Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders (...) who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews. The data were analyzed thematically. Results Perceived benefits of SBDs included increased autonomy, improvement of the therapeutic relationship, possibility of early intervention and prevention of harm, prevention of compulsory care, reduction of the duration of compulsory care and recovery, mitigation of negative experiences around compulsory care, and guidance for professionals in providing compulsory care. Perceived risks included infeasibility of SBD instructions, difficulty in decision-making around SBD activation, limited accessibility of SBDs, disappointment of service users due to non-compliance with SBDs, and limited evaluation and updating of SBD content. Barriers to SBD completion included lack of knowledge of SBDs among professionals, lack of motivation or insight among service users, and lack of professional support for SBD completion. Facilitators of SBD completion and activation included support for SBD completion, involvement of relatives and peer experts, specification of SBD content, and evaluation of compulsory care and SBD content. The new legal framework was regarded as having both positive and negative effects on SBD implementation. Conclusions Stakeholders who have personal or professional experience with legally enforceable SBDs perceive SBDs as having important benefits and tend not to articulate the fundamental ethical concerns about SBDs which can be found in the ethics and legal literature. Instead, they perceive ethical and practical challenges that can be addressed through the implementation of suitable safeguards. (shrink)

This book traces the profound impact of technical media on the sound of music, asking: how do media technologies shape sound? How does this affect music? And how did it change what we listen for in music? Based on the information theoretical proposition that all transmission channels introduce noise and distortion, the argument accounts for the fact that technologically reproduced music is inherently shaped by the technologies that enable its reproduction. The media archaeological assessment of this noise of sound media (...) developed in the book draws from a wide range of sources, both theoretical and historical, conceptual and technical. Together, they show that noise should not be understood as unwanted by-effect but instead plays a foundational role in shaping the sonic contours of technologically reproduced music. Over the course of five chapters, the book sketches a broad history of the problem of noise in sound recording, looks at specific analog and digital noise-related technologies, traces the ideal of sonic purity back to key developments in nineteenth century acoustics, and develops an analysis of the close interrelation between noise and the temporality of sound. This relation, it argues, is central to the way in which recorded sound and music resonate with listeners. Ultimately, this media specific analysis of the noise of sound media thereby greatly enriches our understanding of the way in which they changed and continue to change the sonorous qualities of music, thus offering a new perspective on the interaction between music, media and listeners. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

IntroductionIn May 2006, the small group of doctoral students working on ecophilosophy at the Higher Institute of Philosophy at K.U.Leuven invited the Dutch environmental philosopher Martin Drenthen to a workshop to discuss his writings on the concept of wilderness, its metaphysical and moral meaning, and the challenge social constructivism poses for ecophilosophy and environmental protection. Drenthen’s publications on these topics had already been the subject of intense discussions in the months preceding the workshop. His presentation on the workshop and the (...) three critical responses by Wim Bollen, Glenn Deliège, and Richard Kover are published here in a thoroughly revised form on the basis of further and ongoing discussions about the issues involved. Three further contributions to the discussion are added: one by Nathan Edward Kowalski, a young Canadian philosopher who studied in Leuven and wrote his as yet unpublished dissertation on “Evil in Nature,” a second one by Kingsley Goodwin who is currently writing a dissertation on deep ecology at University College in Dublin and, finally, my own unsystematic thoughts inspired by Martin Drenthen’s provocative and stimulating hermeneutics of our postmodern understanding of nature and wilderness, as well as the diverse critical responses to Drenthen’s views by the other contributors. I owe gratitude to all of them for enriching my own ecophilosophical thought and enlarging its horizon although as my fragmentary reflections show at the cost of yet greater uncertainty and more questions about the possibilities of arguing for a radical environmentalist position. Such a position would somehow connect or ground our moral obligation to preserve genuine non-human otherness, wild and free nature, in the non-human meaning of such nature and in our essential need to be in direct and concrete contact with that field of wild non-human meaning because we ourselves belong to nature, because we are not only and purely civilized but are also and most fundamentally wild and free. Three fundamental questions need to be distinguished: the question about our moral obligations regarding nature and its preservation, the metaphysical question about the nature of nature or the meaning of nature, and the question of the metaphysical grounding of our morals in general, and of our moral obligation regarding nature in particular, in the nature or meaning of nature. The complex intertwinement between these three questions is at the heart of Martin Drenthen’s reflections.The authors contributing to the present discussion approach the various issues from markedly different philosophical