As biobank research has become increasingly widespread within biomedical research, study-specific consent to each study, a model derived from research involving traditional interventions on human subjects, has for the sake of feasibility gradually given way to alternative consent models which do not require consent for every new study. Besides broad consent these models include tiered, dynamic, and meta-consent. However, critics have pointed out that it is normally not known at the time of enrolment in what ways samples deposited in a (...) biobank may be used in future research and that, for a consent to be informed, exactly this kind of knowledge is required. Therefore, there is an ongoing debate about the ethical acceptability of going for less than study-specific consent. In light of this debate we address the question of how to best protect participants against relevant risks and violations of autonomy. We apply the central aims of the informed consent process to the unique circumstances of biobank research where samples and data in many cases are stored for long periods of time and reused in subsequent studies. Thereby we are able to formulate a set of criteria focusing both on the risk of informational harm and the potential violation of participants’ values. We compare existing models of consent based on their ability to satisfy the criteria, and we find that the broad consent model offers the best level of protection for participants, although, it suffers from a few important deficiencies with regards to protection against participant value violations and long-term protection of autonomy, if it is applied without qualifications. For this reason, we propose modifications to the current broad consent model, in order to ensure that it provides protection of autonomy and participant values through strong ethical review and continuous communication. We conclude that a modified form of broad consent is ethically superior in biobank research, not only because it is most feasible but primarily because it offers the best available protection against the hazards facing research subjects in this form of research. (shrink)

In this article we wish to discuss different normative dilemmas that teachers and psychotherapists meet in their work with the student and the patient. We argue that crucial for a good practice is not the actual choice between normativity and freedom, between generalized or authorized standards and individual dialogue. Rather it is the professional’s continuous reflection on the form and quality of the interactions with the pupil and the patient, and the preservation of the balance between personal ethos and professional (...) responsibilities that best safeguard respect for the other's autonomy and self-determination. By illustrating psychotherapeutic malpractice and systematic mistreatment of children in the name of education, we wish to remind the reader that official governmental authorization of the professions pedagogy and psychology / psychotherapy is not automatically a guarantee for high professional standards or for the best possible teaching and psychotherapy. (shrink)

Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

AbstractBackgroundEthical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. In prehospital emergency medicine, decision-making commonly takes place in everyday life, under time pressure, with limited information about a patient and with few possibilities of consultation with colleagues. This paper explores the ethical challenges experienced by prehospital emergency personnel. MethodsThe study was grounded in the tradition of action research related to interventions in health care. Ethical challenges were explored in three focus groups, each attended by (...) emergency medical technicians, paramedics, and prehospital anaesthesiologists. The participants, 15 in total, were recruited through an internal information network of the emergency services. Focus groups were audio-recorded and transcribed verbatim.ResultsThe participants described ethical challenges arising when clinical guidelines, legal requirements, and clinicians’ professional and personal value systems conflicted and complicated decision-making processes. The challenges centred around treatment at the end of life, intoxicated and non-compliant patients, children as patients—and their guardians, and the collaboration with relatives in various capacities. Other challenges concerned guarding the safety of oneself, colleagues and bystanders, prioritising scarce resources, and staying loyal to colleagues with different value systems. Finally, challenges arose when summoned to situations where other professionals had failed to make a decision or take action when attending to patients whose legitimate needs were not met by the appropriate medical or social services, and when working alongside representatives of authorities with different roles, responsibilities and tasks.ConclusionFrom the perspective of the prehospital emergency personnel, ethical challenges arise in three interrelated contexts: when caring for patients, in the prehospital emergency unit, and during external collaboration. Value conflicts may be identified within these contexts as well as across them. A proposed model of analysis integrating the above contexts can assist in shedding light on ethical challenges and value conflicts in other health care settings. The model emphasises that ethical challenges are experienced from a particular professional perspective, in the context of the task at hand, and in a particular, the organisational setting that includes work schedules, medical guidelines, legal requirements, as well as professional and personal value systems. (shrink)

Late eighteenth-century writings on race by Kant and four of his contemporaries.

