Reproductive counseling includes counseling of prospective parents by obstetricians, clinical geneticists, and genetic counselors regarding, for example, the use of assisted reproductive technologies, prenatal testing, and preimplantation genetic diagnosis. Two different views on wisdom and the goal of reproductive counseling are analyzed. According to the first view, the goal of reproductive counseling is to help prospective parents reach a wise decision. A specific course of action is recommended by the counselor in contrast to other possible alternatives. According to the second (...) view, the goal of reproductive counseling is not to help prospective parents reach a wise decision but to help them reach their own decision wisely. It is the prospective parents who should make the decision, and it is their value commitments that should be decisive. It is argued that the second approach is to be preferred to the first. It combines respect for autonomy with a recognition of the need for assistance in decision-making. Both the first and second views relate the goal of reproductive counseling to wisdom. A problem is, however, what wisdom more precisely means — there are many different views. A casuistic view of wisdom is investigated. This view roughly defines wisdom as practical prudence in dealing with particular cases. What characterizes a casuistic decision-making method is elaborated in more detail. Applied to the second view, a casuistic view of wisdom implies that the counselor should encourage prospective parents to take into consideration the nature of the particular problem at hand, the context of the problem, their own individual identities, their personal value commitments, and various alternative perspectives, values and arguments. (shrink)

In the initial phase of the COVID-19 pandemic, Sweden’s response stood out as an exception. For example, Sweden did not introduce any lockdowns, while many other countries did. In this paper I take the Swedish Corona Commission’s critique of the initial Swedish response as a point of departure for a general analysis of precaution in relation to pandemics. The Commission points out that in contrast to many other countries Sweden did not follow ‘the precautionary principle’. Based on this critique, the (...) Commission proposes that the precautionary principle should be included among Sweden’s guiding principles for crisis management. However, as the debate on this principle during the last 30 years indicates, the principle is loaded with problems. I discuss one of these problems, namely its lack of clarity. I argue, however, that this problem is not unsurmountable. A principle is lacking clarity precisely by being a principle and not a rule with a well-defined meaning. As a principle it indicates a direction but does not prescribe a specific action. However, to be action-guiding its content needs to be specified by rational deliberation. With this in mind, I propose a framework for specification of the precautionary principle as applied to pandemics. The framework focuses on the principle’s four key elements: threat, uncertainty, action and responsibility. I also suggest certain general ethical restrictions on specification. (shrink)

In this paper I investigate the web-rhetoric of companies offering home-based personal health monitoring to patients and elderly people. Two main rhetorical methods are found, namely a reference to practical benefits and a use of prestige words like “quality of life” and “independence”. I interpret the practical benefits in terms of instrumental values and the prestige words in terms of final values. I also reconstruct the arguments on the websites in terms of six different types of argument. Finally, I articulate (...) a general critique of the arguments, namely that the websites neglect the context of use of personal health monitoring technologies. Whether or not a technology is good depends on the use of the technology by a particular individual in a particular context. The technology is not good–or bad–in itself. I support this critique with a number of more specific arguments such as the risk for reduced personal contact. For some elderly people social contact with care providers is more valuable than the independent living made possible by remote monitoring, for others independence is more important. (shrink)

Purpose – This paper has three purposes: to identify and discuss values that should be promoted and respected in personal health monitoring, to formulate an ethical checklist that can be used by stakeholders, and to construct an ethical matrix that can be used for identifying values, among those in the ethical checklist, that are particularly important to various stakeholders. Design/methodology/approach – On the basis of values that empirical studies have found important to various stakeholders in personal health monitoring, the author (...) constructs an ethical checklist and an ethical matrix. The author carries out a brief conceptual analysis and discusses the implications. Findings – The ethical checklist consists of three types of values: practical values that a technical product in personal health monitoring must have, quality of life values to be promoted by the development and use of the product, and moral values to be respected in this development and use. To give guidance in practice, the values in the checklist must be interpreted and balanced. The ethical matrix consists of the values in the checklist and a number of stakeholders. Originality/value – The overall ambition is to suggest a way of categorizing values that can be useful for stakeholders in personal health monitoring. In order to achieve this, the study takes empirical studies as a starting-point and includes a conceptual analysis. This means that the proposals are founded on practice rather than mere abstract thinking, and this improves its usability. (shrink)

Values in Bioethics (ViB), co-sponsored by the International Association of Bioethics, makes available original philosophical books in all areas of bioethics, including medical and nursing ethics, health care ethics, research ethics, environmental ethics, and global bioethics. --.

