Background: There is a shortage of reports on what potential recipients of implantable cardioverter–defibrillators need to be informed about and what role they can and want to play in the decision-making process when it comes to whether or not to implant an ICD.Aims: To explore how patients with heart failure and previous episodes of malignant arrhythmia experience and view their role in the decision to initiate ICD treatment.Patients and methods: A qualitative content analysis of semistructured interviews was used. The study (...) population consisted of 31 outpatients with moderate heart failure at the time of their first ICD implantation.Setting: The study was performed at Sahlgrenska University Hospital, Göteborg, Sweden.Results: None of the respondents had discussed the alternative option of receiving treatment with anti-arrhythmic drugs, the estimated risk of a fatal arrhythmia, or the expected time of survival from heart failure in itself. Even so, very little criticism was directed at the lack of information or the lack of participation in the decision-making process. The respondents felt that they had to rely on the doctors’ recommendation when it comes to such a complex and important decision. None of them regretted implantation of the ICD.Conclusions: The respondents were confronted by a matter of fact. They needed an ICD and were given an offer they could not refuse, simply because life was precious to them. Being able to give well-informed consent seemed to be a matter of less importance for them. (shrink)

In recent years, the EU legislation on genetically modified crops has come under severe criticism. Among the arguments are that the present legislation is inconsistent, disproportionate, obsolete from a scientific point of view, and vague in terms of its scope. In this paper, the EU GM legislation is analysed based on five proposed criteria: legal certainty, non-discrimination, proportionality, scientific adaptability, and inclusion of non-safety considerations. It is argued that the European regulatory framework does not at present satisfy the criteria of (...) legal certainty, non-discrimination, and scientific adaptability. Two ways of reforming the present legislation toward greater accommodation of the values expressed through the proposed criteria are briefly introduced and discussed. (shrink)

Obstetric ultrasound has become a significant tool in obstetric practice, however, it has been argued that its increasing use may have adverse implications for women’s reproductive freedom. This study aimed to explore Australian obstetricians’ experiences and views of the use of obstetric ultrasound both in relation to clinical management of complicated pregnancy, and in situations where maternal and fetal health interests conflict.

The normative criterion of attainability, or non-utopianism, is often referred to in discussions of goal-setting rationality. Goals should be realistic, it is argued, since it is unreasonable to adopt goals that cannot be achieved and that are of no use in the selection of means toward their realization. However, despite the proposed requirement of attainability, utopian or semi-utopian goals are often adopted in political contexts, the Swedish Vision Zero for trafflc safety being one example. This paper develops and analyzes four (...) objections that can be raised against the use of utopian goals and to support the normative criterion of attainability: that utopian goals are (1) too imprecise and (2) too far-reaching to guide action effectively, (3) counterproductive, and (4) morally objectionable. A tentative defense of utopian goal-setting is built on the counter-arguments that can be put forward to weaken each of the four objections. (shrink)

The overall aim of this thesis is to present a model for rational goal-setting and to illustrate how it can be applied in evaluations of public policies, in particular policies concerning sustainable development and environmental quality. The contents of the thesis are divided into two sections: a theoretical section and an empirical section. Paper I identifies a set of rationality criteria for single goals and discusses them in relation to the typical function of goals. It is argued that goals are (...) typically set to enhance goal achievement. A goal that successfully furthers its achievement is “achievement-inducing”. It holds for each of the identified criteria that, ceteris paribus, improved satisfaction of a criterion makes a goal better in the achievement-inducing sense.Paper II contains an analysis of the notion of goal system coherence. It is argued that the coherence of a goal system is determined by the relations that hold among the goals in the system, in particular the relations of operationalization, means and ends, support, and conflict. Paper III investigates the rationality of utopian goals. The paper analyzes four arguments that support the normative criterion of attainability: that utopian goals are too imprecise and too far-reaching to guide action effectively, counterproductive, and morally objectionable. A tentative defence of utopian goal-setting is built on counter-arguments that can be put forward to weaken each of the four objections. Paper IV investigates the nature of self-defeating goals. The paper identifies three types of situations in which self-defeating mechanisms obstruct goal achievement: situations in which the goal itself carries the seeds of its own non-fulfilment, situations in which the activity of goal-setting contributes to goal failure, and situations in which disclosure of the goal interferes with progress. Paper V provides a brief description of the Swedish system of environmental objectives and a preliminary inventory of the management difficulties that attach to this goal system.Paper VI contains an investigation into the rationality of five Swedish environmental objectives through an application of the rationality criteria identified in Papers I-II. The paper identifies and discusses some difficulties that are associated with management by objectives and the use of goals in environmental policy. Paper VII analyses the rationality of the Swedish environmental quality objective A good built environment. Among the conclusions drawn in the paper are that some of the sub-goals to the objective are formulated in terms that are unnecessarily vague from an action-guiding standpoint and that others are problematic from the viewpoint of evaluability. (shrink)

