Reviews work on moral judgment motivational internalism from the last two decades.

Motivational internalism postulates a necessary connection between moral judgments and motivation. In arguing for and against internalism, metaethicists traditionally appeal to intuitions about cases, but crucial cases often yield conflicting intuitions. One way to try to make progress, possibly uncovering theoretical bias and revealing whether people have conceptions of moral judgments required for noncognitivist accounts of moral disagreement, is to investigate non-philosophers' willingness to attribute moral judgments. A pioneering study by Shaun Nichols seemed to undermine internalism, as a large majority (...) of subjects were willing to attribute moral understanding to an agent lacking moral motivation. However, our attempts to replicate this study yielded quite different results, and we identified a number of problems with Nichols' experimental paradigm. The results from a series of surveys designed to rule out these problems show that people are more willing to attribute moral understanding than mor.. (shrink)

In some cases of disagreement it seems that neither party is at fault or making a mistake. This phenomenon, so-called faultless disagreement, has recently been invoked as a key motivation for relativist treatments of domains prone to such disagreements. The conceivability of faultless disagreement therefore appears incompatible with traditional realists semantics. This paper examines recent attempts to accommodate faultless disagreement without giving up on realism. We argue that the accommodation is unsatisfactory. However, the examination highlights that “faultless” is multiply ambiguous. (...) The more overarching purpose is to examine the consequences of this—more generally, how to think about faultless disagreement. (shrink)

ABSTRACTIt has been objected to moral non-cognitivism that it cannot account for fundamental moral uncertainty. A person is derivatively uncertain about whether an act is, say, morally wrong, when her certainty is at bottom due to uncertainty about whether the act has certain non-moral, descriptive, properties, which she takes to be wrong-making. She is fundamentally morally uncertain when her uncertainty directly concerns whether the properties of the act are wrong-making. In this paper we advance a new reply to the objection (...) to non-cognitivism, immune to the problems afflicting earlier replies. First, we argue that fundamental moral uncertainty is best understood as classificatory uncertainty, since the psychological factors behind fundamental moral uncertainty are analogous to the factors behind fundamental uncertainty regarding descriptive, non-moral, matters, and fundamental descriptive uncertainty is naturally understood as classificatory uncertainty. We call this the classification account... (shrink)

What is it for a speech act to be sincere? The most common answer amongst philosophers is that a speech act is sincere if and only if the speaker is in the state of mind that the speech act functions to express. However, a number of philosophers have advanced counterexamples purporting to demonstrate that having the expressed state of mind is neither necessary nor sufficient for speaking sincerely. One may nevertheless doubt whether these considerations refute the orthodox conception. Instead, it (...) may be argued, they expose other ways of elucidating sincerity in speech. “Sincerity in speech” is ambivalent between a number of different conceptions. Against this background this paper presents two alternative conceptions, viz., Sincerity as Spontaneity and Sincerity as Presenting Oneself as one takes Oneself to be and develops a third conception which we may call Sincerity as a Communicative Virtue. This conception emphasizes the speaker’s intention in communicating her attitudes and the need to be properly justified in saying what one does. (shrink)

It has recently become popular to apply expressivism outside the moral domain, e.g., to truth and epistemic justification. This paper examines the prospects of generalizing expressivism to taste. This application has much initial plausibility. Many of the standard arguments used in favor of moral expressivism seem to apply to taste. For example, it seems conceivable that you and I disagree about whether chocolate is delicious although we don’t disagree about the facts, which suggests that taste judgments are noncognitive attitudes rather (...) than beliefs. However, there is also a striking difference between moral disagreements and disagreements about taste. Faced with a moral disagreement, we intuit that either party is at fault. Disagreements about taste, by contrast, are occurrences where neither party intuitively is at fault. This leads to a dilemma. On the one hand, if a disagreement in attitude is not intuited as faultless, then it seems implausible if applied to taste. If, on the other hand, a disagreement in attitude is a disagreement that we intuit as faultless, then it seems implausible if applied to the moral domain. The aim of this paper is to examine how an expressivist can avoid this dilemma. (shrink)

