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)

This paper critically examines traditional rule-based and externalist approaches to the teaching of business ethics. The review materializes in a framework of seven pitfalls associated with the traditional approach, and bridges to overcome these perils are offered. Care is taken to avoid submitting the implausible positions of moral relativism. A perspective of methodological pluralism and normative internalism is developed and presented as a fruitful avenue for effective teaching in business ethics, and possible avenues for empirical exploration are offered.

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)

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)

In this study, we build on a recent social data scientific mapping of Danish environmentalist organizations and activists during the COVID-19 lockdown in order to sketch a distinct genre of digital social research that we dub a quali-quantitative micro-history of ideas in real-time. We define and exemplify this genre by tracing and tracking the single political idea and activist slogan of grøn genstart across Twitter and other public–political domains. Specifically, we achieve our micro-history through an iterative and mutual attuning between (...) computational and netnographic registers and techniques, in ways that contribute to the nascent field of computational anthropology. By documenting the serial ways in and different steps through which our inquiry was continually fed and enhanced by crossing over from ethnographic observation to computational exploration, and vice versa, we offer up our grøn genstart case account as exemplary of wider possibilities in this line of inquiry. In particular, we position the genre of micro-history of ideas in real-time within the increasingly wide and heterogeneous space of digital social research writ large, including its established concerns with ‘big and broad’ social data, the repurposing of computational ‘interface’ techniques for socio-cultural research, as well as diverse aspirations for deploying digital data within novel combinations of qualitative and quantitative methods. (shrink)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports from (...) the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (shrink)

Uncoupling proteins (UCPs) regulate mitochondrial function, and thus cellular metabolism. Angiotensin‐converting enzyme (ACE) is the central component of endocrine and local tissue renin–angiotensin systems (RAS), which also regulate diverse aspects of whole‐body metabolism and mitochondrial function (partly through altering mitochondrial UCP expression). We show that ACE expression also appears to be regulated by mitochondrial UCPs. In genetic analysis of two unrelated populations (healthy young UK men and Scandinavian diabetic patients) serum ACE (sACE) activity was significantly higher amongst UCP3‐55C (rather than (...) T) and UCP2 I (rather than D) allele carriers. RNA interference against UCP2 in human umbilical vein endothelial cells reduced UCP2 mRNA sixfold (P < 0·01) whilst increasing ACE expression within a physiological range (<1·8‐fold at 48 h; P < 0·01). Our findings suggest novel hypotheses. Firstly, cellular feedback regulation may occur between UCPs and ACE. Secondly, cellular UCP regulation of sACE suggests a novel means of crosstalk between (and mutual regulation of) cellular and endocrine metabolism. This might partly explain the reduced risk of developing diabetes and metabolic syndrome with RAS antagonists and offer insight into the origins of cardiovascular disease in which UCPs and ACE both play a role. (shrink)

In this article, Herrie and Sørensen examine the mediation of typing indicators (“…”) in online messaging. Their point of departure is a scene from the contemporary novel Exciting Times by Naoise Dolan (2020), in which the ‘dots’ play a prominent role. Their analysis shows how typing indicators, as interface design, mediate the complex communication situation in which they take part: from being mere signals, they have slipped into our emotional lives. From a semiotic perspective (Charles S. Peirce), the authors define (...) typing indicators as uncertain indices which through unknowability and suspense establish an attentional presence. In continuation hereof, the authors argue that the acts of writing and waiting in contemporary attentional ecologies (Yves Citton) through the mediation of typing indicators as indicators of attentional presence, could be considered a mode of caring (Bernard Stiegler). (shrink)

