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

From a cultural-historical perspective, the impairments of a child with a condition like cerebral palsy have biological origins, but the disability evolves from the mismatch between the child and his/her social conditions for development. One example of this dialectical production of disability can be seen in the challenge of the 21st-century welfare state: How to provide economically feasible health and educational services anchored in evidence-based methods and practices. Standardized social service pathways for children with CP illustrates an attempt to address (...) this challenge and moderate the mismatch by acting in the intersection between impairment and society. The aim of the article is to analyze challenges in the practice of connecting research and practice-based knowledge with societal practices in order to diminish the disability of the child. A multidisciplinary group assembled by the Danish National Board of Social Services engaged in a practice of developing a guideline for a social service pathway. Agendas and minutes from their series of meetings provide insight in how the work evolved through conflictual discussions. Rather than a neutral transformation of knowledge into practice, the practice revealed itself as a value-laden process in which the needs of the child and family were at times decentred and the focus shifted to how social services could be realised in complex, structured social practices. While the group managed to overcome several conflicts and agree of a social service pathway, a socio-economic analysis was unable to argue for the comprehensive social service pathway as an economic sound choice for municipal decision-makers. The conflict between the welfare ideology and economic feasibility remains unresolved and can be expected to limit the extent that impairments can be remedied and the mismatch decreased. Overcoming or diminishing the mismatch might never become economic worthwhile. As the political pendulum oscillates between welfare and economic concerns, the experience of disability will likewise diminish or expand. (shrink)

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). (...) No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems. (shrink)

Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching aim in (...) this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory. (shrink)

This World Bank Report offers a new conception of fair decision processes in health financing. It argues that such procedural fairness can contribute to fairer outcomes, strengthen the legitimacy of decision processes, build trust in authorities, and promote the sustainability of reforms on the path to health coverage for all.

Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients (...) who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and (...) 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which (...) is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework’s four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors. (shrink)

Varieties of Ethical Reflection brings together new cultural and religious perspectives—drawn from non-Western, primarily Asian, philosophical sources—to globalize the contemporary discussion of theoretical and applied ethics.

The composition of a timeline depends on purpose, perspective, and scale – and of the very understanding of the word, the phenomenon referred to, and whether the focus is the idea or concept, an instance of an idea or a phenomenon, a process, or an event and so forth. The main function of timelines is to provide an overview over a long history, it is a kind of a mnemotechnic device or a particular kind of Knowledge Organization System (KOS).b The (...) entries in the timeline should be brief and indisputable. Therefore, timelines often identify the first occurrences rather than the most widespread or most qualified instances leaving the fuller and more complex, and possibly disputable story out. But even first occurrences are often difficult to establish. The first occurrence is most often only the first finding of an instance. Older instances may be found and competing definitions develop either within a field or in different fields. This is further complicated since the phenomena, their names, and their meanings may change over time. Former meanings may become redundant, or they must accommodate and coexist with new meanings. The time and place of the composition of the timeline are to be considered in interpreting the things listed. The following note will discuss these issues as they occur in the development of the notions of text, e-text and hypertext, and the origin of machine translation. (shrink)

Throughout what is now the more than 50-year history of the computer many theories have been advanced regarding the contribution this machine would make to changes both in the structure of society and in ways of thinking. Like other theories regarding the future, these should also be taken with a pinch of salt. The history of the development of computer technology contains many predictions which have failed to come true and many applications that have not been foreseen. While we must (...) reserve judgment as to the question of the impact on the structure of society and human thought, there is no reason to wait for history when it comes to the question: what are the properties that could give the computer such far-reaching importance? The present book is intended as an answer to this question. The fact that this is a theoretical analysis is due to the nature of the subject. No other possibilities are available because such a description of the properties of the computer must be valid for any kind of application. An additional demand is that the description should be capable of providing an account of the properties which permit and limit these possible applications, just as it must make it possible to characterize a computer as distinct from a) other machines whether clocks, steam engines, thermostats, or mechanical and automatic calculating machines, b) other symbolic media whether printed, mechanical, or electronic and c) other symbolic languages whether ordinary languages, spoken or written or formal languages. This triple limitation, however, (with regard to other machines, symbolic media and symbolic languages) raises a theoretical question as it implies a meeting between concepts of mechanical-deterministic systems, which stem from mathematical physics, and concepts of symbolic systems which stem from the description of symbolic activities common to the humanities. The relationship between science and the humanities has traditionally been seen from a dualistic perspective, as a relationship between two clearly separate subject areas, each studied on its own set of premises and using its own methods. In the present case, however, this perspective cannot be maintained since there is both a common subject area and a new - and specific - kind of interaction between physical and symbolic processes. (shrink)

Defeasibility, most generally speaking, means that given some set of conditions A, something else B will hold, unless or until defeating conditions C apply. While the term was introduced into philosophy by legal philosopher H.L.A. Hart in 1949, today, the concept of defeasibility is employed in many different areas of philosophy. This volume for the first time brings together contributions on defeasibility from epistemology , legal philosophy and ethics and the philosophy of action . The volume ends with an extensive (...) bibliography. (shrink)

v. 1. Philosophie. Rechtsphilosophie -- v. 2-4. Volkenrecht -- v. 5-6. Rechtsgeschiedenis. Burgerlijk recht. Procesrecht. Octrooirecht. Studie.