The Frege‐Geach problem is probably the most serious worry for the prospects of any kind of metaethical expressivism. In a recent article, Ridge suggests that a new version of expressivism, a view he calls ecumenical expressivism, can avoid the Frege‐Geach problem.1 In contrast to pure expressivism, ecumenical expressivism is the view that moral utterances function to express not only desire‐like states of mind but also beliefs with propositional content. Whereas pure expressivists’ solutions to the Frege‐Geach problem usually have rested on (...) some kind of “logic of attitudes,” Ridge argues that it is the expressed belief in the ecumenical machinery that holds the key. Although Ridge’s ecumenical expressivism is promising, this essay argues that his solution is flawed. However, this does not mean that every form of ecumenical expressivism is a failure. Ridge briefly contrasts his view with the kind of view Hare advanced but argues that Hare cannot make use of the ecumenical machinery.2 I argue that this is incorrect. Not only is an ecumenical reading of Hare very plausible and something that establishes him as an important forerunner of today’s ecumenical trend in metaethics, but, more important, it offers guidance where Ridge goes wrong. It solves the Frege‐Geach problem in a way that meets the criticism of more standard solutions head‐on, and it seems to be able to handle the most pressing problems for ecumenical theories. The ecumenical theory that emerges is therefore powerful enough to establish itself as one of the most (if not the most) plausible form of ecumenism on the market. The first part of this article is largely concerned with advancing an ecumenical reading of Hare’s The Language of Morals and the kind of solution it offers in response to the Frege‐Geach problem. Some of the problems such a reading encounters will be addressed as we outline the theory. The most serious worries, however, are addressed in the final part of the essay. (shrink)

According to expressivism, moral judgments are desire-like states of mind. It is often argued that this view is made implausible because it isn’t consistent with the conceivability of amoralists, i.e., agents who make moral judgments yet lack motivation. In response, expressivists can invoke the distinction between dispositional and occurrent desires. Strandberg (Am Philos Quart 49:81–91, 2012) has recently argued that this distinction does not save expressivism. Indeed, it can be used to argue that expressivism is false. In this paper I (...) argue that expressivism is a much more complex thesis than Strandberg assumes. Once these complexities are acknowledged, Strandberg’s arguments are rendered ineffective and expressivism rendered more plausible. (shrink)

It is part of our everyday experience that there is a reliable connection between moral opinions and motivation. Thinking that an act is right (wrong) tends to be accompanied by motivation to (avoid to) perform the act in question. This is mirrored in moral talk. We tend to think that someone who says that he thinks that it is right (wrong) to act in a certain way without being motivated, to some extent, will most likely be speaking insincerely. Moveover, moral (...) utterances have a dynamic function to exhort and guide conduct. This suggests that moral utterances involve a kind of attitudinal expressiveness that makes them very different from prosaically factual utterances. These commonsensical features of our moral practice represent the practicality of moral thought and talk. The main purpose of this essay is to investigate how the practicality of moral thought and talk is best represented and whether it supports either a cognitivist or noncognitivist analysis of moral judgments. I argue that sophisticated versions of internalism and externalism, the main competing explanations of the connection between moral judgments and motivation, represent the reliable connection equally good and that the relevant kind of attitudinal expression can be accomodated by both cognitivists and noncognitivists. The upshot is that considerations based on the practicality of moral thought and talk does not cut much philosophical ice. Hence, the rivalry between cognitivists and noncognitivists analyses must be settled beyond considerations based on practicality. Maybe the belief-like features of moral thought and talk can tilt things in favor of cognitivism. However, noncognitivists have different ways of accommodating the belief-like features. In fact, in the wake of different accommodation projects one wonders what remains of the traditional debate between cognitivist and noncognitivist analyses, a debate that shaped metaethics as we know it. (shrink)