In this article, I critically assess Hélène Landemore's new model of Open Democracy, asking whether it requires of citizens to blindly defer to the decisions of the mini-public. To address this question, I, first, discuss three institutional mechanisms in Open Democracy, all of which can be read to grant citizens democratic control. I argue that neither the capacity to authorize the selection mechanism (random sortition), nor the lottocratic conception of political equality, nor the self-selection mechanisms of Landemore's model deliver the (...) form of control that would insulate Open Democracy from the charge of blind deference. I then discuss the direct democracy mechanisms that Landemore incorporates into her model. Although these devices grant citizens control and, by extension, offer the resources for repudiating the charge of blind deference, they also, I argue, subvert the logic of Landemore's lottocratic model, rendering Open Democracy predictably unstable. Given the deliberative asymmetries between the mini-public and the citizenry, a high frequency of bottom-up challenges is to be expected that would throw the whole system into jeopardy. Thus, the challenge for lottocrats is to show how democratic control can be achieved in a lottocratic system without undermining the benefits of the legislature by lot. (shrink)

Secular change in sex ratios is examined in relation to experience in the family. Two theoretical perspectives are outlined: Guttentag and Secord’s (1983) adaptation of social exchange theory, and sexual selection theory. Because of large-scale change in number of births and typical age differentials between men and women at marriage, low sex ratios at couple formation ages existed in the U.S. between 1965 and the early 1980s. The currently high sex ratios, however, will persist until the end of the century. (...) High sex ratios appear to be associated with lower divorce rates, male commitment to careers that promise economic rewards, male willingness to engage in child care, higher fertility, and higher rates of sexual violence. Sexual selection theory calls attention to intrasexual competition in the numerically larger sex. (shrink)

Including empirical examples and theoretical clarifications on many of the analytical issues raised in his recently published Down to Earth, this conversation with Bruno Latour and his collaborator, Danish sociologist Nikolaj Schultz, offers key insights into Latour’s recent and ongoing work. Revolving around questions on political ecology and social theory in our ‘New Climatic Regime’, Latour argues that in order to have politics you need a land and you need a people. This interview present reflections on such politics, such land (...) and such people, and it ends with a call for a sociology that takes up the task of connecting the three by investigating what he and Schultz call ‘geo-social classes’. The interview was conducted by Jakob Stein in Paris in November 2018. (shrink)

The Practices of Global Ethics takes a unique look at global ethics: not as mere written statements but as a set of practices undertaken by thousands of organisations and hundreds of thousands of people to shape the normative trajectory of human affairs. It looks at statements of global ethical principles including The Universal Declaration of Human Rights, the Earth Charter and the Rio Documents and positions them as the outcomes and expression of ongoing practices. Offering innovative, critical and thoughtful analyses (...) of ethical practices since World War II, the book examines efforts to promote human rights; foster ecological responsibility; end genocide; reduce global poverty; encourage responsible and sustainable international business practices; cultivate understanding and collaboration amongst the world's religions among other worldwide endeavours. (shrink)

The Covid-19 pandemic creates an unprecedented threatening situation worldwide with an urgent need for critical reflection and new knowledge production, but also a need for imminent action despite prevailing knowledge gaps and multilevel uncertainty. With regard to the role of research ethics in these pandemic times some argue in favor of exceptionalism, others, including the authors of this paper, emphasize the urgent need to remain committed to core ethical principles and fundamental human rights obligations all reflected in research regulations and (...) guidelines carefully crafted over time. In this paper we disentangle some of the arguments put forward in the ongoing debate about Covid-19 human challenge studies and the concomitant role of health-related research ethics in pandemic times. We suggest it might be helpful to think through a lens differentiating between risk, strict uncertainty and ignorance. We provide some examples of lessons learned by harm done in the name of research in the past and discuss the relevance of this legacy in the current situation. (shrink)

In this critical comment, we argue that nondemocratic, but decent regimes fail to constitute legitimate governance under Applbaum’s free group agency account. To make this case, we first introduce the three principles of liberty, equality and agency that Applbaum takes to flow directly from his free agency conception of legitimacy. Against this backdrop, we discuss Applbaum’s claim that a nondemocratic regime along the lines of a Rawlsian decent consultation hierarchy could meet the threshold of legitimacy. Contrary to this suggestion, we (...) argue that nondemocratic, but decent regimes cannot claim legitimacy under Applbaum’s account because they are constitutively inegalitarian, thus failing to adequately grant citizens the equal normative power without which legitimacy is unattainable under the free group agency account. (shrink)

