Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

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

Drawing on both anthropology and philosophy, this paper argues that the profiled form of the human hand is a universally recognizable image; one whose significance transcends temporally and geographically defined cultural divisions, and represents the earliest known artistic symbol of the human form. The unique co-occurrence of five properties in the image of the human hand and the way it is recognized support this argument, including that it is: (1) unmistakably a hand, (2) unmistakably human, (3) a universal point of (...) interface, (4) a universal referent of scale, and (5) an easy way of making a complex shape. This underappreciated aspect of hand art makes these images among the most important forms of early artistic expression encountered in the prehistoric record. (shrink)

This essay discusses three recent books which each offer an integrative account of religious ethics and the environment. Religious environmental ethics is an area of inquiry within the larger field of religion and ecology. After a narrative that contextualizes the development of religious environmental ethics in relation to the environmental social movement, I describe the formation of the field including its focus on worldview, the “cosmological turn,” and its engagement with science, the “cosmic turn.” Elizabeth Johnson exemplifies the cosmic turn (...) by developing a Christian theology of life in nature which explicitly accepts Darwin's theory of evolution. Willis Jenkins advocates a prophetic pragmatism and critiques a focus on worldview that is abstracted from practice and defers moral responsibility. Larry Rasmussen joins analysis of worldview with reflection on cross-cultural resources for “anticipatory communities” of moral formation to catalyze change. I argue with Rasmussen that religious environmental ethics needs multiple approaches and should allow room for methodological pluralism. (shrink)

This paper offers a constructive account of Sri Chinmoy’s philosophy of Nature and the environment, in the context of the modern stream of Vedāntic thought that also includes Sri Ramakrishna, Swami Vivekānanda and Sri Aurobindo. Sri Chinmoy affirms the ontological continuity of the Absolute and the manifested world, or “God the Creator” and “God the creation.” Nature is the universal and manifested aspect of God and the beauty of Nature is a revelation of the Divine. The paper explores Sri Chinmoy’s (...) vision in relation to the views of Śaṅkara and Rāmānuja, focusing on an understanding of non-duality that does not devalue the world, and notes that Rāmānuja’s concept of the world as God’s “Body” is an image Sri Chinmoy also uses. The world is not an “illusion” but must be accepted and loved. Human destruction of the environment stems from ignorance of our oneness with the totality of existence and the resulting greed and desire for power. An ethics that embraces the intrinsic value of Nature and all beings requires that they must be loved and cared for, and celebrates the created world as the divine Līlā. (shrink)

If you want to understand McDowell's spatial metaphors when he talks about perceptual knowledge, place him side-by-side with Dretske on perceptual knowledge. Though McDowell shows no evidence of reading Dretske's writings on knowledge from the late 1960s onwards (McDowell mentions "Epistemic Operators" once in passing), McDowell gives the same four arguments as Dretske for the conclusion that knowledge requires "conclusive" reasons that rule of the possibility of mistake. Despite various differences, we think it is best to read McDowell as re-discovering (...) Dretske on perceptual knowledge. Since Dretske is easy to understand, all of McDowell's metaphors become easy to understand. But what about McDowell's disjunctivism? Turns out McDowell is not an ontological disjunctivist, and his epistemological disjunctivism is really just the banal point that some perceptual experiences provide conclusive reasons for perceptual belief and some do not. Perceptual experiences are either conclusive or inconclusive. Dretske would agree. (shrink)

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...) variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (shrink)