Hybrid expressivists depart from pure expressivists by claiming that moral sentences express beliefs and desires. Daniel Boisvert and Michael Ridge, two prominent defenders of hybrid views, also depart from pure expressivists by claiming that moral sentences express general attitudes rather than an attitude towards the subject of the sentence. This article argues that even if the shift to general attitudes helps solve some of the traditional problems associated with pure expressivism, a view like Ridge's, according to which the descriptive meaning (...) is speaker relative, turns out to have problems explaining moral disagreement. (shrink)

This paper examines some aspects of Mitchell Green’s account of self-expression. I argue that Green fails to address the distinction between success and evidential notions of expression properly, which prevents him from adequately discussing the relation between these notions. I then consider Green’s explanation of how a speech act shows what is within, i.e., because of the liabilities one incurs and argue that this is false. Rather, the norms governing speech acts and liabilities incurred give us reason to think that (...) the speaker is in a particular state of mind. It thus supports an evidential rather than success notion. Finally, I suggest that it is because of the sincerity of what is said, rather than the liabilities incurred, that you show what is within. (shrink)

Richard Rowland has recently argued that considerations based on moral disagreement between epistemic peers give us reason to think that cognitivism about moral judgments, i.e., the thesis that moral judgments are beliefs, is false. The novelty of Rowland’s argument is to tweak the problem descriptively, i.e., not focusing on what one ought to do, but on what disputants actually do in the light of peer disagreement. The basic idea is that moral peer disagreement is intelligible. However, if moral judgments were (...) beliefs, and beliefs track perceived evidence, then moral peer disagreement would not be intelligible. Hence, moral judgments are not beliefs. The argument is both novel and interesting, but this paper argues that it fails to establish the conclusion. Beliefs are plausibly analyzed as constituted by dispositions to respond to what is perceived as evidence, but dispositions can always be interfered with. Provided a background explanation of why the disposition is not manifested, peer intransigence is quite intelligible. (shrink)

Several philosophers have recently challenged cognitivism, i.e., the view that moral judgments are beliefs, by arguing that moral judgments are evidence non-responsive in a way that beliefs are not. If you believe that P, but acquire (sufficiently strong) evidence against P, you will give up your belief that P. This does not seem true for moral judgments. Some subjects maintain their moral judgments despite believing that there is (sufficiently strong) evidence against the moral judgments. This suggests that there is a (...) mismatch between moral judgments and beliefs. This is an interesting argument. In particular, it forces the cognitivist to be more explicit about the nature of belief and the sense in which moral judgments are responsive to evidence. This paper has two aims. First, it aims to systematically examine different versions of the argument from evidence non-responsiveness. Second, it aims to outline a more nuanced understanding of the sense in which beliefs are evidence responsive that explains why the extant versions of the argument do not constitute a challenge to cognitivism. (shrink)

What makes two sentences inconsistent? Expressivists understand the meaning of a sentence in terms of the mental state it expresses. In order to explain the inconsistency between two sentences, the expressivist must appeal to some inconsistency feature of the mental states expressed. A simple explanation is that two sentences, e.g., “murder is wrong” and “murder is not wrong” are inconsistent by virtue of expressing mental states that disagree. Schroeder argues that the expressivist lacks a plausible explanation of the disagreement. Baker (...) & Woods argue that Schroeder is wrong. With these authors, I agree that expressivists have an explanation of disagreement, but this does not adequately explain why two sentences are inconsistent. The reason is that two intuitively inconsistent sentences do not necessarily express mental states that disagree. Moreover, assuming that the expressivist gives a structurally identical explanation for moral and non-moral language, the problem generalizes to non-moral language. It is also argued that the problem extends to thought. How expressivists can and should conceive of inconsistency thus remains a challenge. (shrink)

A well-known challenge for contextualists is to account for disagreement. Focusing on moral contextualism, this paper examines recent attempts to address this challenge by using the standard expressivist explanation, i.e., explaining disagreement in terms of disagreement in attitude rather than disagreement in belief. Assuming that the moral disagreements can be explained in terms of disagreement in attitude, this may seem as a simple solution for contextualists. However, it turns out to be easier said than done. This paper examines a number (...) of different ways in which disagreement in attitude can be incorporated into a contextualist framework and argues that each suggestion is problematic. In particular, the purported explanations of disagreement fail to adequately explain intuitive occurrences of disagreement, the robustness of disagreement intuitions and/or locate the disagreement in the intuitively right place. (shrink)