Human germline gene editing is often debated in hypothetical terms: if it were safe and efficient, on what further conditions would it then be ethically acceptable? This paper takes another course. The key question is: how can scientists reduce uncertainty about safety and efficiency to a level that may justify initiation of first-time clinical trials? The only way to proceed is by well-designed preclinical studies. However, what kinds of investigation should preclinical studies include and what specific conditions should they satisfy (...) in order to be considered well-designed? It is argued that multispecies and multigenerational animal studies are needed as well as human embryo editing without implantation. In order to be possible to translate to first-time clinical trials, animal studies need to satisfy strict conditions of validity. Moreover, embryo studies intended for translation to first-time clinical trials need to correspond to the animal studies in experimental design. Only in this way can uncertainty about risk for harm and prospect of benefit in first-time clinical trials be reduced to a modest level. If uncertainty is not reduced to such a level, first-time clinical trials in germline gene editing should not be initiated. (shrink)

Human germline gene editing is often debated in hypothetical terms: if it were safe and efficient, on what further conditions would it then be ethically acceptable? This paper takes another course. The key question is: how can scientists reduce uncertainty about safety and efficiency to a level that may justify initiation of first-time clinical trials? The only way to proceed is by well-designed preclinical studies. However, what kinds of investigation should preclinical studies include and what specific conditions should they satisfy (...) in order to be considered well-designed? It is argued that multispecies and multigenerational animal studies are needed as well as human embryo editing without implantation. In order to be possible to translate to first-time clinical trials, animal studies need to satisfy strict conditions of validity. Moreover, embryo studies intended for translation to first-time clinical trials need to correspond to the animal studies in experimental design. Only in this way can uncertainty about risk for harm and prospect of benefit in first-time clinical trials be reduced to a modest level. If uncertainty is not reduced to such a level, first-time clinical trials in germline gene editing should not be initiated. (shrink)

The proportion of elderly in society is growing rapidly, leading to increasing health care costs. New remote monitoring technologies are expected to lower these costs by reducing the number of close encounters with health care professionals, for example the number of visits to health care centres. In this paper, I discuss issues of priority setting raised by this expectation. As a starting-point, I analyse the recent debate on principles for priority setting in Sweden. The Swedish debate illustrates that developing an (...) approach to priority setting is an ongoing process. On the basis of this analysis, I conclude that several different ethical principles, and specifications of these principles, can be appealed to for giving priority—over close encounters—to a large-scale introduction of remote monitoring technologies in health care services to elderly people, but also that many specifications can be appealed to against giving such priority. I propose that given the different views on principles, it is necessary to develop fair procedures of deliberation on these principles and their application, in particular in order to reach agreement on exactly how much resources should be allocated to remote monitoring and how much to close encounters. I also present a few points to consider in a large-scale introduction of remote monitoring. (shrink)

The concept of privacy by design is becoming increasingly popular among regulators of information and communications technologies. This paper aims at analysing and discussing the ethical implications of this concept for personal health monitoring. I assume a privacy theory of restricted access and limited control. On the basis of this theory, I suggest a version of the concept of privacy by design that constitutes a middle road between what I call broad privacy by design and narrow privacy by design. The (...) key feature of this approach is that it attempts to balance automated privacy protection and autonomously chosen privacy protection in a way that is context-sensitive. In personal health monitoring, this approach implies that in some contexts like medication assistance and monitoring of specific health parameters one single automatic option is legitimate, while in some other contexts, for example monitoring in which relatives are receivers of health-relevant information rather than health care professionals, a multi-choice approach stressing autonomy is warranted. (shrink)

Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an imaginative casuistry is to be preferred compared to principlism and to other forms of (...) casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases. (shrink)

Mitigation of climate change is often described as a tragedy of the commons. According to this theoretical framework, it is collectively rational for present-generation countries to mitigate climate change, but not individually rational to do so. It is rather in national self-interest to ‘free-ride’ on the mitigation actions of other countries. In this paper, I discuss two arguments criticizing this view. According to these arguments, it is in most cases individually rational for present-generation countries to mitigate, i.e., it is in (...) their national self-interest. The first argument focuses on national self-interest in terms of economic efficiency, the second on national self-interest in terms of national security. I conclude that the critical arguments to a large extent are tenable, but that they seem to underestimate the significance of those cases in which it is not in national self-interest to mitigate climate change. In these cases the tragedy of the commons framework is still applicable. (shrink)

Purpose The purpose of this paper is to pinpoint and analyse ethical issues raised by the dual role of artificial intelligence in relation to climate change, that is, AI as a contributor to climate change and AI as a contributor to fighting climate change. Design/methodology/approach This paper consists of three main parts. The first part provides a short background on AI and climate change respectively, followed by a presentation of empirical findings on the contribution of AI to climate change. The (...) second part presents proposals by various AI researchers and commentators on how AI companies may contribute to fighting climate change by reducing greenhouse gas emissions from training and use of AI and by providing AI assistance to various mitigation and adaptation measures. The final part investigates ethical issues raised by some of the options presented in the second part. Findings AI applications may lead to substantial emissions but may also play an important role in mitigation and adaptation. Given this dual role of AI, ethical considerations by AI companies and governments are of vital importance. Practical implications This paper pinpoints practical ethical issues that AI companies and governments should take into account. Social implications Given the potential impact of AI on society, it is vital that AI companies and governments take seriously the ethical issues raised by the dual role of AI in relation to climate change. Originality/value AI has been the subject of substantial ethical investigation, and even more so has climate change. However, the relationship between AI and climate change has received only limited attention from an ethical perspective. This paper provides such considerations. (shrink)

In this article I analyse and discuss guidelines for priority setting in crisis management at a regional level in Sweden. The guidelines concern three types of crises: pandemics, large losses of electric power and interruptions in water supply. Pandemics are typical public health issues. Large losses of electric power and interruptions in water supply are in themselves not, but may have serious public health consequences. These guidelines are compared with guidelines for priority setting in health care. This is done because (...) of the central position of health care in the management of many different types of crises. The comparison shows clear differences. In the analysis, I use a distinction between substantive principles of priority setting and process-oriented principles. Regarding substantive principles, I have found that the guidelines point in different directions. This seems acceptable, however, since they focus on different problems. Moreover, it seems possible to integrate the various context-dependent principles by relating them to higher order principles. Regarding process-oriented principles, I have found that how and to what extent these principles are applied in the guidelines vary. If we want to apply these principles in a more satisfying way, this would require a more systematic approach. (shrink)

Chronobiologists argue that their scientific findings have implications for prevention of sleep problems. They claim that some sleep problems are caused by the fact that people live against their individual body clock rather than adjusted to it. They also claim that by taking the findings of chronobiology seriously in policy-making some sleep problems can be prevented. I investigate applications of chronobiology in two social areas—school schedules and shift work—and show that in order for these applications to be justified certain implicit (...) presumptions have to be justified. The first presumption is explanatory, namely that a chronobiological explanation is an adequate explanation of the sleep problems at hand. In addition I analyse three ethical presumptions. The first ethical presumption is that sleep is of vital value. The second is that sleep is not an exclusively private issue. The third ethical presumption is that the preventive measures to be undertaken are ethically acceptable. My main point is that it is not possible to simply “read off” policy measures from the empirical findings of chronobiology. (shrink)