The discussion on mandatory turnout, which controversially introduces coercion at the heart of the electoral process, illustrates a dilemma between increasing voter turnout on the one hand and avoiding coercion on the other. If successful, a recent proposal by Elliott solves this dilemma as it removes the compulsory element of mandatory turnout. Specifically, Elliot reinterprets the policy’s purpose as (a) a pre-commitment device for those who believe that they have a duty to vote and (b) a nudge to the surveillance (...) of politics for those who do not believe this. We critically evaluate Elliott’s novel intervention in the debate and argue that it is ultimately unsuccessful. Mandatory turnout can be interpreted as neither a pre-commitment device nor a nudge. Moreover, we present a more promising and novel solution to the dilemma: a genuine state-administered pre-commitment device with respect to voting that also nudges citizens to vote and seems _prima facie_ attractive. (shrink)

Within the caring science paradigm, variations of a method of interpretation inspired by the French philosopher Paul Ricoeur's theory of interpretation are used. This method consists of several levels of interpretation: a naïve reading, a structural analysis, and a critical analysis and discussion. Within this paradigm, the aim of this article is to present and discuss a means of creating distance in the interpretation and the text structure by using narration in a poetic language linked to the meaning of the (...) text. Ricoeur's ‘Hermeneutical function of distanciation’ will be introduced, and this concept of distanciation will be illustrated with reference to narrations from a study of patient's life experiences living with chronic illness and home mechanical ventilation in Denmark. Distanciation in the interpretation objectifies the text, and narration in a poetic language creates a particular kind of mediation in the interpretation. That narration represents an interpreted understanding of the whole, which facilitates an appropriate and evocative presentation of the interpreted data. This way of objectifying the text through narration can contribute yet another perspective to Ricoeur's rich and varied theory of interpretation. (shrink)

Managing aggression in mental health hospitals is an important and challenging task for clinical nursing staff. A majority of studies focus on the perspective of clinicians, and research mainly depicts aggression by referring to patient-related factors. This qualitative study investigates how aggression is communicated in forensic mental health nursing records. The aim of the study was to gain insight into the discursive practices used by forensic mental health nursing staff when they record observed aggressive incidents. Textual accounts were extracted from (...) the Staff Observation Aggression Scale-Revised (SOAS-R), and Fairclough’s Critical Discourse Analysis was used to identify short narrative entries depicting patients and staffs in typical ways. The narratives contained descriptions of complex interactions between patient and staff that were linked to specific circumstances surrounding the patient. These antecedents, combined with the aggression incident itself, created stereotyping representations of forensic psychiatric patients as deviant, unpredictable and dangerous. Patient and staff identities were continually (re)produced by an automatic response from the staff that was solely focused on the patient’s behavior. Such response might impede implementation of new strategies for managing aggression. (shrink)

From Stoicism to Platonism describes the change in philosophy from around 100 BCE, when monistic Stoicism was the strongest dogmatic school in philosophy, to around 100 CE, when dualistic Platonism began to gain the upper hand - with huge consequences for all later Western philosophy and for Christianity. It is distinguished by querying traditional categories like 'eclecticism' and 'harmonization' as means of describing the period. Instead, it highlights different strategies of 'appropriation' of one school's doctrines by philosophers from the other (...) school, with all philosophers being highly conscious of their own identity. The book also sets out to break down the traditional boundaries between, on the one hand, the study of Greco-Roman philosophy in the period and, on the other hand, that of contemporary Hellenistic Jewish and early Christian writings with a philosophical profile. In these ways, the book opens up an immensely fruitful period in the history of philosophy. (shrink)

