Evaluation of clinical ethics support services (CESS) has attracted considerable interest in recent decades. However, few evaluation studies are explicit about normative presuppositions which underlie the goals and the research design of CESS evaluation. In this paper, we provide an account of normative premises of different approaches to CESS evaluation and argue that normativity should be a focus of considerations when designing and conducting evaluation research of CESS. In a first step, we present three different approaches to CESS evaluation from (...) published literature. Next to a brief sketch of the well-established approaches of ‘descriptive evaluation’ and ‘evaluation of outcomes’, we will give a more detailed description of a third approach to evaluation—‘reconstructing quality norms of CESS’—which is explicit about the normative presuppositions of its research (design). In the subsequent section, we will analyse the normative premises of each of the three approaches to CESS evaluation. We will conclude with a brief argument for more sensitivity towards the normativity of CESS and its evaluation research. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Anscombe holds that a proper account of intentional action must exhibit “a ‘form’ of description of events.” But what does that mean? To answer this question, I compare the method of Anscombe’s Intention with that of Frege’s Foundations of Arithmetic—another classic work of analytic philosophy that consciously opposes itself to psychological explanations. On the one hand, positively, I aim to identify and elucidate the kind of account of intentional action that Anscombe attempts to provide. On the other hand, negatively, I (...) hope to dispel the canard that Anscombe’s opposition to the causal theory of action is a product of “behaviorism.”. (shrink)

In the first monograph on Lyotard and education, Derek R. Ford approaches Lyotard's thought as pedagogical in itself. The result is a novel, soft, and accessible study of Lyotard organized around two inhuman educations: that of "the system" and that of "the human." The former enforces an interminable process of development, dialogue and exchange, while the latter finds its force in the mute, secret, opaque, and inarticulable. Threading together a range of Lyotard's work through four pedagogical processes-reading, writing, voicing, and (...) listening-the author insists on the distinct educational logics that can uphold or interrupt different ways of being-together in the world, touching on a range of topics from literacy and aesthetics to time and political-economy. While Inhuman Educations can serve as an introduction to Lyotard's philosophy, it also constitutes a singular, provocative, and fresh take on his thought. (shrink)

This collection of ten essays elucidates some of the more challenging aspects of Anscombe’s work and affirms her reputation as one of our most original ...

Existing social disparities in the United States are inconsistent with the promise of democracy; therefore, there was a need for critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This constructivist grounded theory study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change as it emerged from the nation’s founding documents. A post hoc polytheoretical framework including Foucault’s, Bourdieu’s, and Marx and (...) Engels’s theories of power was used to understand power dynamics. The research question focused on understanding the process of democratic social change in America. The sample comprised the Articles of Confederation, the U.S. Declaration of Independence, The Federalist Papers, and the U.S. Constitution. The documents were retrieved from the National Archives and Library of Congress. The data analysis plan incorporated successive comparison, situational and dramaturgical analysis, deconstruction, and perspective taking as strategies. The result was the construction of a democratic social change process theory preceded by five grounded theories: (a) first principles of democracy, (b) first principles of democracy conceptual framework, (c) socio-ethical principles of democracy, (d) demoralizing process, and (e) either-or approach to democracy. Positive social change implications include applying a democratic social change process to future social change endeavors across domains and levels of analysis, a normative framework for a republican form of government, and a tool to analyze and minimize the latent consequences of social justice policies. (shrink)