Ajan luonnetta koskevissa käsityksissä on tyypillistä erottaa kaksi eriävää kantaa: A-teoreettinen presentismi ja B-teoreettinen eternalismi. Edeltävän väitetään tyypillisesti sopivan yhteen inhimillisen ajallisen kokemuksen kanssa ja jälkimmäisen ontologisesti perustavanlaatuisen luonnontieteen kanssa. Ilmikuvamme ajasta sisältää ehdottoman nykyisyyden ja yksisuuntaisen ajan kulun menneestä tulevaan. Tieteellinen kuva ajasta ei sisällä erityistä nykyisyyttä eikä ajan kulun edellyttämää dynaamista aikamuotojen muutosta. Monet ovat pitäneet kokemustamme ajan kulusta illuusiona. Tässä artikkelissa keskitytään A-sarjan mukaisen ajankulun virheteoreettiseen tulkintaan. Tarkastellaan mahdollisuutta, jonka mukaan meillä ei ole kyseistä kokemusta vaan kuvailemme (...) kokemustamme virheellisesti ajan virtaukseen liittyvillä vertauskuvilla. Tätä tukee fysikalistinen argumentti: Jos ajan kulun kokemuksellamme ei ole fysikaalista perustaa, meillä ei voi olla sen mukaista kokemustakaan ajasta. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bonaventure's Reductio of the Nine Choirs of Angels:How Bonaventure Compressed Two Monumental Traditions into Nine Words and Nine Short PhrasesRandall B. Smith"There is probably no better illustration in medieval thought of how the genius of the symbolic imagination also involves deep speculative insight." So wrote Bernard McGinn of Bonaventure's Itinerarium mentis in deum in The Flowering of Mysticism: Men and Woman in the New Mysticism, 1200–1350.1 There is no (...) question that the Itinerarium is a book suffused with symbolic imagery; so much so, in fact, that it can sometimes seem to lapse into a confusing jumble.Certainly there are many sections of the Itinerarium that have baffled readers over the years, often because Bonaventure's use of imagery is so unique and creative and the truths he is attempting to enunciate are so far beyond our normal ways of thinking about God. But there is a short passage in chapter 4 of the Itinerarium that seems to defy interpretation precisely because of what one might describe as an almost austere terseness and brevity. The point Bonaventure wishes to make is one he communicates in little more than a list of nine words and nine short, parallel phrases.The passage I have in mind is this one in Itinerarium 4.4.When these things have been accomplished, and our spirit has been brought into conformity with the heavenly Jerusalem, it is ordered [End Page 583] hierarchically so that it can ascend upward. For no one enters into that city unless that city has first descended into the person's heart by means of grace, as John sees in his Apocalypse. It descends into the heart when our spirit has been made hierarchical by the reformation of the image, by means of the theological virtues, the enjoyment of the spiritual senses, and the ecstasy of rapture; for it has been purged, illumined and brought to perfection.In this way our spirit is adorned with nine orderly levels when within it the following are found in an appropriate order: announcing, dictating, leading, ordering, strengthening, commanding, receiving, revealing, and anointing. These correspond to the nine choirs of angels. The first three of the foregoing levels in the human mind relate to nature; the next three relate to work; and the final three relate to grace. When it has attained these, the soul, by entering into itself, enters into the heavenly Jerusalem where, as it considers the choirs of angels, it sees in them the God who dwells in them and who works in all their operations.Therefore, Bernard says to Pope Eugene that "God loves in the Seraphim as charity; knows in the Cherubim as truth; sits in the Thrones as justice; reigns in the Dominations as majesty; rules in the Principalities as a guiding principle; protects in the Powers as salvation; is at work in the Virtues as strength; reveals in the Archangels as light; assists in the Angels as kindness." From all this, God is seen as all in all when we contemplate God in our minds where God dwells through the gifts of the most generous charity.2Notice in the passage I have quoted above that Bonaventure says our spirit must be "brought into conformity with the heavenly Jerusalem," and that this requires it be "ordered hierarchically so that it can ascend upward." This serves as a transition into a rather odd pair of lists—one with nine words and the other with nine short, parallel phrases—that Bonaventure associates with the nine angelic choirs. These two lists of the nine choirs of angels do not, however, correspond exactly with one [End Page 584] another, for reasons I will explain below. And although these two lists of the nine ranks of angels in the angelic hierarchy take up just a few lines in Bonaventure's text, there is a lot of background information we will need to fill in to provide the necessary context to appreciate them. Indeed, as we will see, in this short passage, Bonaventure was able using the methods of the thirteenth-century sermo modernus style to reduce two monumental commentary traditions regarding the nine choirs of angels—one that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Boethii Daci Aliorumque Sophismata by Boethius of DaciaJulie Brumberg-ChaumontBoethius of Dacia. Boethii Daci Aliorumque Sophismata. Edited by Sten Ebbesen and Irène Rosier-Catach. Corpus Philosophorum Danicorum Medii Aevi, 9. Odense: University Press of Southern Denmark, 2021. Pp. 624. Hardback, 400.00 DKK.This volume offers a reliable and accurate scholarly edition of two collections of