Experimental studies investigating the contribution of conscious intention to the generation of a sense of agency for one’s own actions tend to rely upon a narrow definition of intention. Often it is operationalized as the conscious sensation of wanting to move right before movement. Existing results and discussion are therefore missing crucial aspects of intentions, namely intention as the conscious sensation of wanting to move in advance of the movement. In the present experiment we used an intentional binding paradigm, in (...) which we distinguished between immediate intention, as usually investigated, and longer standing intention. The results showed that the binding effect was significantly enhanced for distal intentions compared to proximal intentions, indicating that the former leads to stronger sense of agency. Our finding provides empirical support for a crucial distinction between at least two types of intention when addressing the efficacy of conscious intentions. (shrink)

Various authors see human flourishing as the overarching aim to which education should contribute. We ask whether fostering _wonder_ can help education attain this aim. We discuss two possibilities: firstly, it may be that having a sense of wonder as adults (possibly fostered by and/or refined due to education) contributes to flourishing itself. Secondly, it may be that fostering wonder in education increases the likelihood that education promotes flourishing, which it might do simply by increasing children’s intrinsic interest in what (...) they learn. We argue that there are many plausible connections between wonder and human flourishing (relating to its epistemic and aesthetic dimensions, among others), and that we have reason to believe that early experiences can influence adults’ capacity for wonder. Furthermore, wonder increases the likelihood that education ‘succeeds’; and it supports people’s ability to live well by heightening their appreciation for the world, helping to uncover baseless beliefs, and increasing their awareness of possible goods. In sum, while having a sense of wonder may not be a constitutive element of human flourishing, it is hard to imagine education for human flourishing that is not also wonder-full education. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

This article merges the ‘terminologies of social change’ from recognition theory and mediatization research to argue that the mediatization of society has eased and accelerated processes of what recognition theorist Axel Honneth calls individualization and social inclusion. This, however, cannot be understood unambiguously as moral progress. Thus, the first part of the article outlines the conceptualization of social change in Honneth’s recognition-theoretical framework, including the critique of recognition theory’s account of power, which problematizes Honneth’s inherent idea of moral progress. Considering (...) this critique, the article follows Douglas Giles’ suggestion that we must distinguish between affirmational and transformational struggles for recognition. The discussion is subsequently related to the conceptualization of social change in mediatization research, which shows that the closely interrelated phenomena of a social relocation of media and a re-orientation of the self help facilitate and constitute the individual’s increased possibilities, but also dependence, with respect to intersubjective recognition from peer groups in many contemporary societies. This provides the starting point for exemplifying how the conditions for affirmational and transformational recognition struggles, and thus individualization and social inclusion, have changed in a mediatized world. This exemplification draws primarily on an in-depth case study of mediated recognition in the lives of four young Danes aged 15 to 30 years with different subcultural identity positions. The main empirical illustrations involve the experiences of the 22-year-old hijabi football freestyler Maarika, who uses her Muslim identity actively on her social media channels to be a role model and to counter negative stereotypes of Muslims and female footballers. (shrink)

This article elaborates on foundational issues in the social sciences and their impact on the contemporary theory of belief revision. Recent work in the foundations of economics has focused on the role external social norms play in choice. Amartya Sen has argued in [Sen93] that the traditional rationalizability approach used in the theory of rational choice has serious problems accommodating the role of social norms. Sen's more recent work [Sen96, Sen97] proposes how one might represent social norms in the theory (...) of choice, and in a very recent article [BS07] Walter Bossert and Kotaro Suzumura develop Sen's proposal, offering an extension of the classical theory of choice that is capable of dealing with social norms. The first part of this article offers an alternative functional characterization of the extended notion of rationality employed by Bossert and Suzumura in [BS07]. This characterization, unlike the one offered in [BS07], represents a norm-sensitive notion of rationality in terms of a pure functional constraint unmediated by a notion of revealed preference (something that is crucial for the application developed in the second part of this article). This functional characterization is formulated for general domains (as is Bossert and Suzumura's characterization) and is therefore empirically more applicable than usual characterizations of rationality. Interestingly, the functional constraint we propose is a variant of a condition first entertained in [AGM85] by Carlos Alchourrón, Peter Gärdenfors and David Makinson in the area of belief change. The second part of this article applies the theory developed in the first part to the realm of belief change. We first point out that social norms can be invoked to concoct counterexamples against some postulates of belief change (like postulate (*7)) that are necessary for belief change to be relational. These examples constitute the epistemological counterpart of Sen's counterexamples against condition α in rational choice (as a matter of fact, Rott has showed in [Rot01] that condition and postulate (*7) are mutually mappable). These examples are variants of examples Rott has recently presented in [Rot04]. One of our main goals in this article consists in applying the theory developed in the first part to develop a theory of norm-inclusive belief change that circumvents the counterexamples. We offer a new axiomatization for belief change and we furnish correspondence results relating constraints of rational choice to postulates of belief change. (shrink)