The typical function of goals is to regulate action in a way that furthers goal achievement. Goals are typically set on the assumption that they will help bring the agent closer to the desired state of affairs. However, sometimes endorsement of a goal, or the processes by which the goal is set, can obstruct its achievement. When this happens, the goal is self-defeating. Self-defeating goals are common in both private and social decision-making but have not received much attention by decision (...) theorists. In this paper, we investigate different variants of three major types of self-defeating mechanisms: The goal can be an obstacle to its own fulfilment, goal-setting activities can impede goal achievement, and disclosure of the goal can interfere with its attainment. Different strategies against self-defeasance are tentatively explored, and their efficiency against different types of self-defeasance is investigated. (shrink)

Sustainable development is a common goal in the public sector but may be difficult to implement due to epistemic uncertainties and the long time frames required. This paper proposes that some of these problems can be solved by formulating cautious utopias, entailing a relationship between means and goals differing from both utopian and realistic goal-setting. Cautiously utopian goals are believed, but not certain, to be achievable and to remain desirable, but are open to future adjustments due to changing desires and/or (...) factual circumstances. Quality criteria for such goals are suggested. (shrink)

In order to responsibly protect certain cherished values, for instance, human or environmental health, privacy, or ‘human dignity’, societies see a need for oversight, guidance and regulation of de...

It is commonly argued that cultural objects ought to be returned to their place of origin in order to remedy injustices committed in the past. In this paper, it is shown that significant challenges attach to this way of arguing. Although there is considerable intuitive appeal in the idea that if somebody wrongs another person then she ought to compensate for that injustice, the principle is difficult to apply to wrongdoings committed many decades or centuries ago. It is not clear (...) that historic injustices can meaningfully be corrected, or compensated for, and there are several arguments why, even in cases where there is a prima facie moral case for compensation, repatriation might not be a legitimate means of remedy. In order to bring analytical clarity to the issue, this paper discusses the various steps of the argument that must be addressed in order to ground a valid repatriation claim based on historic injustices. (shrink)

Opposition against greenhouse gas emissions reductions is strong among some conservative Christian groups, especially in the United States. In this paper, we identify five scripture-based arguments against greenhouse gas mitigation put forward by a core group of Christian conservatives ('the Cornwallists'): the anti-paganism argument, the enrichment argument, the omnipotence argument, the lack of moral relevance argument and the cost-benefit argument. We evaluate to what extent the arguments express positions that can be characterised as climate science denialist and to what degree (...) they are consistent with support for climate adaptation. Using Stefan Rahmstorf's (2004) taxonomy of climate science denial, we conclude that the Cornwallists could be labelled climate change deniers. However, their opposition is not only based on denial of climate science but often rests on premises that render the science irrelevant, a position we term 'relevance denialism'. (shrink)

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The acute care setting is (...) characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence. (shrink)

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to (...) comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. (shrink)

The aim of this analysis was to examine the concept of time to rejuvenate and extend existing narratives of time within the nursing literature. In particular, we hope to promote a new trajectory in nursing research and practice which focuses on time and person‐centred care, specifically of older people with cognitive impairment hospitalized in the acute care setting. We consider the explanatory power of concepts such as clock time, process time, fast care, slow care and time debt for elucidating the (...) relationship between ‘good care’ and ‘time use’. We conclude by offering two additional concepts of time, plurotemporality and person‐centred time (PCT) which we propose will help advance of nursing knowledge and practice. Nurse clinicians and researchers can use these alternative concepts of time to explore and describe different temporal structures that honour the patient's values and preferences using experiential, observation‐based nursing research approaches. (shrink)

Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the ‘acute care space’ as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person‐centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to (...) older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person‐centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of ‘person‐centred space’ helps to crystallize the relationship between space and person‐centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them. (shrink)

In this article, we sought reconciliation between the “body‐as‐representation” and the “body‐as‐experience,” that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary “technologies” and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the (...) repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter‐bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the “body‐as‐representation” with the “body‐as‐experience” to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person‐centred care which evokes nurses to respond appropriately to the older person's “otherness,” their “variation of being” while enabling them to enact a continuation of themselves and their own version of normality. (shrink)

The normative criterion of attainability, or non-utopianism, is often referred to in discussions of goal-setting rationality. Goals should be realistic, it is argued, since it is unreasonable to adopt goals that cannot be achieved and that are of no use in the selection of means toward their realization. However, despite the proposed requirement of attainability, utopian or semi-utopian goals are often adopted in political contexts, the Swedish Vision Zero for trafflc safety being one example. This paper develops and analyzes four (...) objections that can be raised against the use of utopian goals and to support the normative criterion of attainability: that utopian goals are (1) too imprecise and (2) too far-reaching to guide action effectively, (3) counterproductive, and (4) morally objectionable. A tentative defense of utopian goal-setting is built on the counter-arguments that can be put forward to weaken each of the four objections. (shrink)

The normative criterion of attainability, or non-utopianism, is often referred to in discussions of goal-setting rationality. Goals should be realistic, it is argued, since it is unreasonable to adopt goals that cannot be achieved and that are of no use in the selection of means toward their realization. However, despite the proposed requirement of attainability, utopian or semi-utopian goals are often adopted in political contexts, the Swedish Vision Zero for trafflc safety being one example. This paper develops and analyzes four (...) objections that can be raised against the use of utopian goals and to support the normative criterion of attainability: that utopian goals are (1) too imprecise and (2) too far-reaching to guide action effectively, (3) counterproductive, and (4) morally objectionable. A tentative defense of utopian goal-setting is built on the counter-arguments that can be put forward to weaken each of the four objections. (shrink)

Biodiversity offsetting is an increasingly popular policy instrument used to compensate for losses in biodiversity and ecosystem services caused by development projects. Although evidence suggests that offsetting can yield significant environmental benefits, application of the policy instrument is surrounded by controversy. Among other things, critics argue that offsetting builds on normatively contentious assumptions regarding the value of nature and the fungibility of biodiversity components, such as species, habitats, ecosystems, and landscapes. A large portion of the criticism targets the allegedly illegitimate (...) commodification of nature that the policy instrument entails. Exploring the significantly more developed normative discussion on carbon offsetting, this article identifies four arguments that plausibly could be made to support the claim that it is wrong to commodify nature in the way biodiversity offsetting schemes do: the common ownership argument, the price argument, the non‐substitutability argument, and the “crowding out” argument. Although none of the arguments definitively invalidate the use of biodiversity offsets, they provide good reasons to proceed with caution when designing and implementing them. (shrink)

Исследование посвящено философскому осознанию природы духовности человека. Автор рассматривает духовность внутреннего мира человека как единство высших чувств души и нравственного сознания. Для специалистов в области философии, методологии науки.

Goals are often set as part of clusters of goals. On the assumption that goals are set because we want to achieve them it is interesting to study not only the conditions under which individual goals are rational but also the factors that combine to determine the rationality of a goal system. This paper argues that to be rational goal systems ought to be coherent, at least to some degree. The paper provides an analysis of goal system coherence and discusses (...) to what extent goal conflicts are problematic from an action-guiding viewpoint. /// Muchas veces las metas se fijan como parte de grupos de metas. Bajo el supuesto de que las metas se fijan porque queremos lograrlas, resulta interesante estudiar no sólo las condiciones en las que cada meta es racional, sino también los factores que se combinan para determinar la racionalidad de un sistema de metas. Este trabajo argumenta que, para ser racionales, los sistemas de metas deben ser coherentes, o al menos deben serlo hasta cierto punto. El artículo ofrece un análisis de la coherencia de un sistema de metas y discute en qué grado los conflictos de metas son problemáticos desde el punto de vista de guiar la acción. (shrink)