thirteenthcentury sophismata (logical and grammatical puzzles) contained in ms. Brugge, Stedelijke Openbare Bibliotheek 509 (=B) and (...) ms. Firenze, Biblioteca Medicea-Laurenziana 12 sin. 3 (=F). Taken together, these two collections constitute a set of twenty-three sophismata called "Sophismata Florentino-Brugensia" in the catalogue published by Sten Ebbesen and Frédéric Goubier (A Catalogue of Thirteenth-Century Sophismata [Paris: Vrin, 2010]). These sophismata were previously available only in partial editions. Specifically, the two versions of the sophisma "Omnis homo de necessitate est animal," previously both ascribed to Boethius of Dacia, were partially edited from F by Grabmann in 1940 and from B by Roos in 1962. Other sophismata in this collection have been previously edited by Ebbesen, but their editions should now be considered "obsolete," according to the editor himself (9). Each sophisma is identified by an S followed by a number (S1, S2, etc.). In turn, each sophisma deals with several issues or problems, each one of which is identified by a P followed by a number (P1, P2, etc.). The volume is very usefully completed by an index of explicit and implicit references to other works and an index of parallel passages, both compiled by Kristian Thomsen Purreskov (591–601). Finally, this edition is accompanied by a selective but still rich index of words, where special attention has been dedicated to the sophismata by Boethius of Dacia (603–24). All the material is presented in a clear and accurate way. There are only a few minor material errors (specifically, the running titles for problems in S4 are messy; at 33, "a*" should be read as "b*"; at 49, "S14" should be read as "S18").Sten Ebbesen is the sole editor of all sophismata except for the three that deal with grammatical subjects, for which Irène Rosier-Catach is the main editor, with Ebbesen serving as a coeditor.Concerning the authorship of each sophisma, Ebbesen follows the indications contained in F, but he also provides some independent discussions (24–26). Thus, he ascribes two sophismata to Boethius of Dacia, ten to Peter of Auvergne, one to an otherwise unknown Nicholas of Normandy, and the remaining ten to anonymous masters. They are listed in detail in the "Index sophismatum et problematum" (65–69).After a summary of the contents of the volume, Ebbesen's introduction contains five sections of different lengths: first, a history of the edition (7–9); second, a general description of the structure and functioning of sophismata (9–13); third, a description of the seven manuscripts used for the edition (14–22); fourth, a discussion about authorship (22–58); and fifth, an explanation of the principles of the edition (58–62). In the third section, Ebbesen provides a wealth of information about manuscripts, stemma codicum, and evaluations of variants, especially about the relationship between S and B for the sophismata contained in both manuscripts. In this regard, Ebbesen establishes that B and F are probably not two independent reportationes of the same oral disputation, that they had a common ancestor, and that they do not depend on one another (25–32). The fourth section, about authorship, demonstrates that the collection contained in F is earlier than that contained in B. One major result is that the text copied in B (S1B) ("Omnis homo de necessitate est animal") is not by Boethius of Dacia (35). Because of F priority, that manuscript is chosen as the main witness for those sophismata or parts of sophismata that are common to F and B.The second section makes an extremely significant historical and doctrinal contribution to the history of logic, particularly the history of logical practices and their textual records. [End Page 705] Three constitutive parts of a sophisma are identified: first, the sophismatic sentence itself; second, a brief disputation (called here corpus sophismatis) about the sophismatic sentence... (shrink)

Thompson provides commentary and reaction to other chapters in the book. It is organized as sections identified by the names of chapter authors. Thompson responds to chapters advancing new ideas in agriculture by indicating how he understands the authors’ analysis with respect to his own work. Chapters that address more philosophical dimensions of Thompson’s writings are addressed by clarifying the pragmatist orientation of Thompson’s thought. Michel Foucault’s metaethics is used as a basis for explaining pragmatist ethical pluralism.

Four strands of research in the philosophy of technology have made important contributions to environmental philosophy. First, critical theory of technology emphasizes the environmentally exploitative tendencies of capitalist technological innovation. Second, phenomenologyhas examined how technologies shapeperception and orientation to the world with implications for our treatment of and regard for nature. Third, concurrent with the environmental movement itself, an empirical turn in philosophy of technology resulting in philosophers focusing their attention on particular tools and techniques. Empirical studies have emphasized environmentally (...) significant technologies. Finally, work inspired by philosophy of science has adopted scientific reasoning and methods in environmental policy with tools such as risk analysis and environmental impact assessment. These four strands of work have often merged with the work of sociologists, geographers, and political theorists interested in the connections between science and democracy. (shrink)