Alongside the major narratives of ethics in the tradition of Western philosophy, a reader with an eye to the vague and the peripheral, to the turbulent and shifting, will uncover minor lines of thinking--and with them, new histories and thus new futures. Minor Ethics develops a new approach to reading texts from the history of philosophical ethics. It aims to enliven lines of thought that are latent and suppressed within the major ethical texts regularly studied and taught, and to include (...) texts and ideas that have been excluded from the canon of Western ethics. The editors and contributors have put Gilles Deleuze's concepts--such as affect, assemblage, and multiplicity--into conversation with a range of ethical texts from ancient thought to the present. Rather than aiming for a coherent whole to emerge from these threads, the essays maintain a vigilant alertness to difference, to vibrations and resonances that are activated in the coupling of texts. What emerges are new questions, new problems, and new trajectories for thinking, which have as a goal the liberation of ethical questioning. Minor Ethics takes up a range of canonical ethical questions and thinks through concrete ethical problems relating to drug addiction, environmental responsibility, xenophobia, trauma, refugees, political parties, and cultural difference. The responses to these concerns demonstrate the minoritarian promise of the opening up of ethical thinking. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with (...) key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

Great Britain subjugated colonists using various power strategies, including dehumanization, misinformation, fear, and other divisive strategies. The Founders described these oppressive strategies as “a long train of abuses and usurpations.” Throughout the Declaration of Independence and the U.S. Constitution, the Founding Fathers imbued the people with hope in a government for the people: one unlike that of the monarchy, which sought to protect itself at the expense of colonists. As a result, the Founders created a government more likely to lead (...) with fairness, demonstrate respect for human dignity, unite Americans as one people, empower citizens through hope, and lead the nation toward security. This socio-ethical framework was an abductive discovery nested within a grounded theory study where it had been concluded that the first principles of democracy were woven within the American founding documents. Using Charmaz’s constructivist grounded theory, the first principles of democracy—knowledge, fairness, human dignity, hope, unity, and security—were used to answer an emerging research question: Are there two democratic frameworks in the founding documents, and how do they differ? The first principles of democracy promote a culture of ethics, resilience, and freedom. Their empowering disposition makes them suitable as a normative framework for a democratic government for the people. (shrink)

Background The aim was to explore how the clinical ethics committees in Norway have worked and functioned within mental health care and addiction treatment services. Methods Analysis of 256 annual reports from clinical ethics committees from 2003 to 2012 and a survey to clinicians who had used a clinical ethics committee. Results Dilemmas related to coercion, confidentiality, information, and patient autonomy dominated. The committees established only for psychiatric hospitals, had received more cases from mental health and addiction services than the (...) committees also serving somatic services. Many of the case discussions involved both somatic and mental health care, complicated legal issues as well as ethical dilemmas. Mental health care professionals that have used the clinical ethics committees evaluated the clinical ethics committees deliberation as useful. Conclusion Given the many difficult ethical dilemmas in mental health care ethics work need to be strengthened. The complexity of the cases requires varied and interdisciplinary competence and training among the clinical ethics committee members. (shrink)

Appropriate for both academic readers and informed general enthusiasts of the cinema it addresses, the book demonstrates both philosophy's particular usefulness for the analysis of modernist cinema and film form's inherent potential for ...

An outstanding group of leaders left evidence that a richer and more sustainable democracy could be achieved with American independence and democratic principles integrated into a new republican form of government. They were moved by principles that are the very spirit of democracy. These principles are needed to enhance democracy and improve well-being. Using the constructivist tradition of grounded theory and Aristotle’s conception of abstraction, the article proposes a theory of the first principles of democracy based on substantive data: the (...) Declaration of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. Knowledge, fairness, human dignity, hope, unity, and security are the first principles of democracy and are regarded as the bedrock of democracy and a government framework for the people. This theory contributed to a formal model of democratic social change. It also contributes a conceptual framework that supports Solum’s semantic originalism, a theory of constitutional interpretation. The principles of democracy can revitalize democracy and provide new possibilities by protecting education as an innate human right, abolishing capital punishment, criminalizing private prisons on the stock market, and reevaluating the proportionality of prison sentences. (shrink)

What about honesty? -- History of honesty in society -- Honesty and the Constitution -- Honesty in society today.