It is a common experience among care professionals that persons with dementia often say ‘no’ to conventional caring measures such as taking medication, eating or having a shower. This tendency to say ‘no’ may also concern the use of assistive technologies such as fall detectors, mobile safety alarms, Internet for social contact and robots. This paper provides practical recommendations for care professionals in home health care and social care about how to respond to such resistiveness towards assistive technologies. Apart from (...) the option of accepting the ‘no’, it discusses a number of methods for influencing persons with dementia in order to overcome the ‘no’. These methods range from various non-coercive measures—including nudging—to coercion. It is argued that while conventional caring measures like those mentioned are essential for survival, health or hygiene, assistive technologies are commonly merely potentially beneficial supplements. With this in mind, it is concluded that care professionals should be more restrictive in using methods of influence involving some degree of pressure regarding assistive technologies than regarding conventional caring measures. (shrink)

In the debate on climate change commentators often express pessimistic or optimistic views. We see this mainly in the media and popular literature, but also in various academic fields. The aim of this paper is to investigate different kinds of pessimistic and optimistic views put forward in this debate and suggest explanations of the diversity of views. The paper concludes that pessimism and optimism may concern, for example, climate change as an unmitigated or poorly mitigated process, mitigation of climate change (...) or specific measures of mitigation. These aspects are important to distinguish, because a person can be pessimist concerning climate change as an unmitigated or poorly mitigated process and optimist concerning mitigation of climate change, and be pessimist concerning one specific mitigation measure and optimist concerning another. It is suggested that the diversity of pessimistic and optimistic views is due to the uncertainty of scientific climate models and the influence of evaluative and ideological assumptions. (shrink)

In this paper I discuss ethical issues related to mitigation of climate change. In particular, I focus on mitigation of climate change to the extent this change is caused by livestock production. I support the view—on which many different ethical approaches converge—that the present generation has a moral obligation to mitigate climate change for the benefit of future generations and that developed countries should take the lead in the process. Moreover, I argue that since livestock production is an important contributing (...) factor to climate change, we should undertake mitigation measures also in this sector and not only in, for example, the transport and energy sectors. However, technological solutions do not seem sufficient in the livestock sector, leaving us with the option of reduced meat production and consumption. In order to reach significant results in mitigation of climate change, political steering seems necessary. With this in mind, I argue in favor of a tax on meat consumption. (shrink)

The theory of evolution has beenused in arguments regarding animalexperimentation. Two such arguments areanalyzed, one against and one in favor. Eachargument stresses the relevance of the theoryof evolution to normative ethics but attemptsexplicitly to avoid the so-called naturalisticfallacy.According to the argument against animalexperimentation, the theory of evolution`undermines' the idea of a special humandignity and supports `moral individualism'. Thelatter view implies that if it is wrong to usehumans in experiments, then it is also wrong touse animals, unless there are relevantdifferences between (...) them that justify adifference in treatment. No such differencescan be found with regard to animals which lead`biographical lives'.The argument in favor of animal experimentationis based on evolutionary psychology. It statesthat humans, as all social animals, arespeciesist by nature and stresses that thisshould be taken seriously in normative ethics.This does not mean that animal interests shouldnot be considered, only that vital humaninterests may outweigh them.In order to assess the arguments, one has totake a stand on certain more basic issues: `is'versus `ought', impartiality versus specialobligations, and feelings/intuitions versusreason. Given the author's own position withregard to these more basic considerations, theevolutionary argument in favor of animalexperimentation is judged to be more convincingthan the one against but not decisive. It isalso maintained that not all animal experimentsare acceptable. Which animal experiments areacceptable and which are not has to be decidedon a case-by-case basis. (shrink)

