In his Analytical Philosophy of History A. C. Danto suggests that the main difference between an Ideal Chronicle (i.e. an account of events that is contemporaneous and exhaustive) and a History is that the Chronicle cannot by its nature treat adequately the significance of the events it describes. For, Danto claims, events derive significance from their relations with other events, including those that are future to themselves, and this latter type of significance cannot be described in a Chronicle since it (...) would involve knowledge of the future. In the following discussion it is suggested that the difference between Ideal Chronicles and Histories, if it exists, cannot be the one suggested by Danto. It is claimed that all significance-giving relations are fully described in a Chronicle and that it is only by the order of its material that it differs from a History. (shrink)

Background and objectives: Summary measures of overall health inequality are independent of group membership and enable international comparisons of distribution of health. We compare inequality between and within countries over time and identify normative issues underlying such comparisons. Methods: We used a set of modeled historical life tables for 193 World Health Organization member states from the years 1990, 2000 and 2008 and calculated inequality in age at death and inequality-adjusted life expectancy. Results: Our calculations suggest that overall health inequalities (...) in age at death have been decreasing in the period 1990–2008 in most countries of the world. Only 20 countries experienced increasing distribution in age at death. Simultaneously, overall life expectancy has increased in 85 per cent of all countries. Thus, the combined measure IALE has improved globally. The same overall trend of reduced health inequality applies to all groups of countries stratified by income level. Conclusion: Overall health inequalities, in addition to average health outcomes, could be reported regularly to monitor the health status of populations and the performance of health systems. We find, on normative grounds, the combined measure IALE to be preferable to measuring trends in inequality only. Likewise, we find the Absolute GiniH to be preferable to Relative GiniH. (shrink)

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

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

Minority governments in parliamentary democracies are conventionally considered to be unstable and ineffective aberrations from the principle of majority rule. Through analysis of over 350 postwar governments, the author shows that minority governments are neither exceptional nor unstable but in fact a common feature of parliamentary democracies and frequently perform as well as, or better than, majority coalitions. Using the Italian and Norwegian governments as case studies, he suggests that minority governments are particularly likely to form when parties anticipate competitive (...) elections and when opposition parties are able to influence legislative decisions. As an attempt to document and explain a very common form of government in parliamentary democracies, this book will contribute significantly to the understanding of the importance of electoral competition in democratic politics. (shrink)

Socioscientific issues receive considerable public attention and there are concerns that people in general are not able or willing to deal with information at odds with what they believe to be true. In this study, we focused on students’ beliefs about two controversial issues: whether consumption of the artificial sweetener aspartame and use of cell phones, respectively, represent any serious health risks. Our aim was to investigate whether students’ trust in the information was related to prior beliefs, the nature of (...) the message, and students’ critical reading strategies. Results showed interactions between prior beliefs about the issues and text condition (risk vs. no risk) on trust in conclusions that indicated a confirmation bias assumption. Additionally, students trusted conclusions ascertaining that there were risks more than conclusions ascertaining that there were no risks. Finally, students’ self-reported use of critical reading strategies implied less trust in both types of conclusions. (shrink)

Ragnar Frisch received the first Nobel Memorial Prize in Economic Science together with Jan Tinbergen in 1969 for having played an important role in ensuring that mathematical techniques figure prominently in modern economic analysis. Frisch was also a co-founder of the Econometric Society in 1930, the inaugural editor of its journal Econometrica for over 20 years, and a major figure in Norwegian academic life. This collection of essays derived from the centennial symposium which marked Frisch's birth explores his contributions to (...) econometrics and other key fields in the discipline as well as the results of new research. Contributors include eminent scholars from Europe, the United Kingdom and North America who investigate themes in utility measurement, production theory, microeconomic policy, econometric methods, macrodynamics, and macroeconomic planning. (shrink)