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

Our main aim in this paper is to contribute towards a better understanding of the epistemology of absence-based inferences. Many absence-based inferences are classified as fallacies. There are exceptions, however. We investigate what features make absence-based inferences epistemically good or reliable. In Section 2 we present Sanford Goldberg’s account of the reliability of absence-based inference, introducing the central notion of epistemic coverage. In Section 3 we approach the idea of epistemic coverage through a comparison of alethic and evidential principles. The (...) Equivalence Schema–a well-known alethic principle–says that it is true that $p$ if and only if $p$ . We take epistemic coverage to underwrite a suitably qualified evidential analogue of the Equivalence Schema: for a high proportion of values of $p$ , subject $S$ has evidence that $p$ due to her reliance on source $S^{*}$ if and only if $p$ . We show how this evidential version of the Equivalence Schema suffices for the reliability of certain absence-based inferences. Section 4 is dedicated to exploring consequences of the Evidential Equivalence Schema. The slogan ‘absence of evidence is evidence of absence’ has received a lot of bad press. More elaborately, what has received a lot of bad press is something like the following idea: absence of evidence sufficiently good to justify belief in $p$ is evidence sufficiently good to justify belief in $\sim p$ . A striking consequence of the Evidential Equivalence Schema is that absence of evidence sufficiently good to justify belief in p is evidence sufficiently good to justify belief in $\sim p$ . We establish this claim in Section 4 and show how this supports the reliability of an additional type of absence-based inference. Section 4 immediately raises the following question: how can we make philosophically good sense of the idea that absence of evidence is evidence of absence? We address this question in Section 5. Section 6 contains some summary remarks. (shrink)

According to moderate truth pluralism, there is a single property that qualifies as truth for any domain whatsoever. However, propositions concerning different domains may possess this single truth property in virtue of different properties. Empirical propositions may be true in virtue of corresponding to reality while legal propositions may be true in virtue of cohering with the body of law. Moderate pluralists claim that truth is a completely general doxastic norm: for any p, the belief that p is correct if (...) and only if p is true—regardless of what domain p pertains to. Moderate pluralists additionally claim that domain-specific properties are local doxastic norms which serve as standards of correctness within their respective domains, and that they do so because they are ways of being true and truth is a general, doxastic norm. This paper offers a grounding-theoretic account of the metaphysics of moderate pluralism and uses it as platform for developing a criticism of the moderate pluralist’s account of doxastic normativity. Two strategies are explored as potential responses to the criticism, but are ultimately dismissed. (shrink)

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

Social bots are computer programs that act like human users on social media platforms. Social bot detection is a rapidly growing field dominated by machine learning approaches. In this paper, we propose a complementary method to machine learning by exploring bot detection as a model checking problem. We introduce Temporal Network Logic (TNL) which we use to specify social networks where agents can post and follow each other. Using this logic, we formalize different types of social bot behavior with formulas (...) that are satisfied in a model of a network with bots. We also consider an extension of the logic where we explore the expressive power of including elements from hybrid logic in our framework. We give model checking algorithms for TNL and its hybrid extension, and show that the complexity of the former is in p and the latter in pspace. (shrink)

Animals are at work everywhere in education, yet existing nowhere: Education doesn’t know them beyond their instrumental use value; as animals-for-us (Pedersen, 2019a, p. 7; Wallin, 2014, p. 149; c...

Accession Number: ATLA0001713191; Hosting Book Page Citation: p 836-849.; Language(s): English; General Note: Bibliography: p 849.; Issued by ATLA: 20130825; Publication Type: Essay.

Les décennies qui vont de la Première Guerre mondiale jusqu'à la fin de la Seconde Guerre ont été marquées par le développement de l'État-providence en Grande-Bretagne et en France, mais ces deux États-providence étaient fort différents. D'après Pedersen, en France, le principe de base était que les familles, et non les individus, possédaient des droits sociaux ; on définissait la justice distributive en termes d'égalisation des revenus entre familles, plutôt qu'entre les classes sociales.