Motivational internalism—the idea that moral judgments are intrinsically or necessarily connected to motivation—has played a central role in metaethical debates. In conjunction with a Humean picture of motivation, internalism has provided a challenge for theories that take moral judgments to concern objective aspects of reality, and versions of internalism have been seen as having implications for moral absolutism, realism, and rationalism. But internalism is a controversial thesis, and the apparent possibility of amoralists and the rejection of strong forms of internalism (...) have also been seen as a problem for non-cognitivists. The last decades have seen a number of developments of internalist positions and arguments for and against internalism. This chapter provides a structured overview of the more important themes, including the development of new forms of conditional internalism, deferred internalism, and non-constitutional internalism, as well as the emergence of empirically-based arguments and new forms of a posteriori internalism. (shrink)

Motivational internalism—the idea that there is an intrinsic or necessary connection between moral judgment and moral motivation—is a central thesis in a number of metaethical debates. In conjunction with a Humean picture of motivation, it provides a challenge for cognitivist theories that take moral judgments to concern objective aspects of reality. Versions of internalism have potential implications for moral absolutism, realism, non-naturalism, and rationalism. Being a constraint on more detailed conceptoins of moral motivation and moral judgment, it is also directly (...) relevant to wider issues in moral psychology. But internalism is a controversial thesis, and the apparent possibility of amoralists and the rejection of strong forms of internalism have also been seen as problems for non-cognitivists. -/- This volume’s thirteen new essays and introduction are meant to help readers appreciate state-of-the-art of research on internalism, to identify connections between various aspects of the debate, and to deepen discussion of a number of central aspects of metaethics. The introductory chapter provides a structured overview of the debate with a focus on the last two decades, while the book’s three main sections focus on what evidence there is for or against various versions of internalism, the relevance of versions of internalism for wider metaethical issues, and different ways of accommodating both internalist and externalist aspects of moral practice, respectively. (shrink)

Our starting point in this article is the debate between John Harris and Iain Brassington on whether or not there is a duty to take part in scientific research. We consider the arguments that have been put forward based on fairness and a duty to rescue, and suggest an alternative justification grounded in a hypothetical agreement: that is, because effective healthcare cannot be taken for granted, but requires continuous medical research, and nobody knows what kind of healthcare they will (...) need, participating in research should be viewed from the perspective of a social contract, based on our mutual need for medical advances. (shrink)

Accommodating degrees of moral certitude is a serious problem for non-cognitivism about ethics. In particular, non-cognitivism has trouble accommodating fundamental moral certitude. John Eriksson and Ragnar Francén Olinder [2016] have recently proposed a solution. In fact, Eriksson and Francén Olinder offer two different proposals—one ‘classification’ account and one ‘projectivist’ account. We argue that the classification account faces the same problem as previous accounts do, while the projectivist account has unacceptable implications. Non-cognitivists will have to look elsewhere for (...) a plausible solution to the problem of accommodating fundamental moral certitude. (shrink)

The esteemed psychologist and thinker John Dewey headed for previously unexplored philosophical territory with this influential work. Written shortly after World War I, it embodies Dewey's system of pragmatic humanism and maintains that individuals can attain "a more ordered and intelligent happiness" by reconsidering the ultimate effects of their deepest beliefs and feelings. With its promise of achieving an understanding of the past and attaining a brighter future, Reconstruction in Philosophy remains ever relevant. "A modern classic." — Philosophy and (...) Phenomenological Research. (shrink)

Norms are a pervasive yet mysterious feature of social life. In Explaining Norms, four philosophers and social scientists team up to grapple with some of the many mysteries, offering a comprehensive account of norms: what they are; how and why they emerge, persist and change; and how they work.