A growing number of consumer technology companies are aiming to convince older people that humanoid robots make helpful tools to support aging-in-place. As hybrid devices, socially assistive robots (SARs) are situated between health monitoring tools, familiar digital assistants, security aids, and more advanced AI-powered devices. Consequently, they implicate older people’s privacy in complex ways. Such devices are marketed to perform functions common to smart speakers (e.g., Amazon Echo) and smart home platforms (e.g., Google Home), while other functions are more specific (...) to older people, including health and safety monitoring and serving as companions to mitigate loneliness. Privacy is a key value central to debates about the ethics of using SARs in aged care, yet there has been very little interchange between these debates and the robust theoretical discussion in the legal literature about the future of privacy and AI governance. Drawing on two qualitative studies of older people’s views on consumer SARs, the paper contributes novel findings about older people’s thinking on privacy and data governance at the intersection of their experiences with present day digital technologies and projections for future AI systems, and places their views in dialogue with debates about the future of privacy protection and AI governance. (shrink)

Formal learning theory formalizes the process of inferring a general result from examples, as in the case of inferring grammars from sentences when learning a language. In this work, we develop a general framework—the supervised learning game—to investigate the interaction between Teacher and Learner. In particular, our proposal highlights several interesting features of the agents: on the one hand, Learner may make mistakes in the learning process, and she may also ignore the potential relation between different hypotheses; on the other (...) hand, Teacher is able to correct Learner’s mistakes, eliminate potential mistakes and point out the facts ignored by Learner. To reason about strategies in this game, we develop a modal logic of supervised learning and study its properties. Broadly, this work takes a small step towards studying the interaction between graph games, logics and formal learning theory. (shrink)

An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)

This is the first edited collection entirely dedicated to non-evidentialist epistemology or non-evidentialism—the controversial view that evidence is not required in order for doxastic attitudes to enjoy a positive epistemic status. Belief or acceptance can be epistemically justified, warranted, or rational without evidence. The volume is divided into three section: the first focuses on hinge epistemology, the second offers a critical reflection about evidentialist and non-evidentialist epistemologies, and the third explores extensions of non-evidentialism to the fields of social psychology, psychiatry, (...) and mathematics. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti. (shrink)

This book presents an innovative challenge to the traditional reading of Paul. Troels Engberg-Pedersen argues that the usual, mainly cognitive and metaphorical ways of understanding central Pauline concepts must be supplemented by a literal understanding that directly reflects Paul's materialist cosmology.