Existing social disparities in the United States are inconsistent with Lincoln’s promise of democracy; therefore, there is a need for a critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change. The result was the construction of two frameworks: the demoralization process that triggers social change, and a formal grounded theory that (...) could explain democratic social change endeavors across different domains and levels of analysis. This democratic social change grounded theory answers the research question: How do the principles of the American founding documents provide an understanding of the process of American democratic social change? (shrink)

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and (...) nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk. (shrink)

In this article we report findings from a qualitative study that explored how doctors and nurses in nursing homes describe professional collaboration around dying patients. The study also examined the consequences this can have for the life-prolonging treatment of patients and the care of them and their relatives. Nine doctors and 10 nurses from 10 Norwegian nursing homes were interviewed about their experience of decision-making processes on life-prolonging treatment and care. The findings reveal that the frameworks for the professional collaboration (...) and organization of physicians and nurses prevent patient treatment and care complying with ethical considerations and the law. These conditions have a challenging impact on the care of dying patients and their relatives. (shrink)

The polarities of democracy framework is used to achieve human emancipation by simultaneously managing multiple paradoxes by employing Johnson’s polarity management as the conceptual framework. Although Johnson’s framework may be appropriate for managing other tension-dependent pairs, it is less suitable for managing multiple democratic values when the goal is human emancipation and sustainable democratic social change. Managing multiple polarities is exacerbated by the problem-shifting and problem-creation effect inherent in a tension-driven framework. The aim was to develop a constructivist grounded theory (...) to answer the research question: How can the first principles of democracy be used to reduce dynamic tension and achieve human emancipation? This gap has been filled by a parsimonious conceptual framework based on three democratic principles: human dignity, fairness, and knowledge. The principles of democracy conceptual framework can synthesize the tension between democratic values in order to manage, plan, and evaluate democratic social change initiatives. (shrink)

As hunters, Sam and Dean kill monsters because such creatures pose a threat to the lives of innocent people. Sam and Dean are confronted with a complex array of moral issues in killing.Supernatural depicts hunters as ordinary people who know of the hidden supernatural evil that exists in the world and choose to spend their lives fighting it. Hunting, as the name suggests, involves tracking down these creatures and figuring out a way to destroy them. There are three fundamentally important (...) types of creatures in Supernatural: monsters, spirits, and demons. As hunters, Sam and Dean are motivated to kill monsters to defend innocent people from being victims of those monsters. As hunters, Sam and Dean follow typical rules of morality when dealing with people, but if they're warriors, those rules might change significantly. Warriors are bound by “Just War Theory,” which gives combatants special permissions for killing enemy combatants. (shrink)

This wide-ranging conversation explores the potential of comedy to effect social change; the connections and disconnections between comedy and tragedy; the problem of laughter, humor, and ridicule; and the power of feminist humor.

Russell Ford examines Gilles Deleuze's Empiricism and Subjectivity within its academic and philosophical context, arguing that the significance of this work only becomes apparent in connection to a larger problematic: the conceptual constitution of a purely immanent account of existence.

Background: The United States symbolizes democracy in the new world and contributes to global prosperity. Nevertheless, incrementalism is a historically dominant national approach to public policy implementation that delays democracy and undermines human dignity. Human flourishing and national development are endangered by slow-moving democratic changes. This necessitates a social justice framework that traces the exploitation of incrementalism and the consequences of opportunity gaps. Objectives: This study aims to construct a grounded theory to address and answer the following research question: Are (...) anti-democratic concepts part of a process or strategy that hinders democratic change, and what reinforces it, if anything? Methods: Two categories emerged from a grounded theory of democratic social change. This combination of anti-democratic tenets and democratic principles led to abductive reasoning to fill the research gap. Results: The key finding was the existence of a systematic approach that led to democracy while simultaneously disempowering the same group through legal and extralegal means. Two processes hinder democracy: incrementalism and an anti-democratic demoralizing process. A constructivist social justice grounded theory was developed to analyze and evaluate public policy for barriers and facilitators of democracy. A thorough analysis and evaluation of the impact and consequences of public policy is recommended to better understand how such policies impede democracy and influence American perceptions of justice. (shrink)