What is philosophy of mathematics and what is it about? The most popular answer, I suppose, to this question would be that philosophers should provide a justification for our presently most cherished mathematical theories and for the most important tool to develop such theories, namely logico-mathematical proof. In fact, it does cover a large part of the activity of philosophers that think about mathematics. Discussions about the merits and faults of classical logic versus one or other ‘deviant’ logics as the (...) logical basis for mathematical theories, ranging from intuitionist over modal logic to paraconsistent logic, typically belong to this area, as do debates about the natural-number concept, its ‘nature’, its properties, especially its uniqueness, and so on. No doubt sociologists of knowledge could explain why philosophers of mathematics came to select these particular problems and deal with them the way they do. What it does imply, however, is that the question is meaningful whether different kinds of philosophies of mathematics are possible, and—why not?—perhaps even desirable. To a certain extent, the answer is trivial: look at what, e.g., phenomenologists have to say about mathematics and you must notice it does not fit into the scheme sketched above.1 Rather, the question should be whether there are forms that, on the one hand, reinterpret the whole enterprise, and, on the other hand, somehow remain related to the work of ‘mainstream’ philosophers of mathematics today.The book under review here does precisely that. Let me be a bit more precise. The general proposal, present throughout all the contributions, is that even at a first, superficial, glance at what mathematicians do when they do mathematics, it is far more complex than ‘just thinking about and …. (shrink)

Objective: The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement. Methods: (1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals. Results: In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as (...) bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs’ members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was “conflict of interest” that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review. Discussion: After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved. Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (shrink)

Sustainability challenges typically occur across sectoral boundaries, calling the state, market, and civil society to action. Although consensus exists on the merits of cross-sector collaboration, our understanding of whether and how it can create value for various, collaborating stakeholders is still limited. This special issue focuses on how new combined knowledge on cross-sector collaboration and business models for sustainability can inform the academic and practitioner debates about sustainability challenges and solutions. We discuss how cross-sector collaboration can play an important role (...) for the transition to new and potentially sustainability-driven business models given that value creation, delivery, and capture of organizations are intimately related to the collaborative ties with their stakeholders. Sustainable alternatives to conventional business models tend to adopt a more holistic perspective of business by broadening the spectrum of solutions and stakeholders and, when aligned with cross-sector collaboration, can contribute new ways of addressing the wicked sustainability problems humanity faces. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Burma’s Healthcare Under Fire: My Experience as an Exiled Medical ProfessionalP. P. KyawI used to work as a medical doctor in a less developed state than many big cities in Burma1 that experienced prolonged civil wars and current similar atrocities decades before the urban areas of the country experienced them. Before everything started, I was responsible for the medical management of the most vulnerable communities and had been struggling (...) with pandemic-related medical activities. Those were the happiest years of my life. I was with one of the best international organizations, where every effort I made was directly delivered to the patients with no unnecessary paperwork. The system was efficient, my colleagues were supportive, and I had a good work-life balance. I supported my family and whoever needed temporary financial support, played music weekly, met good friends who I hung out with every weekend, and [End Page 164] found hobbies like gardening and crocheting. I was content and happy. I even postponed my plans to get registered as a doctor in the Western world.Before moving to this beautiful ethnic state in 2019, I previously worked as a government medical doctor in Yangon, the capital. As much as I loved working in those civilian hospitals, I could not support myself with a monthly pay of $100-$150 USD. It was a hard decision to leave the service because it meant I could not pursue the medical specialty that I had always longed for and had to leave like-minded supportive colleagues. In Myanmar, unless you are a civil servant, you cannot pursue further clinical specialties. However, after leaving the government’s service to work in humanitarian medical assistance in hard-to-reach areas of Burma, I learned that life is still beautiful outside my comfort zone, until February 2021 when the coup began. Democratically elected members of the country’s ruling party were overthrown by the military, which then bestowed power in a military junta.I expected the election prior to the coup in November 2020 to be an uphill battle for Burma, but nothing more. I was still in denial when I first heard the news from one of the town’s NGO staff. The person had to travel on a motorbike to inform everyone that the junta had staged the coup. No telephone or internet was working at that time. My colleagues and I cried in our office, saying, “We are so young, and the future is still ahead. I don’t think this is going to last long. Maybe it will be over in a few days or, at most, a few weeks.” Once the peaceful protests started nationwide, my friends and I provided medical cover for the protesters, initially for minor medical problems such as low sugar, low blood pressure, injuries from accidental minor slips and falls, etc. Never in my life had I imagined that I would be taking care of bullet wounds and people injured by live rounds. While learning about gunshot wounds in forensic medicine, I thought, “Oh, this is not going to be very useful because Burma is not America, and I am not going there.” Then suddenly, it became too real and more useful than I would’ve liked it to be.I always think back to one especially bloody day when many people in the town were shot with live rounds. We assisted many patients. Usually, we would go around with the protest groups until they were over in the late afternoon. The protesters were always peaceful. There were no riots, no harmful acts, or vandalism. Only when the protesters were cruelly dispersed with tear gas, high-pressure pumps, rubber bullets, and live rounds (to the head) did they decide to defend themselves while still making their voices heard. The only defenses people had to counteract the live rounds were things like metal covers, firecrackers, and slingshots.One afternoon in March 2021, my team and I took an early break for lunch—unaware that some people would lose their lives that afternoon. We followed the local protests through Facebook Live while having lunch and started to hear firecracker sounds. A few seconds later, we knew... (shrink)