In this paper we analyse and discuss the views of Swedish stakeholders on how to mitigate climate change to the extent it is caused by meat production. The stakeholders include meat producer organisations, governmental agencies with direct influence on meat production, political parties as well as non-governmental organisations. Representatives of twelve organisations were interviewed. Several organisations argued against the mitigation option of reducing beef production despite the higher greenhouse gas intensity of beef compared to pork and chicken meat (according to (...) life cycle analysis). Regarding feed production some organisations proposed use of the best available industrial fertilizers, others were against all use of such fertilizers. Several organizations suggested domestic production of more protein-rich fodder and use of manure for biogas production. Regarding meat consumption the focus was on throwing away less food as waste and on eating less meat but the best (most climate friendly) meat, which was considered to be Swedish meat in contrast to imported meat. There was agreement on many issues. Most disagreement was found regarding political steering. We find many of the stakeholders’ mitigation proposals regarding meat production and consumption acceptable. However, we are to some extent critical to their defence of Swedish beef production. We also point out certain problems with the suggestion to reduce consumption of imported meat but not of domestically produced meat. (shrink)

The possibility of enhancing human abilities often raises public concern about equality and social impact. This chapter aims at one particular group of technologies, cognitive enhancement, and one particular fear, that enhancement will create social divisions and possibly expanding inequalities. The chapter argues that cognitive enhancements could offer significant social and economic benefits. The basic forms of internal cognitive enhancement technologies foreseen today are pharmacological modifications, genetic interventions, transcranial magnetic stimulation, and neural implants. Cognitive enhancements can influence the economy through (...) reduction of losses, individual economic benefits, and society‐wide benefits. The strongest objection to the introduction of any enhancement technology is that it will create inequality, injustice, and unfairness. While there are clear economic and social benefits to cognitive enhancement, there exist anumber of obstacles to its development and use. One obstacle is the present system for licensing drugs and medical treatments. (shrink)

As cognitive neuroscience has advanced, the list of prospective internal, biological enhancements has steadily expanded. Education and training, as well as the use of external information‐processing devices, may be labeled as “conventional” means of cognition enhancement (CE). They are often well established and culturally accepted. By contrast, methods of enhancing cognition through “unconventional” means, such as ones involving deliberately created nootropic drugs, gene therapy, or neural implants, are nearly all to be regarded as experimental at the present time. Transcranial magnetic (...) stimulation (TMS), genetic interventions, brain‐computer interfaces and new senses are highly experimental and unlikely to be important over the next 15 years. Many of the concerns about enhancement are nonspecific to the tools used to achieve it, which means that enhancement–ethic scrutiny should also apply to nonbiological external enhancements. (shrink)

This chapter examines Soren Kierkegaard's views and relationship with the Church, explaining that while Kierkegaard was a frequent churchgoer, he also considered the Church a corrupt and disgraceful business enterprise. It discusses Kierkegaard's criticism on the development of the Church as an institution and analyses various aspects of his ecclesiastical conception of the Church. The chapter also considers Kierkegaard's own experiences in writing and delivering sermons.

Inference has long been a concern in epistemology, as an essential means by which we extend our knowledge and test our beliefs. Inference is also a key notion in influential psychological or philosophical accounts of mental capacities, from perception via utterance comprehension to problem-solving. Consciousness, on the other hand, has arguably been the defining interest of philosophy of mind over recent decades. Comparatively little attention, however, has been devoted to the significance of consciousness for the proper understanding of the nature (...) and role of inference. It is commonly suggested that inference may be either conscious or unconscious. Yet how unified are these various supposed instances of inference? Does either enjoy explanatory priority in relation to the other? In what ways or senses, can an inference be conscious, or fail to be conscious, and how does this matter? This book brings together original essays from established scholars and emerging theorists that illustrate how several current debates in epistemology, philosophy of psychology, and philosophy of mind can benefit from reflections on these and related questions about the significance of consciousness for inference. Contributors include: Kirk Ludwig and Wade Munroe; Michael Rescorla; Federico Bongiorno and Lisa Bortolotti; Berit Brogaard; Nicholas Allott; Jake Quilty-Dunn and Eric Mandelbaum; Corine Besson; Anders Nes; David Henderson, Terry Horgan, and Matjaž Potrč; Elijah Chudnoff; and Ram Neta. (shrink)