With precision and profundity born of 30 years of devoted study, John Boyle offers an essential introduction to St. Thomas Aquinas on Scripture, shedding helpful light on the goals, methods, and commitments that animate the Angelic Doctor's engagement with the sacred page. Because the genius of St. Thomas's approach to the Bible lies not so much in its novelty but rather in the fidelity and clarity with which he recapitulates the riches of the preceding interpretive Tradition, this initiation into (...) St. Thomas's vision of Scripture is itself an orientation to the Church's vision of Scripture, from the Fathers through and beyond the Middle Ages. St. Thomas's embeddedness within the Church's Tradition and his own historical context is integral to his approach to Scripture, yet it sets him at some distance from modern readers, for whom his interpretive vision may seem perplexing or even impenetrable. In this Primer, Boyle first provides an acclimation to this medieval context through a survey and explanation of pertinent technical terminology used by St. Thomas and characteristic of the scholastic theology of the time. With an eye to the medieval practice of considering Scripture according to the fourfold division of causes, Boyle builds on this initial foundation by exploring in turn St. Thomas's accounts of the end or use of Scripture (final cause), its divine and human authorship (efficient cause), its order and division (material cause), and its literary styles or genres (formal cause). Drawing on writings from across St. Thomas's corpus, but especially his work On the Commendation and Division of Sacred Scripture and the prologues to his biblical commentaries, Boyle masterfully elucidates both the hermeneutical principles and deep wisdom of the Angelic Doctor's approach to Scripture, imparting invaluable guidance not only for reading and understanding St. Thomas and other great masters of the Tradition, but also-and ultimately-for understanding Scripture in light of this Tradition and reading it with greater benefit and joy. (shrink)

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications (...) of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

Despite recurring efforts, a gap exists across a variety of contexts between the protection of patients' safety in theory and in practice. This timely Research Handbook highlights these critical issues and suggests both legal and policy changes are necessary to better protect patients' safety. Multidisciplinary in nature, this Research Handbook features contributions from eminent academics, policy makers and medical practitioners from the Global North and South, discussing the essential facets concerning patient safety and the law. It highlights how the role (...) of legislation and case law has the potential to influence, both positively and negatively, medical practice and the quality of care. Chapters explore patient safety and the global health agenda; physiotherapy; 'non-therapeutic' clinical research with children; patient safety awareness in healthcare education; and the increasing use of robotics and artificial intelligence in healthcare. Outlining a wide range of international perspectives on patient safety and the law, this Research Handbook will appeal to academics and researchers specialising in health and medical law, human rights and healthcare regulation. It will also serve as a valuable resource for legal and medical practitioners alike, as well as clinicians and professionals working in healthcare governance. (shrink)

abstract ‘Time is money’, Benjamin Franklin's ‘Poor Richard’ tells us. But instead of converting time expenditures into monetary equivalents, it makes more sense in many cases to convert money into temporal equivalents. The difficulty in putting a monetary value on time in unpaid household labour, when adjusting the National Accounts, points to the problems of the first approach. The advantages of the latter approach are illustrated by the Swedish system of specifying criminal fines in terms of the number of days (...) the offender would have to work to pay them off. (shrink)

The notion of proof is central to mathematics yet it is one of the most difficult aspects of the subject to teach and master. In particular, undergraduate mathematics students often experience difficulties in understanding and constructing proofs. Understanding Mathematical Proof describes the nature of mathematical proof, explores the various techniques that mathematicians adopt to prove their results, and offers advice and strategies for constructing proofs. It will improve students’ ability to understand proofs and construct correct proofs of their own. The (...) first chapter of the text introduces the kind of reasoning that mathematicians use when writing their proofs and gives some example proofs to set the scene. The book then describes basic logic to enable an understanding of the structure of both individual mathematical statements and whole mathematical proofs. It also explains the notions of sets and functions and dissects several proofs with a view to exposing some of the underlying features common to most mathematical proofs. The remainder of the book delves further into different types of proof, including direct proof, proof using contrapositive, proof by contradiction, and mathematical induction. The authors also discuss existence and uniqueness proofs and the role of counter examples. (shrink)

