Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

The book deals with the notion of Downward Causation from a wide array of perspectives, including physics, biology, psychology, social science, communication studies, text theory, and philosophy. The book includes proponents as well as opponents discussing the validity of the notion.

Advance directives (ADs) have for some time been championed by ethicists and patient associations alike as a tool that people newly diagnosed with dementia, or prior to onset, may use to ensure that their future care and treatment are organized in accordance with their interests. The idea is that autonomous people, not yet neurologically affected by dementia, can design directives for their future care that caregivers are morally obligated to respect because they have been designed by autonomous individuals. In this (...) paper, we first criticize the idea that ADs can retain moral authority in severe dementia by arguing that it is paradoxical. Second, we consider two arguments that initially seem to refute this critique of ADs, but we eventually dismiss them. The first argument states that ADs retain moral authority in severe dementia because autonomously formed interests, for example, ADs, can only be appropriately discarded by autonomous persons. This we term the historical autonomy argument. We dismiss it by demonstrating how we, in analog cases, are not obligated to continue to respect autonomously formed interests even though they have been discarded under nonappropriate conditions. The second argument is that ADs can be justified by what we term external interests. While we agree that people with severe dementia plausible can be said to have external interests, we show that ADs cannot express such interests and hence cannot be justified by them. We conclude that none of the discussed arguments support the use of ADs and because of this, the idea of ADs should be reassigned. (shrink)

The frame problem refers to the fact that organisms must be able to zero in on relevant aspects of the world and intelligently ignore the vast majority of the world that is irrelevant to their goals. In this paper we aim to point out the connection between two leading frameworks for thinking about how organisms achieve this. Predictive processing is a rapidly growing framework within cognitive science which suggests that organisms assign a high ‘weight’ to relevant aspects of the world, (...) effectively treating relevant aspects of the world as if they are more precise. This assignment of weight is called precision-weighting and is the predictive processing account of how organisms allocate their attention. Relevance Realization is a framework that conceptualizes an organism’s ability to realize relevance as resulting from a dynamical system in which a cognitive agent makes use of opponent processing relationships to zero in on relevant aspects of the world. In this paper we use recent work on the diametric model of autism and psychosis to demonstrate that the tradeoffs inherent to precision-weighting are also inherent to relevance realization. This connection will demonstrate that although these frameworks have a different intellectual background and use a different set of concepts and vocabulary, they are both pointing to the same underlying process. The fact that these different frameworks have converged on such a similar solution to the problem of how organisms realize relevance serves to demonstrate the plausibility of that solution. (shrink)

This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and the (...) questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use. (shrink)

Under conditions of physiological stress, officers are sometimes required to make split-second life-or-death decisions, where deficits in performance can have tragic outcomes, including serious injury or death and strained police–community relations. The current study assessed the performance of 122 active-duty police officers during a realistic lethal force scenario to examine whether performance was affected by the officer’s level of operational skills training, years of police service, and stress reactivity. Results demonstrated that the scenario produced elevated heart rates, as well as (...) perceptual and cognitive distortions, such as tunnel vision, commensurate with those observed in naturalistic use of force encounters. The average performance rating from the scenario was 59%, with 27% of participants making at least one lethal force error. Elevated stress reactivity was a predictor of poorer performance and increased lethal force errors. Level of training and years of police service had differential and complex effects on both performance and lethal force errors. Our results illustrate the need to critically reflect on police training practices and continue to make evidence-based improvements to training. The findings also highlight that while training may significantly improve outcomes, flawless performance is likely not probable, given the limits of human performance under stress. Implications for the objective reasonableness standard, which is used to assess the appropriateness of force in courts of law, are discussed. (shrink)