The twenty-first century has witnessed a pervasive militarization of aesthetics with Western military institutions co-opting the creative worldmaking of art and merging it with the destructive forces of warfare. In Martial Aesthetics, Anders Engberg-Pedersen examines the origins of this unlikely merger, showing that today's creative warfare is merely the extension of a historical development that began long ago. Indeed, the emergence of martial aesthetics harkens back to a series of inventions, ideas, and debates in the eighteenth and early nineteenth (...) century. Already then, military thinkers and inventors adopted ideas from the field of aesthetics about the nature, purpose, and force of art and retooled them into innovative military technologies and a new theory that conceptualized war not merely as a practical art, but as an aesthetic art form. This book shows how military discourses and early war media such as star charts, horoscopes, and the Prussian wargame were entangled with ideas of creativity, genius, and possible worlds in philosophy and aesthetic theory (by thinkers such as Leibniz, Baumgarten, Kant, and Schiller) in order to trace the emergence of martial aesthetics. Adopting an approach that is simultaneously historical and theoretical, Engberg-Pedersen presents a new frame for understanding war in the twenty-first century. (shrink)

BackgroundEthically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors’ descriptions of how they include the patient and next of kin in end-of-life decisions.MethodsWe performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation.ResultsThe doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors (...) were more concerned about the opinion of next of kin than ensuring the patient’s best interest.ConclusionsMany end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient’s values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed. (shrink)

Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to (...) clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services. (shrink)

A central task for clinical ethics consultants and committees (CEC) is providing analysis of, and advice on, prospective or retrospective clinical cases. However, several kinds of biases may threaten the integrity, relevance or quality of the CEC's deliberation. Bias should be identified and, if possible, reduced or counteracted. This paper provides a systematic classification of kinds of bias that may be present in a CEC's case deliberation. Six kinds of bias are discussed, with examples, as to their significance and risk (...) factors. Possible remedies are suggested. The potential for bias is greater when the case deliberation is performed by an individual ethics consultant than when an entire clinical ethics committee is involved. (shrink)

When not acting in ways that are recognised as physical self-defence, women are often – in psychology and in other dominant discourses – generalised as inherently passive during subjection to sexualised coercion (rape and attempted rape). Likewise, in the aftermaths, their (in)actions are frequently pathologised as ‘maladaptive coping strategies’. We present theoretically and empirically based arguments for an agency-oriented approach to women’s perspectives on sexualised coercion. Agency is understood as intentional, situated and strategic. Sexualised coercion is not generalised as a (...) single “traumatic” event, but conceptualised as life events. Meanings of coercion are embedded in social activities connected to discourses on ‘rape’ and ‘trauma’. Thus personal meanings of subjection are understood as developed in and through participation in trajectories across diverse contexts. Adopted in our study, this approach points to the great diversity of personal meanings of sexualised coercion. Moreover, it reveals intimate connections between situated, personal and dominant discursive meanings of coercion, and women’s strategies of (in)actions during and in the aftermaths of the events. Our analysis of participants’ perspectives also indicates an imperative need for reinterpreting concepts such as ‘victim’ and ‘passivity’. In a reinterpretation women, although subjected to sexualised coercion, emerge as subjects both during subjection and in the aftermaths. Furthermore their seemingly pathological behaviour may be re-conceptualised as person ally sense-making strategies of action in reflected attempts at (re)formulating and (re)organising their life strategies. (shrink)

Executive compensation has long been a prominent topic in the management literature. A main question that is also given substantial attention in the business ethics literature—even more so in the wake of the recent financial crisis—is whether increasing levels of executive compensation can be justified from an ethical point of view. Also, the relationship of executive compensation to instances of unethical behavior or outcomes has received considerable attention. The purpose of this paper is to explore the social, ecological, and existential (...) costs of economic incentives, by discussing how relying on increasing levels of executive compensation may have an adverse effect on managerial performance in a broad sense. Specifically, we argue that one-dimensional economic incentives may destroy existential, social, and systemic values that influence the manager’s commitment to ensure responsible business conduct, and have negative spillover effects that may reduce the manager’s performance. There are well-documented findings that demonstrate that reliance on sources of extrinsic motivation (such as economic incentives) may displace intrinsic motivation. Our perspective is a holistic one, in the sense that we will explore the influence of sources of extrinsic motivation on the manager’s intrinsic commitment to different types of values. We will in particular investigate how it may influence the manager’s ethical reflection and behavior or lack thereof. (shrink)

Anthropologists and philosophers initiate a dialogue on trust and hope. The book combines work between scholars from different universities in the U.S. and Denmark and cuts across differences in national contexts and academic style.