Current debate and policy surrounding the use of genetic editing in humans often relies on a binary distinction between therapy and human enhancement. In this paper, we argue that this dichotomy fails to take into account perhaps the most significant potential uses of CRISPR-Cas9 gene editing in humans. We argue that genetic treatment of sporadic Alzheimer’s disease, breast- and ovarian-cancer causing BRCA1/2 mutations and the introduction of HIV resistance in humans should be considered within a new category of genetic protection (...) treatments. We find that if this category is not introduced, life-altering research might be unnecessarily limited by current or future policy. Otherwise ad hoc decisions might be made, which introduce a risk of unforeseen moral costs, and might overlook or fail to address some important opportunities. (shrink)

In this paper, we argue that same is fundamentally different from different, in that same imposes a discourse condition on eventualities, while different compares individuals. This difference has not been noted in previous literature. Furthermore, in the literature on same, there has been a persistent puzzle about the contribution of the definite article with which same must co-occur. We show that this puzzle is resolved once the contribution of same is adjusted to apply to eventualities: then the definite article can (...) be interpreted in the usual way, as generating a presupposition about individuals. (shrink)

In 2014, the European Union Agency for Fundamental Rights ranked Denmark as the European Union country with the highest occurrence of male physical violence and sexual assault against women. This report was described as ‘grotesque’, ‘misguided’ and ‘untrustworthy’ in the Danish mainstream media, which cited a number of prominent political commentators and expert researchers who debunked these findings. Using this case of overt public rejection of violent and white masculinity as a central analytical thread, this article explores how the invisiblization (...) of Danish male violence, as well as the projection of sexual aggression onto minority communities, produces a peculiar politics of denial and denialism in Denmark. The authors argue that the nationalist myth of gender equality branded within the Danish mainstream media and society is a variety of gender exceptionalism; which in turn generates racist, reactionary and suppressive ideologies on violence, racial discrimination and social inequality. (shrink)

The analysis is based on some moral experiences taking place during a terrorist attack on the Norwegian Labor Party’s youth camp on the island of Utøya July 22, 2011, where 69 young people were killed and several seriously injured. After the attack many of the survivors told stories of how strangers spontaneous had helped and cared for each other. In the midst of the horror there occurred sudden “moments of goodness” or “points of light” that revealed hope for the persons (...) involved, as well as for the society. The article examines these spontaneous moral practices in light of moral educational theory, as well as discusses the terrorists own way of thinking and acting. The spontaneous practices point toward another basis for a moral approach then a cognitive development tradition. The importance of community is underlined, as well as an interpersonal dimension. In the last section the fostering of moral and ethical thinking and acting is discussed in light of general education and the three functions of education proposed by Biesta. It is suggested that moral education could contribute something to all of the three dimensions but based on the experiences from Utøya, there will be a particular emphasis on the subjectification function of education. (shrink)

Based on a dataset of more than 5,000 contentious collective actions from 1700-2000, this paper examines the relation between popular protest and democratization of the Danish political system. The first wave of protests began in the 1830s and culminated in 1848 with the fall of absolutism and the transition to constitutional monarchy. The next protest wave from 1885 to 1887 arose from the so-called ‘constitutional struggle’ and mobilized hundreds of thousands of ordinary Danes, and contributed to the parliamentarization and nationalization (...) of the political system. The third wave unfolded around the end of World War II, while the hitherto last wave of popular struggle erupted in 1968 with the youth rebellion. The analysis show that ‘democracy’ was the central issue of contention in all four of these protest waves, and support the main thesis that periods of intense interaction between popular protest and the state have had a decisive formative influence on the genesis and further development of Danish democracy. (shrink)