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically ‘the good death’. A genealogical approach informed by actor‐network theory and appreciative inquiry were used to compose a broad socio‐material account of how nurses concern themselves with the care of the dying and end‐of‐life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of ‘the good death’ (...) were re‐presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death. (shrink)

Despite Vision Zero’s moral appeal and its expansion throughout the world, it has been criticized on different grounds. This chapter is based on an extensive literature search for criticism of Vision Zero, using the bibliographic databases Philosopher’s Index, Web of Science, Science Direct, Scopus, Google Scholar, PubMed, and Phil Papers, and by following the references in the collected documents. Even if the primary emphasis was on Vision Zero in road traffic, our search also included documents criticizing Vision Zero policies in (...) other safety areas, such as public health, the construction and mining industries, and workplaces in general. Based on the findings, we identify and systematically characterize and classify the major arguments that have been put forward against Vision Zero. The most important arguments against Vision Zero can be divided into three major categories: moral arguments, arguments concerning the rationality of Vision Zero, and arguments aimed at the practical implementation of the goals. We also assess the arguments. Of the 13 identified main arguments, 6 were found to be useful for a constructive discussion on safety improvements. (shrink)

Person‐centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person‐centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing (...) constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person‐centred. In this article, we explore key concepts of neo‐liberal thought which forms an important back‐story to the articles. Economic concepts, “efficiency” and “freedom” are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo‐liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power. (shrink)

In this age of DNA computers and artificial intelligence, information is becoming disembodied even as the "bodies" that once carried it vanish into virtuality. While some marvel at these changes, envisioning consciousness downloaded into a computer or humans "beamed" _Star Trek_-style, others view them with horror, seeing monsters brooding in the machines. In _How We Became Posthuman,_ N. Katherine Hayles separates hype from fact, investigating the fate of embodiment in an information age. Hayles relates three interwoven stories: how information lost (...) its body, that is, how it came to be conceptualized as an entity separate from the material forms that carry it; the cultural and technological construction of the cyborg; and the dismantling of the liberal humanist "subject" in cybernetic discourse, along with the emergence of the "posthuman." Ranging widely across the history of technology, cultural studies, and literary criticism, Hayles shows what had to be erased, forgotten, and elided to conceive of information as a disembodied entity. Thus she moves from the post-World War II Macy Conferences on cybernetics to the 1952 novel _Limbo_ by cybernetics aficionado Bernard Wolfe; from the concept of self-making to Philip K. Dick's literary explorations of hallucination and reality; and from artificial life to postmodern novels exploring the implications of seeing humans as cybernetic systems. Although becoming posthuman can be nightmarish, Hayles shows how it can also be liberating. From the birth of cybernetics to artificial life, _How We Became Posthuman_ provides an indispensable account of how we arrived in our virtual age, and of where we might go from here. (shrink)

We argue that the appraisal of models in social epistemology requires conceiving of them as argumentative devices, taking into account the argumentative context and adopting a family-of-models perspective. We draw up such an account and show how it makes it easier to see the value and limits of the use of models in social epistemology. To illustrate our points, we document and explicate the argumentative role of epistemic landscape models in social epistemology and highlight their limitations. We also claim that (...) our account could be fruitfully used in appraising other models in philosophy and science. (shrink)

Philosophy Then and Now provides an innovative and engaging blend of introductory text with classic and contemporary readings. Each of the eight parts begins with an introductory section on the major ideas associated with a seminal figure from the history of philosophy. This is followed by key selections from the essential writings of that philosopher, as well as influential selections from contemporary figures. Key figures covered include: Socrates, Aquinas, Locke, Descartes, Mill, Nietzsche, Marx, and Sartre. By focusing on the core (...) themes, issues and problems of philosophy, the volume motivates student interest in the subject, and represents a distinctive text for all introductory courses in philosophy. (shrink)

Tipy mirovozzreniĭ -- Chuvstvennai︠a︡, intellektualʹnai︠a︡ i misticheskai︠a︡ intuit︠s︡ii︠a︡ -- Ideal-realizm.