This paper sketches a general account of how to respond in an epistemically rational way to moral disagreement. Roughly, the account states that when two parties, A and B, disagree as to whether p, A says p while B says not-p, this is higher-order evidence that A has made a cognitive error on the first-order level of reasoning in coming to believe that p. If such higher-order evidence is not defeated, then one rationally ought to reduce one’s confidence with respect (...) to the proposition in question. We term this the higher-order evidence account, and present it as a superior to what we might call standard conciliationism, which holds that when agents A and B disagree about p, and are epistemic peers, they should both suspend judgement about p or adjust their confidence towards the mean of A and B’s prior credences in p. Many have suspected that standard conciliationism is implausible and may have skeptical implications. After presenting the HOE account, we put it to work by applying it to a range of cases of moral disagreement, including those that have feature in recent debates assuming standard conciliationism. We show that the HOE account support reasonable, non-skeptical verdicts in a range of cases. Note that this is a paper on moral disagreement, not on the HOE account, thus the account is merely stated here, while defended more fully elsewhere. (shrink)

Tom Andersen’s reflecting team process, which allowed families to witness and respond to the talk of professionals during therapy sessions, has been described as revolutionary in the field of family therapy. Reflecting teams are prominent in a number of family therapy approaches, more recently in narrative and dialogical therapies. This way of working is considered more a philosophy than a technique, and has been received positively by both therapists and service users. This paper describes how dialogical therapists conceptualise the (...) reflective process, how they work to engage families in reflective dialogues and how this supports change. We conducted semi-structured, reflective interviews with 12 dialogical therapists with between 2 and 20 years of experience. Interpretative Phenomenological analysis of transcribed interviews identified varying conceptualisations of the reflecting process and descriptions of therapist actions that support reflective talk among network members. We adopted a dialogical approach to interpretation of this data. In this sense, we did not aim to condense accounts into consensus but instead to describe variations and new ways of understanding dialogical reflecting team practices. Four themes were identified: Lived experience as expertise; Listening to the self and hearing others; Relational responsiveness and fostering connection; and Opening space for something new. We applied these themes to psychotherapy process literature both within family therapy literature and more broadly to understand more about how reflecting teams promote helpful and healing conversations in practice. (shrink)

Mathematicians appear to have quite high standards for when they will rely on testimony. Many mathematicians require that a number of experts testify that they have checked the proof of a result p before they will rely on p in their own proofs without checking the proof of p. We examine why this is. We argue that for each expert who testifies that she has checked the proof of p and found no errors, the likelihood that the proof contains no (...) substantial errors increases because different experts will validate the proof in different ways depending on their background knowledge and individual preferences. If this is correct, there is much to be gained for a mathematician from requiring that a number of experts have checked the proof of p before she will rely on p in her own proofs without checking the proof of p. In this way a mathematician can protect her own work and the work of others from errors. Our argument thus provides an explanation for mathematicians’ attitude towards relying on testimony. (shrink)

"Science and religion are often viewed as dichotomies. But although our contemporary society is often perceived as a rationalization process, we still need broad, metaphysical beliefs outside of what can be proven empirically. Rituals and symbols remain at the core of modern life. Do our concepts of science and religion require revitalization? Can science itself be considered a religion, a belief, or an ideology? Science's authority and prestige allows for little in the way of alternate approaches not founded in empirical (...) science. It is not unusual to believe that technology and science will solve the world's fundamental problems. Has truth been colonized by science? Have scientific disciplines become so specialized and "operationally closed" that they have constructed barriers to other disciplines as well as the general public? The writers of this book set out to investigate whether the symbols of academia may in some cases take on a quality of sacrality, whether the rule of experts can be said to have the character of a "priesthood of knowledge", whether religion has a place in scientific contexts, and a selection of other questions concerning science and its relations to religious belief."--P. [4] of cover. (shrink)