The purpose of this dissertation is to establish an interpretive framework for the study of Kant's Critique of Judgment. The central themes of the text are presented in the first chapter in terms of two different problems. The first is referred to as the prima facie problem. This problem concerns the search for a transcendental principle for the faculty of judgment corresponding to the principles established for understanding and reason in the first two critiques. The second is referred to as (...) the systematic problem. This problem concerns the search for a transcendental principle which can mediate between the domains of understanding and reason and provide for a "unity of transition" between nature and freedom. ;The value of this interpretation is demonstrated in the second chapter through a criticism of Paul Guyer's work on the third critique, Kant and the Claims of Taste . This criticism focuses on Guyer's interpretive method and scholarship. ;The interpretation is developed further in the third and fourth chapters in which specific problems that have not been dealt with adequately in the recent literature in English are addressed. The systematic argument of the two introductions that Kant prepared for the text is presented in the third chapter. Finally, the fourth chapter focuses on the deduction of pure aesthetical judgments and advances an account of this argument that is shown to be preferable to the account of Guyer as well as that developed by Donald Crawford in his study Kant's Aesthetic Theory. (shrink)

The Gnostic World is an outstanding guide to Gnosticism, designed as a collection of critical studies by experts to both widen and deepen study in Gnostic movements and strands of speculation as a discrete "World" of human socio-spiritual life from the distant past until today. An international team of contributors examines these manifestations in a variety of contexts, from the ancient pre-Christian to the contemporary. The volume considers the intersection of Gnosticism with Jewish, Christian, Islamic and Indic practices and beliefs, (...) and also with such new religious movements as Theosophy, Scientology, Western Sufism, and the Nation of Islam. This illustrated handbook will be an invaluable resource for students, scholars, and researchers of Gnostic doctrine and history. (shrink)

Review of Steve J. Heims's "John Von Neumann and Norbert Wiener: From Mathematics to the Technologies of Life and Death".

Review of Peter Caws's "Two Centuries of Philosophy in America".

This article systematically reviews studies investigating the effect of three operationalizations of complexity in emotion experience on situat...

The theoretical and empirical link between leadership and workplace bullying needs further elaboration. The aim of the study is to examine the relationship between quality of leadership and the occurrence of workplace bullying 2 years later. Furthermore, we aim to examine a possible mechanism from leadership to bullying using social community at work as mediator. Using survey data that were collected at two different points in time among 1664 workers from 60 Danish workplaces, we examined the total, direct and indirect (...) effects between quality of leadership and workplace bullying. Our results indicate that quality of leadership plays a role in establishing working conditions that lead to workplace bullying. Furthermore, social community at work fully mediates the effect of poor quality of leadership on workplace bullying. This longitudinal study adds to previous cross-sectional studies on the substantial role played by leaders in the bullying process. Within the leadership–bullying relationship, social community at work acts as a full mediator, adding a significant contribution to the discussion of mechanisms involved in the bullying process. Plausible explanations of this mechanism and practical implications are discussed. (shrink)

Recording and manipulating neuronal ensemble activity is a key requirement in advanced neuromodulatory and behavior studies. Devices capable of both recording and manipulating neuronal activity brain-computer interfaces should ideally operate un-tethered and allow chronic longitudinal manipulations in the freely moving animal. In this study, we designed a new intracortical BCI feasible of telemetric recording and stimulating local gray and white matter of visual neural circuit after irradiation exposure. To increase the translational reliance, we put forward a Göttingen minipig model. The (...) animal was stereotactically irradiated at the level of the visual cortex upon defining the target by a fused cerebral MRI and CT scan. A fully implantable neural telemetry system consisting of a 64 channel intracortical multielectrode array, a telemetry capsule, and an inductive rechargeable battery was then implanted into the visual cortex to record and manipulate local field potentials, and multi-unit activity. We achieved a 3-month stability of the functionality of the un-tethered BCI in terms of telemetric radio-communication, inductive battery charging, and device biocompatibility for 3 months. Finally, we could reliably record the local signature of sub- and suprathreshold neuronal activity in the visual cortex with high bandwidth without complications. The ability to wireless induction charging combined with the entirely implantable design, the rather high recording bandwidth, and the ability to record and stimulate simultaneously put forward a wireless BCI capable of long-term un-tethered real-time communication for causal preclinical circuit-based closed-loop interventions. (shrink)