The work of general practitioners is infused by norms from several movements, of which evidence based medicine, patient-centredness, and virtue ethics are some of the most influential. Their precepts are not clearly reconcilable, and structural factors may limit their application. In this paper, we develop a conceptual framework that explains how GPs respond, across different fields of interaction in their daily work, to the pressure exerted by divergent norms. Data was generated from unstructured interviews with and observations of sixteen Swedish (...) GPs and family medicine residents between 2015 and 2017. Straussian Grounded Theory was used for analysis. We found that GPs’ maxims of action can be characterised in terms of dichotomous responses to demands from four distinct sets of norms, or “voices”: the situation, the self, the system, and the profession. From the interactions between these voices emerge sixteen clusters of maxims of action. Based on the common features of the maxims in each cluster, we have developed a conceptual framework that appears to be rich enough to capture the meaning of the ethical decisions that GPs make in their daily work, yet has a high enough level of abstraction to be helpful when discussing the factors that influence those decisions. Our four-dimensional model of GPs’ responses to norms is a first step toward a middle-range theory of quality from GPs’ perspective. It brings out the complexity of their practice, reveals tensions that easily remain invisible in more concrete accounts of their actions, and aids the transferability of substantive theories on GPs’ ethical decision making. By explaining the nature of the ethical conflicts that they experience, we provide some clues as to why efforts to improve quality by imposing additional norms on GPs may meet with varying degrees of success. (shrink)

In _Plato on Democracy and Political technē_ Anders Dahl Sørensen offers an in-depth investigation of Plato’s discussions of democracy’s ‘epistemic potential’, arguing that this question is far more central to his political thought than is usually assumed.

It is often supposed one can draw a distinction, among the assumptions on which an inference rests, between certain background assumptions and certain more salient, or foregrounded, assumptions. Yet what may such a fore-v-background structure, or such structures, consist it? In particular, how do they relate to consciousness? According to a ‘Boring View’, such structures can be captured by specifying, for the various assumptions of the inference, whether they are phenomenally conscious, or access conscious, or else how easily available they (...) are to such consciousness. According to an ‘Interesting View’, there are fore-v-background structures over and above such classifications. The chapter gestures at reasons for thinking that an Interesting View at least merits exploration. The paper discusses some recent contributions to such a view in analytical philosophy; some remarks in Husserl on what he dubbed the horizonal dimension of acts of consciousness; and psychological work on the role of gist or schema representations in perception and memory. It is proposed that background assumptions can figure in consciousness by being as it were condensed into a consciously, though inattentively, entertained notion of their overall thematic gist, where this thematic gist gives the drift of a possible elucidation of how or why such-and-such salient grounds mean that so-and-so conclusion holds. (shrink)

1. The application of literature to life -- 2. Examples of application -- 3. Application and the act of reading -- 4. Literature and cognitive enrichment -- 5. Transportation and empathy -- 6. Simulation and identification -- 7. The aesthetic approach to literature -- 8. Conceptions of the text -- 9. Literary practice -- 10. The concepts of literature -- 11. Questions of norms and values -- 12. A final look at application.

This paper explores the connection between wonder and meaning, in particular ‘the meaning of life’, a connection that, despite strong intrinsic connections between wonder and the (philosoph...

A brain emulation would be a one‐to‐one simulation where every causal process in the brain is represented, behaving in the same way as the original. Opponents of animal testing often argue that much of it is unnecessary and could be replaced with simulations. Personal identity is going to be a major issue with brain emulations, both because of the transition from an original unproblematic single human identity to successor identity/identities that might or might not be the same, and because software (...) minds can potentially have multiple realizability. The process might produce distressed minds that have rights yet have an existence not worth living, or that lack the capacity to form or express their wishes. Emulations will experience and behave on a timescale set by the speed of their software. Brain emulations would not be self‐contained, and their survival would depend upon hardware over which they might not have any control. (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that (...) promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)