Individual differences in ethical ideology are believed to play a key role in ethical decision making. Forsyths (1980) Ethics Position Questionnaire (EPQ) is designed to measure ethical ideology along two dimensions, relativism and idealism. This study extends the work of Forsyth by examining the construct validity of the EPQ. Confirmatory factor analyses conducted with independent samples indicated three factors – idealism, relativism, and veracity – account for the relationships among EPQ items. In order to provide further evidence of the instruments (...) nomological and convergent validity, correlations among the EPQ subscales, dogmatism, empathy, and individual differences in the use of moral rationales were examined. The relationship between EPQ measures of idealism and moral judgments demonstrated modest predictive validity, but the appreciably weaker influence of relativism and the emergence of a veracity factor raise questions about the utility of the EPQ typology. (shrink)

A principle that many have found attractive is one that goes by the name “'Ought' Implies 'Can'.” According to this principle, one morally ought to do something only if one can do it. This essay has two goals: to show that the principle is false and to undermine the motivations that have been offered for it. Toward the end, a proposal about moral obligation according to which something like a restricted version of 'Ought' Implies 'Can' is true is floated. Though (...) no full-fledged argument for this proposal is offered, that it fits with a rather natural and intuitive picture of the structure of morality and seems to explain certain salient features of the debate over whether the principle is true, goes some way toward recommending it. (shrink)

The purpose of this study is to examine the relationship between the corporate social performance of an organization and three variables: the size of the organization, the financial performance of the organization, and the environmental performance of the organization. By empirically testing data from 1987 to 1992, the results of the study show that a firm's corporate social performance is indeed impacted by the size of the firm, the level of profitability of the firm, and the amount of pollution emissions (...) released by the firm. (shrink)

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if (...) any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation—that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures—is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope. (shrink)

A relative value of life dependent on age has been produced from a survey of 721 randomly selected individuals together with other observations of professional practice. The results are presented in diagrammatic form. If two identical people, except for age, present for medical treatment for a life-threatening condition and only one can be treated then the diagram indicates what the choice should be.

We know that John Milton read Machiavelli’s Discourses on Livy with very great care, and there is evidence suggesting that initially he found its argument attractive. In the end, however, he repudiated Machiavelli’s peculiar populism in no uncertain terms, and he did so by embracing Aristotle and Cicero in a manner that highlights the radical break which the Florentine initiated with the republicanism of the ancient Romans and Greeks.

Social evolution theory conventionally takes an externalist explanatory stance, treating observed cooperation as explanandum and the positive assortment of cooperative behaviour as explanans. We ask how the circumstances bringing about this positive assortment arose in the first place. Rather than merely push the explanatory problem back a step, we move from an externalist to an interactionist explanatory stance, in the spirit of Lewontin and the Niche Construction theorists. We develop a theory of ‘social niche construction’ in which we consider biological (...) entities to be both the subject and object of their own social evolution. Some important cases of the evolution of cooperation have the side-effect of causing changes in the hierarchical level at which the evolutionary process acts. This is because the traits that act to align the fitness interests of particles in a collective can also act to diminish the extent to which those particles are bearers of heritable fitness variance, while augmenting the extent to which collectives of such particles are bearers of heritable fitness variance. In this way, we can explain upward transitions in the hierarchical level at which the Darwinian machine operates in terms of particle-level selection, even though the outcome of the process is a collective-level selection regime. Our theory avoids the logical and metaphysical paradoxes faced by other attempts to explain evolutionary transitions. (shrink)

Current focus in the health care ethics literature on the character of the practitioner has a reputable pedigree. Rather than offer a staple diet of Aristotelian ethics in the undergraduate curricula, perhaps instead one should follow Murdoch's suggestion and help the practitioner to develop vision and moral imagination, because this has a practical rather than a theoretical aim. The imaginative capacity of the practitioner plays an important part in both the quality of the nurse's role enactment and the moral strategies (...) which the nurse uses. It also plays a central part in the practitioner's ability to communicate with a patient and in the type of person which the practitioner becomes. Can the moral imagination be stimulated and nurtured? Some philosophers and literary critics argue that not only is this possible, but that literature is the means of doing so. If this is the case then a place should be made for literature in already crowded health care curricula. (shrink)

