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)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (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)

I dette bogkapitel skrevet sammen med Ingeborg Ilkjær fremlægges tre etiske positioner herunder dydsetik, pligtetik og konsekvensetik. Disse teorier er sammen med eksempler på etiske principper og værdier det grundlag, som sygeplejersker kan benytte sig af i arbejdet med patientinvolvering og etiske dilemma, hvor der skal foretages et valg, der har betydning for patienter, pårørrende og de klinisk involverede. -/- For at kunne træffe valg af denne art er det vigtigt at kunne gøre det på et oplyst grundlag samt at (...) kunne påtage sig et klinisk lederskab. Derfor er det nødvendigt at benytte sig af en etisk refleksionsmodel. Dette arbejde kan være med til at skabe klarhed over en given situation, der rummer vanskelige etiske dilemmaer. -/- Bogkapitlet findes i bogen Sygepleje & Patientinvolvering Bind 3 redigeret af Steen Hundborg og udgivet på FADL’s Forlag I 2019. (shrink)

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)

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

Dette kapitel fokuserer på ’etik og patientinddragelse’, men søger med afsæt i devisen ‘sapere aude’ også at skabe interesse for filosofi og etik blandt sygeplejestuderende. Kapitlet er en opfordring til sygeplejestuderende om at betjene sig af egen forstand og finde mod til at filosofere over problematikker i forbindelse med patientinddragelse frem for at falde tilbage i umyndighedens bekvemmelighed og vente på at andre træder til. Kapitlet starter med at se nærmere på, hvordan patientinddragelse italesættes i vor tid efterfulgt af en (...) kort eksposition af to af oplysningstidens vigtigste libera- le filosoffer, herunder pligtetikeren Immanuel Kant og nytteetikeren John Stuart Mill, hvis syn på henholdsvis autonomi og frihed influerer debatten om patientinddragelse. Efterfølgende præsenteres og diskuteres to eksempler, hvor patientinddragelse og etik er i rampelyset. Mere specifikt rettes fokus på 1) etik, patientinddragelse og den psykiatriske patient og 2) etik, patientinddragelse og unge mennesker. Eksemplerne er udvalgte med henblik på at belyse, hvad der kan komme på spil i sundhedsfaglige situationer udspændt mellem individuel frihed, herunder også ideen om autonomi; sygehusvæsenet, inklusive personale, som autoritær vi- dens-institution/aktør og det etiske, herunder ideen om ’det gode’ eller efterstræbelsesværdige. Afslutningsvis argumenteres der for, at sundhedsarbejdere med blik for etik og patientinddragelse kan udgøre en positiv kraft for den inddragede patient, men at det kræver, at denne vover at være vis. Afsnit: Resume Patientinddragelse i vor tid Autonomi, frihed og patientinddragelse Etik, patientinddragelse og den psykiatriske patient Etik, patientinddragelse og den unge Afslutning . (shrink)