People taking part in research vary in the extent to which they understand information concerning their participation. Since they may choose to limit the time and effort spent on such information, lack of understanding is not necessarily an ethical problem. Researchers who notice a lack of understanding are in the quandary of not knowing whether this is due to flaws in the information process or to participants’ deliberate choices. We argue that the two explanations call for different responses.A tool for (...) identifying those research participants who want limited information is presented. This consists of a restricted number of questions about trust in and appraisal of research, priority of time and privacy, and perception of a duty to participate. It is argued that an important group of participants who purposely lack understanding of the study can be identified with this tool. Some limitations to this approach are also discussed. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

Voices on the political right have long claimed that the welfare state ought to be kept small, and that charities can take over many of the tasks involved in helping those at the bottom of society. The arguments in favor of this claim are controversial, but even if they are accepted at face value the policy proposal remains problematic. For the proposal presupposes that charities would, in fact, be able to raise enough money to provide adequate help to those in (...) need, and therefore assumes that charities are able to very significantly increase the number and/or size of donations they receive. We argue that there are good reasons for doubting that charities will be able to do this. Our argument turns on the fact that the most powerful strategy for eliciting donations—namely, allowing donors to use their donation to signal their pro-sociality—has an inbuilt upper limit. If too much emphasis is placed on the signaling opportunities donating to charity provides, donating no longer functions as an effective signal and the motivation to donate declines. (shrink)

Over the past few decades, a body of research has developed examining the academic dishonesty of university and college students. While research has explored academic dishonesty amongst American criminal justice and policing students, no research has specifically focused on investigating the dynamics and correlates of academic dishonesty amongst Australian criminology students. This study drew upon data obtained from a survey of 79 undergraduate criminal justice and policing students studying at an Australian university. Overall, the results suggest that male gender, viewing (...) academic dishonesty as less serious and holding justifications for engaging in this type of behaviour were significant predictors of self-reported academic dishonesty. The findings suggest that more proactive strategies need to be implemented by universities to prevent student involvement in academic dishonesty. (shrink)

Distribution of responsibility is one of the main focus areas in discussions about climate change ethics. Most of these discussions deal with the distribution of responsibility for climate change mitigation at the international level. The aim of this paper is to investigate if and how these principles can be used to inform the search for a fair distribution of responsibility for climate change adaptation on the local level. We found that the most influential distribution principles on the international level were (...) in turn built on one or more of seven basic principles: (P1) equal shares, (P2) desert, (P3) beneficiary pays, (P4) ability, (P5) self-help, (P6) limited responsibility for the worst off, and (P7) status quo preservation. It was found that all the basic principles, but P1, P3, and P7, are to some extent translatable to local climate adaptation. Two major problems hamper their usefulness on the local level: (1) several categories of agents need to take on responsibility; and (2) emissions do not work as a base for all principles. P4, P5, and P6 are applicable to local adaptation without changes. P4 is of particular importance as it seems to solve the first problem. P2 is applicable only if the second problem is solved, which can be achieved by using risk of harm instead of emissions as the basis for desert. (shrink)

The purpose of this study was to explore the views and experiences of adult cancer patients about patient participation in care and decision making and the preconditions for this participation. The data were collected by means of focused interviews; in addition the patients completed depression and problem-solving instruments. The sample comprised 34 cancer patients from the haematological and oncological wards of one university hospital in Finland. The results revealed considerable variation in the patients’ views on their participation in care and (...) decision making. Some of the patients understood participation either in terms of contributing to the decision making or in terms of expressing their views on treatment options. Some considered that their participation in care was impossible. Patient participation in care and decision making was promoted by good health, access to information, assertiveness, good interactive relationships with nurses and physicians, and encouragement by nurses and physicians to participate. Factors restricting such patient participation were poor health, ignorance, anxiety, age, time pressures of staff, lack of time, high staff turnover and poor interactive relationships. With regard to participation in medical decision making, the patients were divided into three groups: active participants, patients giving active consent, and patients giving passive consent to medical decisions. (shrink)

