvements in animal welfare. The Danish pork market is our (...) reference case, but we also widen the context by comparing the markets for pork in three other European countries. Our findings suggest that in order to improve animal welfare through demand for welfare-friendly products it is important to maintain separate the market for products with strong animal welfare profiles from markets for products with medium levels of animal welfare where, often, animal welfare is bundled together with other food quality attributes. We conclude that such quality labels may indeed play an important role in promoting higher animal welfare standards provided that they offer real improvements in animal welfare as compared with standard products. They will be attractive to consumers with a positive, but not especially strong interest in animal welfare as an individual food attribute who would otherwise be inclined to purchase standard products. (shrink)

This book contains scholarly contributions to several current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental illness, phenomenological conceptions of health and illness, allocation of health care resources, criteria for proper medical science, the clinical meeting, and ethical constraints in such a meeting. With one exception, the authors in this book are or have been teachers or graduate students at the interdisciplinary Department of Health and Society (...) (Tema H) at Linköping University, Sweden. While all the texts have a philosophical focus, many other disciplines have influenced the choice of specific perspectives. The university backgrounds of the authors range from medicine, psychology, sociology, and religion to philosophy. What binds the authors together is their deep interest in the theory of medicine and in the pursuit of a philosophy of humanistic medicine and health care. (shrink)

Kierkegaard's view of time and eternity.

The main purpose of this paper is to clarify some senses of dignity that are particularly relevant for the treatment and care of the elderly. I make a distinction between two quite different ideas of dignity, on the one hand the basic kind of dignity possessed by every human being, and on the other hand the dignity which is the result of a person's merits, whether these be inherited or achieved. Common to both these ideas is that having a dignity (...) entails having a set of rights, in the case of basic dignity the set of rights which we call human rights, the rights which the United Nations, among others, has tried to determine. The dignities of merit also provide some rights, although normally rights with limited scope covering, for instance, a professional area. This observation gives my preliminary answer to the fundamental question of what distinguishes dignity from other high values that could be attached to humans. I discuss further a kind of value that might be mistaken for a kind of dignity, viz. what I call public status. This status is to be distinguished from social status (the status of e.g. kings, governors, and officials) that I take to be a proper dignity of merit. The public status is the status gained solely via public perception and not directly via any merits on the part of the dignified. Finally, I turn to the topic of the dignity of the elderly and try to determine whether there is some dignity peculiar to the elderly, and which is over and above the basicMenschenwrde. My two preliminary proposals are the following: the elderly have a dignity of wisdom and they have a highly general dignity of merit, which results from their life-long efforts and achievements, and for this they deserve our gratitude. (shrink)

This book is a contribution to the general philosophy of action and the philosophy of welfare. The author makes separate analyses of concepts such as action, ability, interaction, action-explanation, happiness, health, illness and disability. At the same time he explores and substantiates the idea of a strong interdependence between the concept of action and some of the central concepts of welfare, in particular health and illness and related concepts.

Experts have been claimed to perceive risks in a different way than the general public. It is likely that experts often see risks in their own field of expertise as smaller than the public does, but that does not imply that their risk perception is also driven by other factors. Topical experts and general risk assessors are two quite different types of experts. Still, common assertions as to the simple structure of expert risk perception, said to be related only to (...) technical or statistical risk estimates, builds on a meager database consisting of 15 general risk assessors. Results from a study reported here show that the factors explaining experts’ risk perception are similar to those of a comparable group of nontopical experts with a similar level of technological literacy and to the general public, and that the level of explained variance is quite comparable for experts and the general public. (shrink)