Ideal interpretation is understanding a text in the best possible way. It is usually used when the text has a canonical status, such as the Bible or the U.S. Constitution. We argue that Zhu Xi’s view about interpreting the Four Books and Ronald Dworkin’s view about constitutional interpretation are examples of ideal interpretation and that their basic principles are similar. Each holds, roughly, that their target text contains moral truth; that the author’s mind requires the mediation of learning; that the (...) purpose of interpretation is not only to lead the reader to the moral truth but to become a better person; that all propositions are about the same moral truth or about political justice; that the interpretation ultimately must come from oneself, purged of prejudices; and that the only correct interpretation is one that captures the original meaning. (shrink)

The modern historian of Greece and Rome often depends for his information on writings whose reliability is no greater, though often much less, than that of the histories, now lost in whole or part, which their authors followed. The quality of these histories can sometimes be detected from the internal evidence of the extant derivative accounts, even when we cannot name the historians with any certainty.

In the contemporary period of history, so deeply contradictory and in many respects conflict ridden, eschatological themes, predictions of universal catastrophe and the ecological or nuclear destruction of mankind, and other motifs of the end of human history have become unprecedentedly widespread and greatly attractive. Despite the huge stores of scientific knowledge accumulated in the past few decades, many people are being drawn more and more into the stream of mystical monstrous visions and are beginning to connect the end of (...) the second millennium with implausible, obsessive apocalyptic presentiments with regard to the world as a whole as well as to our own Russian history. Soothsayers have appeared who have begun to link the phenomena of disintegration and decline and the destruction of political, ethical, and aesthetic criteria being manifested in our country in one way or another directly with the end of Russian history, with the final act of the Russian historical drama. In the sphere of concrete theoretical and philosophical-sociological knowledge, notions of the limit of historical progress, that history has fundamentally, in its essentials, run its course and that from now on the future will bring nothing essentially new, are being put forward and defended. (shrink)

The World Health Organization has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants from all Spanish regions completed the survey. Binomial (...) logistic regressions adjusted for socioeconomic characteristics, body mass index, previous HRBs, and confinement context were conducted to investigate associations between the number of weeks confined and a set of six HRBs. When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49–0.81 for the second and OR 0.47; 95% CI: 0.36–0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors. (shrink)

There are complex unresolved ethical, legal and social issues related to the use of human tissues obtained in the course of research or diagnostic procedures and retained for further use in research. The question of intellectual property rights over commercially viable products or procedures that are derived from these samples and the suitability or otherwise of participants relinquishing their rights to the samples needs urgent attention. The complexity of these matters lies in the fact that the relationship between intellectual property (...) rights and ownership or rights pertaining to the samples on which the intellectual property right is based may either be overlooked or taken for granted. What equally makes the matter complex is that samples may be obtained from participants in developing countries and exported to developed countries for analysis and research. It is important for research ethics committees to tread carefully when reviewing research protocols that raise such issues for purposes of ensuring that appropriate benefit sharing agreements, particularly with developing countries, are in place.This paper attempts to analyse the key questions related to ownership and intellectual property rights in commercially viable products derived from human tissue samples. Patent law is used as a point of reference as opposed to other forms of intellectual property rights such as industrial designs because it is the right that most inventors apply for in respect of human tissue-related inventions. The key questions are formulated following a systematic analysis of peer reviewed journal articles that have reported original investigations into relevant issues in this field. Most of the cases and reported studies that are referred to in this paper do not directly deal with HIV/AIDS research but the underlying principles are helpful in HIV/AIDS research as well. Pertinent questions, which members of ethics review committees should focus on in this regard are discussed and suggestions on appropriate approaches to the issues are proposed in the form of specific questions that an ethics review committee should consider. Specific recommendations regarding areas for further research and action are equally proposed. (shrink)