De senere år har pleie- og omsorgstjenesten i mange norske kommuner startet med ulike former for etikkarbeid, oftest initiert av KS’ prosjekt “Samarbeid om etisk kompetanseheving”. Hensikten med vår studie var å evaluere innsatsen i de kommunene som deltok i prosjektet fra starten av, med vekt på hvilke tiltak som var iverksatt, hvilke virksomheter dette omfattet, og om tiltakene har fortsatt utover prosjektperioden. Studien har et kvalitativt design. Materialet er hovedsakelig basert på telefonintervjuer med kontaktpersoner for etikksatsingen i 34 kommuner. (...) Det transkriberte materialet er analysert ved kvalitativ innholdsanalyse. Med unntak av fem kommuner som aldri kom i gang med etikkarbeidet, hadde de fleste startet etikkrefleksjon innenfor flere tjenester, oftest i sykehjem og hjemmetjenester. Noen kommuner hadde imidlertid ikke klart å videreføre etikkarbeidet utover en prosjektperiode. Det var stor variasjon både i etikkarbeidets forankring i kommunen, omfang, hyppighet og metoder. Et gjennomgående funn er vektlegging av behovet for etikkkompetanse og oppfølging av dem som skal lede etikkarbeidet. Flertallet av kommunene som fortsatt gjennomfører etikkrefleksjon, tar utgangspunkt i egen praksis, men et mindretall anvender strukturerte metoder. Dersom etikkarbeidet i kommunen skal være levedyktig over tid, bør arbeidet forankres på flere nivåer i organisasjonen, og de som skal lede dette arbeidet, bør få styrket sin kompetanse i etikk og etikkrefleksjon.Nøkkelord: etikk, evaluering, kommunehelsetjenestenEnglish summary: Building ethical competence in Norwegian municipalities: What has been done and what has been sustainable?“Cooperation for building ethics competence” is a national project aimed to stimulate moral reflection and build competence in ethics in community health services in Norway. This article is based on an evaluation of the activities implemented by the first 34 participating municipalities, exploring which measures were implemented, which services and employees were involved, and if the measures are sustainable. The study has a qualitative design, and the data mainly consists of telephone interviews with “key” persons in 34 municipalities. With the exception of five municipalities that never really started ethics work, the majority had implemented ethical reflection in several areas, most often in nursing homes and home care services. There was great variation with regard to the implementation. Many had tried a variety of reflection models, and only a minority of the municipalities were using a structured method of ethical reflection. A consistent finding is the need for more competence; many of those who run ethical reflection are reported to need more competence both in ethics and methods for systematic reflection. There were also great variations in how well the ethics projects were anchored within the municipality. To make ethical interventions sustainable, this study indicates the importance of strong anchoring within the municipality, the need for ethical competence, as well as good methods for structuring ethical reflection. (shrink)

Despite All Critique (2014) -- World Politics and Western Reason (1980) -- The Doubled Outsides of the Modern International (2005) -- The Subject of Security (1995) -- The Protection of Nature and the Nature of Protection (2005) -- Social Movements/World Politics (1994) -- Europe is Not Where It is Supposed to Be (2000) -- They Seek it Here, They Seek it There : Looking for Politics in Clayoquot Sound (2003) -- Violence, Modernity, Silence : From Weber to International Relations (1993) (...) -- Hobbes, Origins, Limits (2011) -- War, Terror, Judgement (2002) -- International, Imperial, Exceptional (2005) -- Which Democracy for Which Demos? (2013) -- The Political Theory of Boundaries and the Boundaries of Political Theory : Interview With Raia Prokhovnik (2012). (shrink)

To controlforceaccurately under a wide range of behavioral conditions, the central nervous system would either require a detailed, continuously updated representation of the state of each muscle (and the load against which each is acting) or else force feedback with sufficient gain to cope with variations in the properties of the muscles and loads. The evidence for force feedback with adequate gain or for an appropriate central representation is not sufficient to conclude that force is the major controlled variable in (...) normal limb movements.Morton's hypothesis, thatlengthis controlled by a follow-up servo, has a number of difficulties related to the delays, gains, variability, and specificity in feedback pathways comprising potential servo loops. However, experimental evidence is consistent with these pathways providing servo assistance for some movements produced by coactivation of α- and static γ-motoneurons. Dynamic γ-motoneurons may provide an additional input for adaptive control of different types of movements.The idea that feedback is used to compensate for changes in musclestiffnesshas received experimental support under static postural conditions. However, reflexes tend to increase rather than decrease the range of variation in muscle stiffness during some cyclic movements. Theoretical problems associated with the regulation of stiffness are also discussed. The possibilities of separate control systems forvelocityorviscosityare considered, but the evidence is either negative or lacking. I conclude that different physical variables can be controlled depending on the type of limb movement required. The concept of stiffness regulation is also useful under some conditions, but should probably be extended to the regulation of the visco-elastic properties (i.e., the mechanical impedance) of a muscle or joint. (shrink)

This volume is a collection of original essays by eminent philosophers written for R. B. Braithwaite's eightieth birthday to celebrate his work and teaching. In one way or another, all the essays reflect his central concern with the impact of science on our beliefs about the world and the responses appropriate to that. Together they testify to the signal importance of his contributions in areas of philosophy bearing on this concern: the philosophy of science, especially of the statistical sciences, theories (...) of belief and of probability, decision theory and games theory. This book, which includes a full bibliography of Professor Braithwaite's work, will interest advanced students and professionals in the fields of philosophy and psychology. (shrink)

This article is in a larger textbook of articles on Medical Ethics. It identifies a number of values that underlie professional commitments to confidentiality that are involved in protecting or promoting the client's (1) privacy, (2)social status, (3) economic advantages, (4) openness of communications, (5) seeking professional help, (6) trust in professionals, (7) autonomous control over personal information. The problem of making exceptions to confidentiality commitments is also examined.