This study examines the impact of impression management and overclaiming on self-reported ethical conduct of 174 managers (67 male, 107 female) who worked for a large not-for-profit organization. As anticipated, impression management and overclaiming positively influenced perceived unethical conduct of managers. Female managers were more prone to impression management than male managers. There was no significant difference in perceived unethical conduct or level of overclaiming of male and female managers.

It has been argued that the fundamental laws of physics are deceitful in that they give the impression of greater unity and coherence in our theories than is actually found to be the case. Causal stories and phenomenological relationships are claimed to provide a more acceptable account of the world, and only theoretical entities — not laws — are considered as perhaps corresponding to real features of the world.This paper examines these claims in the light of the author's own field (...) of research: high energy physics. Some of the distinctions upon which the above conclusions are based are found not to be tenable in practice. Examples from experimental particle physics are presented which suggest an important role of the underlying theoretical structure which cannot be overlooked. It is argued that the fundamental theories must, in fact, be treated as being as worthy or unworthy of ontological commitment as the entities they postulate or the phenomenological relationships they inspire. Whilst it is conceded that aspects of the current theoretical formalism belie literal interpretation, it is maintained that revision in these particular areas need not affect the symmetry principles, particle spectra, or coupling strengths that largely determine the empirical content of the theory. (shrink)

The relative merits and demerits of historically prominent views such as the correspondence theory, coherentism, pragmatism, verificationism, and instrumentalism have been subject to much attention in the truth literature and have fueled the long-lived debate over which of these views is the most plausible one. While diverging in their specific philosophical commitments, adherents of these historically prominent views agree in at least one fundamental respect. They are all alethic monists. They all endorse the thesis that there is only one property (...) in virtue of which propositions can be true, and so, in this sense, take truth to be one. The truth pluralist, on the other hand, rejects this idea. There are several properties in virtue of which propositions can be true. The literature on truth pluralism has been growing steadily for the past twenty years. This volume, however, is the first of its kind—the first collection of papers focused specifically on pluralism about truth. Part I is dedicated to the development, investigation, and critical discussion of different forms of pluralism. An additional reason to look at truth pluralism with interest is the significant connections it bears to other debates in the truth literature—the debates concerning traditional theories of truth and the deflationism/inflationism divide being cases in hand. Parts II and III of the volume connect truth pluralism to these two debates. (shrink)

Here is a well-known thought about truth: Truth consists in correspondence with reality. A sentence is true just in case what it says corresponds with how the world is. Theories of truth that incorporate this thought are naturally regarded as robust or “heavyweight”. Truth is to be understood in a realist fashion. The world decides what is true and what is not. A recent incarnation of the correspondence view is found in truth-maker theories, whose adherents maintain that truths are true (...) in virtue of there being something – a truth-maker – in the world that makes them so.2. (shrink)