Negative emotion differentiation has been suggested to be important for adaptive emotion regulation. However, knowledge concerning how ED may impact specific ER strategy choice remains surprisingly sparse. We therefore investigated if person-level negative ED was associated with habitual use of individual ER strategies, how person-level negative ED was associated with daily use of individual ER strategies, and finally how within-person daily fluctuations in negative ED were associated with daily use of individual ER strategies. During a 10-day experience sampling study, 90 (...) healthy participants rated their momentary emotions and their ER efforts in response to those emotions. ER strategies included four putatively adaptive strategies and four putatively maladaptive strategies. Results revealed that negative ED at the person level was neither associated with habitual nor daily ER strategy endorsement when controlling for negative emotions. Likewise, associations between within-individual daily variation in negative ED and daily ER did not remain statistically significant after controlling for negative emotions. The results thus point to no or weak associations between negative ED and ER choice above and beyond negative emotions. Future experimental studies addressing ED at the momentary level and teasing out the ED–ER causal timeline are needed to further evaluate ED–ER associations. Findings from such research may represent an important step toward refining psychotherapeutic interventions aimed at improving emotional problems. (shrink)

The "morning morality effect"-the alleged phenomenon that people are more likely to act in unethical ways in the afternoon when they are tired and have less self-control than in the morning-may well be expected to influence prehospital anaesthesiologist manning mobile emergency care units (MECUs). The working conditions of these units routinely entail fatigue, hunger, sleep deprivation and other physical or emotional conditions that might make prehospital units predisposed to exhibit the "morning morality effect". We investigated whether this is in fact (...) the case by looking at the distribution of patient transports to hospital with and without physician escort late at night at the end of the shift as a surrogate marker for changing thresholds in ethical behaviour. All missions over a period of 11 years in the MECU in Odense were reviewed. Physician-escorted transports to hospital were compared with non-physician-escorted transports during daytime, evening, and night-time (which correlates with time on the 24 h shifts). In total, 26,883 patients were transported to hospital following treatment by the MECU. Of these, 27.4% (26.9%-27.9%) were escorted to the hospital. The ratio of patient transports to hospital with and without physician escort during the three periods of the day did not differ (p = 1.00). We found no evidence of changes in admission patterns over the day. Thus, no evidence of the expected "morning morality effect" could be found in a prehospital physician-manned emergency care unit. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

In this article, 41 models of covariation detection from 2 × 2 contingency tables were evaluated against past data in the literature and against data from new experiments. A new model was also included based on a limiting case of the normative phi‐coefficient under an extreme rarity assumption, which has been shown to be an important factor in covariation detection (McKenzie & Mikkelsen, 2007) and data selection (Hattori, 2002; Oaksford & Chater, 1994, 2003). The results were supportive of the (...) new model. To investigate its explanatory adequacy, a rational analysis using two computer simulations was conducted. These simulations revealed the environmental conditions and the memory restrictions under which the new model best approximates the normative model of covariation detection in these tasks. They thus demonstrated the adaptive rationality of the new model. (shrink)

There is a famous and important dictum reminiscent of the medieval age posited by Carl Jung in Alchemical Studies, the thirteenth volume of his collected works: in sterquiliniis invenitur—in filth it shall be found (35). Translated for modern society this might be better understood as “that which is most valuable will be found in the place you least want to look.” If there is one source in the corpus of popular culture that best typifies “the last place we would want (...) to look” for masculine values, it would be Mads Mikkelsen’s portrayal of Hannibal Lector, particularly Lector’s relationship with FBI profiler Will Graham during the first two seasons of the HBO series Hannibal. By stripping away the perverse horror of Lector’s actions toward Graham, and treating their relationship as an absolute value, I systematically explore the series’ portrayal of masculine nurturing in a way that reveals potentially praiseworthy facets relevant to modern masculinity. (shrink)