This paper argues that some of the discussion around meta-scientific issues can be viewed as an argument over different “meta-hypotheses” – assumptions made about how different hypotheses in a scientific literature relate to each other. I argue that, currently, such meta-hypotheses are typically left unstated except in methodological papers and that the consequence of this practice is that it is hard to determine what can be learned from a direct replication study. I argue in favor of a procedure dubbed the (...) “limited homogeneity assumption” – assuming very little heterogeneity of effect sizes when a literature is initiated but switching to an assumption of heterogeneity once an initial finding has been successfully replicated in a direct replication study. Until that has happened, we do not allow the literature to proceed to a mature stage. This procedure will elevate the scientific status of direct replication studies in science. Following this procedure, a well-designed direct replication study is a means of falsifying an overall claim in an early phase of a literature and thus sets up a hurdle against the canonization of false facts in the behavioral sciences. (shrink)

Background:Organ donation and transplantation have made it possible to both save life and to improve the quality of life for a large number of patients. In the last years there has been an increasing gap between the number of patients who need organs and organs available for transplantation, and the focus worldwide has been on how to meet the organ shortage. This also rises some ethical challenges.Objective:The objective of this study was to explore healthcare professionals' experience of ethics related to (...) care and interaction with critically ill patients with severe brain injuries and their families.Research design:A hermeneutic phenomenological approach was used to explore the participants' experiences. Methods for collecting data were a combination of participant observations and in-depth interviews.Participants and research context:Two ICUs in a Norwegian university hospital were recruited for data collection. A total of 12 cases were observed, and 32 of the healthcare professionals involved were interviewed.Ethical considerations:The study was approved by the Regional Committee for Research Ethics. Permission to the study in the ICUs was obtained from the Chief Physician in the two ICUs respectively. The right of the participants was ensured by written, voluntary, and informed consent.Findings:From the thematic analysis, a structure of the participants' experiences emerged as a process. While the patients' condition was clarified through phases of prognostic ambiguity, gradual clarification and prognostic certainty, interaction with the families was characterized by ambiguity that involved withholding. The prognostic process had a great impact on how the healthcare professionals interacted with the family. The interaction challenged the participants' caring values in various ways and captured an important structure in their experiences of the ethical interaction with the patients' families. These challenges distinguish caring for families in donation situations from caring for relatives of critically ill patients in general.Discussion:In the discussion we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.Conclusion:Ethical questions should be discussed more both in educations of healthcare professionals and in clinical practice. (shrink)

Many countries have included agriculture as one of the sectors where they intend to obtain significant greenhouse gas emission reductions. In Norway, the dairy-beef sector, in particular, has been targeted for considerable emission cuts. Despite publicly expressed interest within the agricultural sector for reducing emissions, significant measures have yet to be implemented. In this paper, we draw on qualitative data from Norway when examining the extent the wider agri-food network around farmers promotes or restrains the transition toward low-emission agricultural production. (...) A qualitative analysis based on interviews with key stakeholders from various parts of the agri-food network of dairy-beef indicates that, if it is up to the dairy-beef system itself, it will develop in the direction of continued increased production volumes and increased efficiency in production, combined with moderate measures to reduce emissions. There is an obvious reluctance to stimulate the consumer demand toward other products or meat products with reduced emissions because such a solution would complicate full exploitation of existing agricultural resources and hence could bring considerable negative economic consequences. Another factor limiting the scope and drive towards a low-carbon production is that the effects of various potential climate measures do not appear as unambiguous. Our study indicates that the dairy-beef sector will likely not reach the goal of reduced emissions from its own initiatives. Rather, significant changes would probably require both push and pull support from forces outside the agricultural system. (shrink)

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals (...) and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses. (shrink)

This paper examines the existential context of physical and mental health. Hans Georg Gadamer and The World Health Organization’s conceptualizations are discussed, and current medicalized and idealized views on health are critically examined. The existential dimension of health is explored in the light of theories of selfhood consisting of different parts, Irvin Yalom’s approach to “ultimate concerns” and Martin Heidegger’s conceptualization of “existentials.” We often become aware of health as an existential concern during times of illness, and health and illness (...) can co-exist. The paper discusses how existential suffering in Western culture is described, to an increasing degree, as disorders or psychological deficits, and perfectionistic health goals easily can become a problem. We seek to avoid suffering rather than relate to it, with all the tension that may create. The paper argues that suffering is an unavoidable aspect of people’s experience of their lives, and actively relating to suffering must be regarded as a fundamental aspect of health. The need and usefulness of a concept of “existential health” is discussed. (shrink)