Few scholars have explored the founding documents to identify the deliberate social change strategy that led to America's independence and a new form of government that was of, by, and for the people. This study aimed to apply a post-hoc polytheoretical framework of power to the findings of a democratic social change study to understand the dynamics of power between Great Britain and the American colonists. The original study employed the constructivist grounded theory tradition to explore democracy in the Declaration (...) of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. This produced two frameworks of power strategies, one empowering and the other demoralizing: principles of democracy and anti-democratic tenets. To gain a holistic perspective of the interplay of power, a polytheoretical framework of power consisting of theories of power proposed by Marx and Engels, Bourdieu, and Foucault was employed to discuss the findings. The findings suggested that democratic social change interacts with structural forces, culture, and power strategy selection. This could provide an alternative lens through which to explore whether people of color in America were used instrumentally to sustain democracy. (shrink)

Theoretical models for patient-physician communication in clinical practice are frequently described in the literature. Respecting patient autonomy is an ethical problem the physician faces in a medical emergency situation. No theoretical physician-patient model seems to be ideal for solving the communication problem in clinical practice. Theoretical models can at best give guidance to behavior and judgement in emergency situations. In this article the premises of autonomous treatment decisions are discussed. Based on a case-report we discuss different genuine efforts the physician (...) can do to uncover treatment refusal and respect patient autonomy in an emergency situation. Autonomy requires competence and in emergency medicine time does not allow intimate exploration of patient competence and reasons for treatment refusal. We find that the physician must base her decision on a firm theoretical base combined with a practical and realistic view of the patient's situation on a case to case basis. (shrink)

Multidisciplinary healthcare committees meet regularly to discuss patients’ candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation . Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non-neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the expansion (...) of therapy applications. (shrink)

To date, few Norwegian clinical ethics committees (CECs) have included patients or next of kin in case discussions. In 2008, Rikshospitalet's (The National Hospital's) CEC began to routinely invite patients and relatives into case discussions. In this paper, we describe seven cases discussed by this committee in 2008. Six involved life and death decision-making in collaboration with the next of kin, while one related case did not include relatives. In our opinion, representing the patient's perspective was advantageous to the discussion (...) itself, to the conclusion made and to the next of kin's acceptance of the resolution. We believe that if the patient had been represented in the last case, the outcome might have been different. We conclude that successful patient involvement will rely on well-structured case discussions, an open atmosphere and good preparation and follow-up. (shrink)

Biological science uses multiple species concepts. Order can be brought to this diversity if we recognize two key features. First, any given species concept is likely to have a patchwork structure, generated by repeated application of the concept to new domains. We illustrate this by showing how two species concepts (biological and ecological) have been modified from their initial eukaryotic applications to apply to prokaryotes. Second, both within and between patches, distinct species concepts may interact and hybridize. We thus defend (...) a semantic picture of the species concept as a collection of interacting patchwork structures. Thus, although not all uses of the term pick out the same kind of unit in nature, the diversity of uses reflects something more than mere polysemy. We suggest that the emphasis on the use of species to pick out natural units is itself problematic, because that is not the term’s sole function. In particular, species concepts are used to manage inquiry into processes of speciation, even when these processes do not produce clearly delimited species. (shrink)

If ethics consultation services influence medical decisions it is important to evaluate how ethical dilemmas are dealt with by clinical ethics committees (CECs). Such evaluation is rare. This study presents a feasible and practical method of evaluating case discussions in CECs and the results emerging from the use of this method. A written presentation of an end-of-life dilemma was sent to all Norwegian ethics committees. The committees were asked to deal with the case as they would do if it was (...) a real case, and to prepare a written report of the discussion. A majority of the committees approached the case systematically. All emphasized the importance of good communication with the next of kin. However, their conclusions varied, medical facts were interpreted differently, possible patient suffering was dealt with differently, and some committees revealed insufficient legal knowledge. Such findings are useful in the future education of committee members. (shrink)