Friedrich Schleiermacher is often considered the Father of Modern Theology, known for his attempt to reconcile traditional Christian doctrines with philosophical criticisms and scientific discoveries. Despite the influence of his work on significant figures like Karl Barth, he has been largely ignored by contemporary theologians. Focussing on Schleiermacher's doctrine of sin, this book demonstrates how Schleiermacher has not only been misinterpreted, but also underestimated, and deserves a critical re-examination. The book approaches Schleiermacher on sin with respect to three themes: one, (...) its power to transcend an intractable metaethical dilemma at the heart of modern debates over sin; two, its intended compatibility with natural science; and three, to re-evaluating its place, and so Schleiermacher's place, in the history of theology. It solves and dissolves problems arising simultaneously from natural science, confessional theology, ethics, and metaphysics in a single, integrated account using Schleiermacher's understudied thought from his dogmatics The Christian Faith. In contrast to the account sometimes given of modern theology as marked by a break with "Greek metaphysics," Schleiermacher's account is shown to stand in stark contrast by retrieving, not excising, ancient thought in service of an account of sin adequate to natural science. This is a vital rediscovery of a foundational voice in theology. As such, it will greatly appeal to scholars of Modern Theology, theological ethics, and the history of Modern Christianity. (shrink)

Dilation occurs when an interval probability estimate of some event E is properly included in the interval probability estimate of E conditional on every event F of some partition, which means that one’s initial estimate of E becomes less precise no matter how an experiment turns out. Critics maintain that dilation is a pathological feature of imprecise probability models, while others have thought the problem is with Bayesian updating. However, two points are often overlooked: (1) knowing that E is stochastically (...) independent of F (for all F in a partition of the underlying state space) is sufficient to avoid dilation, but (2) stochastic independence is not the only independence concept at play within imprecise probability models. In this paper we give a simple characterization of dilation formulated in terms of deviation from stochastic independence, propose a measure of dilation, and distinguish between proper and improper dilation. Through this we revisit the most sensational examples of dilation, which play up independence between dilator and dilatee, and find the sensationalism undermined by either fallacious reasoning with imprecise probabilities or improperly constructed imprecise probability models. (shrink)

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

Recent global advances in available technology to prevent mother-to-child HIV transmission necessitate a rethinking of contemporary and previous ethical debates on HIV testing as a means to preventing vertical transmission. In this paper, we will provide an ethical analysis of HIV-testing strategies of pregnant women. First, we argue that provider-initiated opt-out HIV testing seems to be the most effective HIV test strategy. The flip-side of an opt-out strategy is that it may end up as involuntary testing in a clinical setting. (...) We analyse this ethical puzzle from a novel perspective, taking into account the moral importance of certain hypothetical preferences of the child, as well as the moral importance of certain actual preferences of the mother. Finally, we balance the conflicting concerns and try to arrive at an ethically sound solution to this dilemma. Our aim is to introduce a novel perspective from which to analyse testing strategies, and to explore the implications and possible benefits of our proposal. The conclusion from our analysis is that policies that recommend provider-initiated opt-out HIV testing of pregnant mothers, with a risk of becoming involuntary testing in a clinical setting, are acceptable. The rationale behind this is that the increased availability of very effective and inexpensive life-saving drugs makes the ethical problems raised by the possible intrusiveness of HIV testing less important than the child's hypothetical preferences to be born healthy. Health care providers, therefore, have a duty to offer both opt-out HIV testing and available PMTCT (preventing mother-to-child transmission) interventions. (shrink)

This is the introduction to Moretti, Luca and Nikolaj Pedersen (eds), Non-Evidentialist Epistemology. Brill. Contributors: N. Ashton, A. Coliva, J. Kim, K. McCain, A. Meylan, L. Moretti, S. Moruzzi, J. Ohlorst, N. Pedersen, T. Piazza, L. Zanetti.