This paper examines the psychology of existential guilt with Martin Heidegger and Rollo May’s conceptualizations as the point of departure. The concept of existential guilt describes preconditions for responsibility and accountability in life choices and the relationship to the potential given in the life of a human. It might also be used as a starting point to examine an individual’s relationship to the potential offered in their life and life context and, in this way, the hitherto unlived life of an (...) individual. The following questions are discussed in contexts of identity development, perfectionism, and current cultural shifts in conceptualizations of selfhood: How can humans relate to the fact that only limited parts of who they might be can ever be actualized? Moreover, how can they relate to the fundamental ambiguity and “groundlessness” in the contexts of life where choices are made? There are striking parallels between the role of exploration in the Eriksonian approaches to healthy identity development and the ontological groundlessness that stands out as a premise for existential guilt. There are also parallels between identity fore-closure and normative identity styles and “falling” into das Man in the existential framework. Perfectionistic ideals easily become an objectivization – and closure – of possible alternatives and choices. In contemporary theories of constructions of selfhood, the dangers of alienation from the community on the one hand and escape into what might become totalitarian collectivism on the other is pointed out. The contextualization of personal responsibility offered through the concept of existential guilt might address both dangers. It provides a perspective on how personal responsibility is embedded in contexts of human relationships, relationships to nature, and the finitude, freedom, uncertainties, and suffering that is given through human existence. Existential guilt can wake sorrow and regret over opportunities overlooked and lost. However, most of all, it can be seen as a drive toward repair in the relationship toward both oneself and the other. It takes the form of receptivity, an openness to a life not yet lived, and creative use of imagination. (shrink)

Rebecca Brown and Julian Savulescu argue in ‘Responsibility in Healthcare Across Time and Agents’ that if responsibility should play a crucial role in healthcare, then we need a concept of responsibility that reflects that an individual’s behaviour is sometimes, if not routinely, influenced by external factors in various ways. As Brown and Savulescu convincingly show, health-related behaviour in particular is often affected by other agents and typically involves multiple decisions on different occasions. Smoking and a poor diet are but two (...) examples where these factors are salient. Since health-related behaviour is often influenced by others, and often spread out over time, a notion of responsibility that does not take these two factors into account will be inadequate. In this comment to their paper I wish to raise an issue concerning Brown and Savulescu’s characterisation of individual responsibility for health-related behaviour that involves multiple choices by the same agent over a period of time. For simple acts—smoking a cigarette or eating some junk food for example—Brown and Savulescu assume two necessary conditions for responsibility: a ‘control condition’ and a ‘epistemic condition’. These conditions are intended to capture the plausible idea that …. (shrink)

Decentring the Avant-Garde presents a collection of articles dealing with the topography of the avant-garde. The focus is on different responses to avant-garde aesthetics in regions traditionally depicted as cultural, geographical and linguistic peripheries. Avant-garde activities in the periphery have to date mostly been described in terms of a passive reception of new artistic trends and currents originating in cultural centres such as Paris or Berlin. Contesting this traditional view, Decentring the Avant-Garde highlights the importance of analysing the avant-garde in (...) the periphery in terms of an active appropriation of avant-garde aesthetics within different cultural, ideological and historical settings. A broad collection of case studies discusses the activities of movements and artists in various regions in Europe and beyond. The result is a new topographical model of the international avant-garde and its cultural practices. (shrink)

A common intuition is that there is a moral difference between ‘making people happy’ and ‘making happy people.’ This intuition, often referred to as ‘the Asymmetry,’ has, however, been criticized on the grounds that it is incoherent. Why is there, for instance, not a corresponding difference between ‘making people unhappy’ and ‘making unhappy people’? I argue that the intuition faces several difficulties but that these can be met by introducing a certain kind of reason that is favouring but non-requiring. It (...) is argued that there are structural similarities between the asymmetry and moral options and that the asymmetry can be defended as an instance of a moral option. (shrink)