As neural implants transition from engineering design and testing into human subjects research, careful consideration must be paid to the ethical elements in developing research protocols. Although these ethical aspects may be framed by the design choices of the engineering, a number of challenging choices arise. In spite of many ethical considerations for neural implant technologies being shared with generic research ethics questions, there are subsets needing special attention. Even in considerations requiring increased attention, substantial overlap can be found with (...) research ethics questions for general medical implants and for psychiatric pharmaceuticals. The special attention to specific ethical questions in neural implants exists because of the value placed on preserving cognition and control as well as our continued memory of significant past research abuses in neurosurgery. This paper focuses on three issues of particular saliency to neural implant testing: inclusion/exclusion of subjects with psychiatric conditions, consent withdrawal of research subjects, and enhancement as a goal. (shrink)

Grounded theory methodology is perceived as challenging due to its systematic and rigorous process. However, this is because most people do not realize that the strategies used in the grounded theory data analysis process are used by laypeople and professionals regularly, if not daily. This article aims to help others interested in grounded theory with a background in qualitative data analysis feel comfortable engaging in the methodology and constructing multiple theories in the same study. It shares my latest experience incorporating (...) various data analysis strategies with the constructivist approach: holistic and systems thinking, situational analysis, dramaturgical analysis, perspective taking, and abstraction. The examples remove the mystery from abstraction and abductive reasoning. (shrink)

Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & othersThe decision of Dame Butler-Sloss in the case of Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & Others1 has already achieved notoriety. The disturbing facts have received widespread media coverage and fuelled further legal and political debate surrounding the “reproductive revolution”.2 This short paper assesses the context and potential implications of the recent decision and, in particular, the nature and meaning of parenthood and the family.THE CASETwo (...) couples, referred to Mr and Mrs A and Mr and Mrs B, were attending the assisted conception unit at Leeds General Infirmary to receive infertility treatment. Both couples understood that they were participating in a technique called intracytoplasmic sperm injection , a technique which would use the eggs of the wife and the sperm of the husband in each case. Mrs A had consented to her eggs being mixed with her husband’s sperm to create an embryo which would then be implanted in her, hopefully resulting in pregnancy. Mr A had consented to his wife’s treatment. Mr and Mrs B gave their consent to similar IVF procedures, although Mr B had expressly refused to consent to his sperm being used in treating others.Following a mix up at the unit, which Butler-Sloss referred to as “a ‘mistake’ … despite its inadequacy as a description of what occurred”, Mr B’s sperm was injected into Mrs A’s eggs. She became pregnant and later gave birth to healthy twins. The mistake became apparent only on Mrs A’s delivery of twins of mixed race; Mr and Mrs A are both white, Mr and Mrs B both black. DNA testing subsequently established that Mr B was the biological father of the children. He has had no subsequent contact with them and …. (shrink)

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the (...) Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)

Objectives: To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems. Design: Systematic review of case reports. Findings: Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved (...) in the ethical problem, either explicitly (n = 3) or implicitly (n = 22). Conclusion: Problems related to information/communication may underlie a classic ethical problem. Identification of these “hidden” problems may be important for the analysis, and hence, the solution to the ethical dilemma. (shrink)

This article examines the involvement of residents and their relatives in end-of-life decisions and care in Norwegian nursing homes. It also explores challenges in these staff—family relationships. The article is based on a nationwide survey examining Norwegian nursing homes’ end-of-life care at ward level. Only a minority of the participant Norwegian nursing home wards ‘usually’ explore residents’ preferences for care and treatment at the end of their life, and few have written procedures on the involvement of family caregivers when their (...) relative is in the terminal phase. According to the respondents, most staff seem to comfort relatives well. However, several challenges were described. The study revealed a need for better procedures in the involvement of residents and relatives in nursing home end-of-life care. The findings emphasize a need to strengthen both the involvement of nursing home physicians and staff communication skills. (shrink)