Although we find Gangestad & Simpson's argument intriguing, we question some of its underlying assumptions, including: (1) that fluctuating asymmetry (FA) is consistently heritable; (2) that symmetry is driving the effects; (3) that use of parametric tests with FA is appropriate; and (4) that a short-term mating strategy produces more offspring than a long-term strategy.

BackgroundDecisions about appropriate treatment at the end of life are common in modern healthcare. Non-treatment decisions (NTDs), comprising both withdrawal and withholding of (potentially) life-prolonging treatment are in principle accepted in Norway. However, in practice they may give rise to significant moral problems for health professionals, patients and next of kin. Here, patient values must be considered. It is relevant to study the moral views and intuitions of the general population on NTDs and special areas of contention such as the (...) role of next of kin in decision-making.MethodsElectronic survey to members of a nationally representative panel of Norwegian adults. Respondents were presented with vignettes describing patients with disorders of consciousness, dementia, and cancer where patient preferences varied. Respondents answered ten questions about the acceptability of non-treatment decision making and the role of next of kin.ResultsWe received 1035 complete responses (response rate 40.7%). A large majority, 88%, supported the right of competent patients to refuse treatment in general. When an NTD was in line with the patient’s previously expressed preferences, more respondents tended to find NTDs acceptable. More respondents would accept NTDs for themselves than for the vignette patients. In a scenario with an incompetent patient, clear majorities wanted the views of next of kin to be given some but not decisive weight, and more weight if concordant with the patient’s wishes. There were, however, large variations in the respondents’ views.ConclusionThis survey of a representative sample of the Norwegian adult population indicates that attitudes to NTDs are often in line with national laws and guidelines. However, the high variance among the respondents and relatively large weight given to next of kin’s views, indicate a need for appropriate dialogue among all stakeholders to prevent conflicts and extra burdens. Furthermore, the emphasis given to previously expressed opinions indicates that advance care planning may increase the legitimacy of NTDs and prevent challenging decision-making processes. (shrink)

Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Using a questionnaire, we studied the (...) decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 patients treated in nursing homes to the 84 nursing home patients treated in the hospital. The patients’ capacity to consent was considered prior to treatment in 197 of the patients treated in nursing homes and 56 of the patients treated in hospitals. The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital. Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital. Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. ClinicalTrials. gov NCT01023763 [The registration was delayed one month after study onset due to practical reasons]. (shrink)

This article has two objectives. In the first part, I present a critical overview of the extensive anthropological literature that may be deemed “phenomenological.” Following this critique, which is built up around a classification into four different varieties of phenomenological anthropology, I discuss the relationship between phenomenological anthropology and the ontological turn (OT). Contrary to received wisdom within the anthropological discipline, I suggest that OT has several things in common with the phenomenological project. For the same reason, I argue, it (...) is not accurate to posit OT and phenomenology as opposing or antagonistic projects, as they are often depicted among critics and advocates of OT alike. On the contrary, I go as far as suggesting, OT may be understood as one of the most concerted attempts anthropology has produced to realize a distinctly anthropological version of Husserl’s method of phenomenological bracketing, namely what could be called the ontological epoché. (shrink)

In this paper I discuss two fundamental challenges concerning Crispin Wright's notion of entitlement of cognitive project: firstly, whether entitlement is an epistemic kind of warrant since, seemingly, it is not underwritten by epistemic reasons, and, secondly, whether, in the absence of such reasons, the kind of rationality associated with entitlement is epistemic in nature. The paper investigates three possible lines of response to these challenges. According to the first line of response, entitlement of cognitive project is underwritten by epistemic (...) reasons – and thus supports epistemic rationality – because, when P is an entitlement, trust in P is a dominant strategy with respect to promotion of epistemic value. The second line of response replaces dominance with maximization of expected utility. I argue that both of these proposals are flawed and develop an alternative line of response. (shrink)