According to an infinite frequency principle, it is rational, under certain conditions, to set your credence in an outcome to the limiting frequency of that outcome if the experiment were repeated indefinitely. I argue that most infinite frequency principles are undesirable in at least one of the following ways: accepting the principle would lead you to accept bets with sure losses, the principle gives no guidance in the case of deterministic experiments like coin tosses and the principle relies on a (...) metaphysical property, ‘chanciness’, whose necessary and sufficient conditions are unknown. I show that a frequency principle that is based on the principal principle suffers from problems related to the definition of ‘chance’ or ‘chanciness’, which could lead to all three of the above problems. I introduce a version of the infinite frequency principle that does not rely on a notion of chance or chanciness and does not suffer from any of these problems. (shrink)

In this article I provide an analysis of some salient concepts of dignity. The text is a development of a work which was initiated in the year 2000 in the research programme Dignity and Older Europeans supported by the European Union. The programme was both theoretical and empirical. The empirical part, which was the most comprehensive, consisted of focus-group interviews with health care and social care personnel, elderly persons within health care or social care, and representatives from the general public. (...) The interviews concerned the care of the elderly and attitudes towards the elderly. Some questions concerned how the interviewees conceived the concept of dignity and what they meant by behaviour respectful of dignity in the care of the elderly. Altogether around 1000 focus-group interviews were conducted in seven of the countries involved. The theoretical part of the programme consisted of an analysis of the concepts of dignity based on studies of dictionary entries in six languages as well as previous philosophical analyses of the concept. In the theoretical part of the study there emerged four different concepts of dignity: dignity of merit, dignity of moral standing, dignity of identity and human dignity. Characterizations of these concepts have been presented and developed in several publications, for example Nordenfelt and. In the present article this analysis is taken a step further. I take as a starting point some previous studies, including Schroeder, Sulmasy and my earlier ones, and propose an improvement and clarification of my earlier classification of dignities. At the same time I enlarge the analysis to concern worths in general and how these are attached to entities in general, not just human beings. The four kinds of dignities which I now propose are called: attributed dignity, dignity of inflorescence, dignity of identity and human dignity. (shrink)

Emotions are an important clue for the characterisation of individuals in Xenophon’s “Hellenica”. Especially joy and schadenfreude have an important narrative function. Malicious joy and spite point at the flaws of the Spartan hegemony after the Peloponnesian War. However, pleasure at the misfortune of others is not negative in itself. Defeating hubristic enemies is a proper reason to rejoice for Xenophon. Emotions can be vices or virtues, it is the circumstances that define their moral value.

The paper presents an infinite hierarchy PR m [ m = 1, 2, . . . ] of sound and complete axiomatic systems for modal logic with graded probabilistic modalities , which are to reflect what I have elsewhere called the Bolding-Ekelöf degrees of evidential strength as applied to the establishment of matters of fact in law-courts. Our present approach is seen to differ from earlier work by the author in that it treats the logic of these graded modalities not (...) only from a semantical or model-theoretic viewpoint but from a prooftheoretical and axiomatic stance as well. A paramount feature of the approach is its use of so-called systematic frame constants as labels of diverse grades of probability. Apart from this novel feature our approach can be seen to go back to pioneering work by Lou Goble in 1970. (shrink)

Contemporary philosophy of health and disease has been quite focused on the problem of determining the nature of the concepts of health and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atoms, metal, and rain are value-free and descriptive. According to this descriptive or naturalist line of thought, the notions of health and disease are furthermore related to the idea of a (...) normal or natural function. A bodily organ is healthy insofar as it functions normally, and it is diseased when it does not fulfill its functions. Other philosophers claim that the concept of health, together with other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. My purpose in this article is to scrutinize the relation between the notion of a natural function, on the one hand, and the concepts of health and disease on the other. In characterizing the notion of a normal function I will follow the classic analysis put forward by American philosopher Christopher Boorse. I will criticize Boorse’s proposal mainly by using arguments from the analysis of ordinary lay and medical language. I ask questions such as: what do we normally mean when we ascribe health or disease to a person? In the end I will recommend an analysis of these and related medical notions, which is unrelated to the notion of a natural function as normally interpreted. (shrink)