The JSTOR Archive is a trusted digital repository providing for long-term preservation and access to leading academic journals and scholarly literature from around the world. The Archive is supported by libraries, scholarly societies, publishers, and foundations. It is an initiative of JSTOR, a not-for-profit organization with a mission to help the scholarly community take advantage of advances in technology. For more information regarding JSTOR, please contact [email protected].

It is a common complaint against moral philosophers that their abstract theorising bears little relation to the practical problems of everyday life. Professor Braithwaite believes that this criticism need not be inevitable. With the help of the Theory of Games he shows how arbitration is possible between two neighbours, a jazz trumpeter and a classical pianist, whose performances are a source of mutual discord. The solution of the problem in the lecture is geometrical, and is based on the formal analogy (...) between the logic of the situation and the geometry of a parabola. But an appendix provides the alternative algebraic treatment of a general two-person collaboration situation. (shrink)

In this paper a formalized logic of propositions, PA1, is presented. It is proven consistent and its relationships to traditional logic, to PM ([15]), to subjunctive (including contrary-to-fact) implication and to the “paradoxes” of material and strict implication are developed. Apart from any intrinsic merit it possesses, its chief significance lies in demonstrating the feasibility of a general logic containing theprinciple of subjunctive contrariety, i.e., the principle that ‘Ifpwere true thenqwould be true’ and ‘Ifpwere true thenqwould be false’ are incompatible.

R.G. Collingwood defined historical knowledge as essentially ‘scientific’, and saw the historian's task as the ‘re-enactment of past thoughts’. The author argues the need to go beyond Collingwood, first by demonstrating the authenticity of available evidence, and secondly, using Namier as an example, by considering methodology as well as epistemology, and the need to relate past thoughts to their present context. The ‘law of the consumption of time’ encourages historians to focus on landmark events, theories and generalisations, thus breaking from (...) Collingwood's emphasis on fidelity to past ideas and interpreting the past from the concepts of the present. This conflict can only be reconciled by the study of historiography. (shrink)

R.G. Collingwood defined historical knowledge as essentially ‘scientific’, and saw the historian's task as the ‘re-enactment of past thoughts’. The author argues the need to go beyond Collingwood, first by demonstrating the authenticity of available evidence, and secondly, using Namier as an example, by considering methodology as well as epistemology, and the need to relate past thoughts to their present context. The ‘law of the consumption of time’ encourages historians to focus on landmark events, theories and generalisations, thus breaking from (...) Collingwood's emphasis on fidelity to past ideas and interpreting the past from the concepts of the present. This conflict can only be reconciled by the study of historiography. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and (...) made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The question of whether or not children may be used as subjects in non-therapeutic research projects has generated a great deal of debate and received answers varying from 'no, never' to 'yes, if societal interests are served'. It has been claimed that a Kantian, deontological ethics would necessarily rule out such research, since valid consent would be impossible. The present paper gives a deontological argument for allowing children to be subjects in certain types of research.

This book is not a study of Plato's philosophy, but a contribution to the literary interpretation of the dialogues, through analysis of their formal structure, ...

This article is in a larger textbook of articles in Medical Ethics.

In the fourteenth century William of Occam in the course of his attack on the medieval scholastic philosophy enunciated his famous “razor”: Entia non sunt multiplicanda praeter necessitatem. This is the classic claim for the description of nature in terms of the minimum possible number of fundamental concepts. It was presumably so recognized by Newton in the third book of his “Principia” in 1687 when he wrote: “We are to admit no more causes of natural things than such as are (...) both true and sufficient to explain their appearances. To this purpose the philosophers say that Nature does nothing in vain, and more is in vain when less will serve; for Nature is pleased with simplicity and affects not the pomp of superfluous causes.”. (shrink)