Theories of discourse bring to realism new ideas about how knowledge develops and how representations of reality are influenced. We gain an understanding of the conceptual aspect of social life and the processes by which meaning is produced. This collection reflects the growing interest realist critics have shown towards forms of discourse theory and deconstruction. The diverse range of contributions address such issues as the work of Derrida and deconstruction, discourse theory, Eurocentrism and poststructuralism. What unites all of the contributions (...) is a sense that it is essential to provide a realist alternative to the hitherto dominance of social constructionism, hermeneutics and postmodernism, over many of the issues discussed. By developing a realist perspective the different authors attempt to embed discourse within the structured nature of the reality of the world. Realism can situate language, discourse and ideology within context specific, or 'causally efficacious' circumstances. Realism can help to uncover issues of power, representation, and subjectivity and how discursive and other social practices produce real effects. This can help us understand the manner in which social structures are reproduced through various forms of ideology and discourse. And by knowing this, we can start to address questions concerning human emancipation and how the world is to be transformed. (shrink)

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

Probabilism is committed to two theses: 1) Opinion comes in degrees—call them degrees of belief, or credences. 2) The degrees of belief of a rational agent obey the probability calculus. Correspondingly, a natural way to argue for probabilism is: i) to give an account of what degrees of belief are, and then ii) to show that those things should be probabilities, on pain of irrationality. Most of the action in the literature concerns stage ii). Assuming that stage i) has been (...) adequately discharged, various authors move on to stage ii) with varied and ingenious arguments. But an unsatisfactory response at stage i) clearly undermines any gains that might be accrued at stage ii) as far as probabilism is concerned: if those things are not degrees of belief, then it is irrelevant to probabilism whether they should be probabilities or not. In this paper we scrutinize the state of play regarding stage i). We critically examine several of the leading accounts of degrees of belief: reducing them to corresponding betting behavior (de Finetti); measuring them by that behavior (Jeffrey); and analyzing them in terms of preferences and their role in decision-making more generally (Ramsey, Lewis, Maher). We argue that the accounts fail, and so they are unfit to subserve arguments for probabilism. We conclude more positively: ‘degree of belief’ should be taken as a primitive concept that forms the basis of our best theory of rational belief and decision: probabilism. (shrink)

What is the relation between norms (in the sense of ?socially accepted rules?) and conventions? A number of philosophers have suggested that there is some kind of conceptual or constitutive relation between them. Some hold that conventions are or entail special kinds of norms (the ?conventions-as-norms thesis?). Others hold that at least some norms are or entail special kinds of conventions (the ?norms-as-conventions thesis?). We argue that both theses are false. Norms and conventions are crucially different conceptually and functionally in (...) ways that make it the case that it is a serious mistake to try to assimilate them. They are crucially different conceptually in that whereas conventions are not normative and are behaviour dependent and desire dependent, norms are normative, behaviour independent, and desire independent. They are crucially different functionally in that whereas conventions principally serve the function of facilitating coordination, norms principally serve the function of making us accountable to one another. (shrink)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of (...) Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

The aim of this study was to explore the ethical foundations for a caring conversation. The analysis is based on the ethics of Paul Ricoeur and deals with questions such as what kind of person the nurse ought to be and how she or he engages in caring conversations with suffering others. According to Ricoeur, ethics (the aim of an accomplished life) has primacy over morality (the articulation of aims in norms). At the ethical level, self-esteem and autonomy were shown (...) to be essential for a person (nurse) to act with respect and responsibility. The ethical relationship of a caring conversation was found to be asymmetrical, because of the passivity inflicted by suffering. This asymmetry was found to be potentially unethical if not balanced with reciprocity. In the ethical context, the caring conversation is one in which the nurse makes room through the ethos of caritas for a suffering person to regain his or her self-esteem, and thus makes a good life possible. (shrink)