backgrounds and concerns: critical theory, anthropology, analytic philosophy, phenomenology, hermeneutics, and deep ecology are all to some degree or other brought to bear on the question of what wilderness means for us, why we are fascinated by it and what it actually and in the first place is.Another interesting difference between the five respondents to Martin Drenthen’s wilderness-philosophy relates to the place from which they write: while the Canadians Richard Kover and Nathan Edward Kowalski have wilderness of some sort still close at hand, the Belgians Wim Bollen and Glenn Deliège write from a place which has been thoroughly domesticated, cultivated, and industrialised for a long time. Martin Drenthen himself, of course, writes from the same kind of place as these last two, which explains why he only refers to the wilderness that he has read about in novels, seen in movies, or experienced as recreated in the reserves of the Netherlands. The Irish Kingsley Goodwin writes perhaps from a third, intermediate place that is not wild anymore but still much more natural than Belgium or the Netherlands are.The differences in philosophical approach and concern combined with the difference of place generate a rich tapestry of perspectives and voices wrestling with the fundamental questions of our perceived homelessness and alienation from nature, our cultural discontent, our longing for and need for radical alterity, of immanence and transcendence, of who we are and where we belong, and more concretely of whether there is more to ground our efforts to preserve nature than enlightened self-interest and subjective preference. Martin Drenthen deserves praise for inaugurating this fruitful discussion with his intriguing and highly paradoxical effort to hybridize a postmodern deconstruction of the idea and ideal of wilderness as unspoilt and true nature on the one hand with a new metaphysics of wilderness on the other. Arne Naess, who is generally regarded as the founding father of deep ecology, pointed out the positive and stimulating role that vagueness in the expression of ideas can play in political and philosophical debate. Such general and vague but highly suggestive expressions as ‘all life is one’ are not empty at all, as is often claimed; they are rather full of possibilities of ‘precisation’ and differentiation. Drenthen’s wilderness-philosophy is certainly not vague to the degree of ‘all life is one,’ but his expositions are similarly pregnant with a wealth of further questions, precisations, distinctions, and conceptual clarifications. Good examples of different kinds are to be found in the contributions of Nathan Edward Kowalski and Richard Kover. Kowalski points out that Drenthen’s notions of culture and wilderness need to be made more precise by distinguishing them from the notions of civilization and wildness such that wild cultures become a conceptual possibility. Richard Kover takes the lead from Drenthen’s question about the reason for our postmodern fascination for wilderness to confront it with our primordial fascination in terms of the dependence in the evolution of our subjectivity and our consciousness on the focused perceptual attention on wild forms.Glenn Deliège situates Martin Drenthen’s wilderness-philosophy in its original context of the Dutch debate on the preservation of nature, in particular on the new wilderness paradigm. According to this paradigm, the nature to be preserved should be true and pure, truly natural and wild nature, that is nature outside of and free from the cultivating and domesticating influence of humans. In the Netherlands, however, such nature no longer exists; it can only be preserved after it has first been artificially recreated. Deliège gives an informative summary account of the highly charged three-cornered debate between the adepts of this wilderness-paradigm, the proponents of the more traditional form of conservation of remnants of the typical European landscapes created by pre-industrial farming practices and the modern technocratic functionalists. This debate makes obvious that there are quite different views of the nature of nature and its value. Enter social constructivism: the contested nature of nature is nothing more than a social construct, an idea in a collective mind. The contestation itself is a struggle for authority and power between different such social constructs, any claim to scientific objectivity and objective truth for one’s image of nature is an arrogation of a truth which doesn’t exist and is potentially oppressive by silencing other views. Nature then is up for the grabs of politics, political negotiation, and compromise between various interest groups who all want to get some benefit from nature, some use-value.The problem with Drenthen’s effort to articulate a normative concept of nature which cannot be deconstructed in this way is the extreme formality and emptiness of his metaphysical concept of wilderness as that which is always ‘beyond’, always ‘more’ and which can never be exhausted by any image and construction of nature. Any more concrete determination is mere appearance; the thing in itself is a border concept of that which in fact cannot be grasped conceptually. Glenn Deliège is critical of this formality and emptiness from which it will be impossible to derive any concrete guidance for our conservation practices. He then goes on to defend the Arcadian tradition of our appreciation of nature as giving us a historically well-grounded orientation for those practices. Of course that Arcadian tradition is obviously a cultural construction but that doesn’t make it completely arbitrary and contingent since it is itself ultimately grounded in and open to modification by our concrete sensuous experiences of nature.Deliège here raises the very important issue of the relation between our concrete perceptual and bodily experiences in and with nature and our concepts and metaphysical images of nature. Drenthen himself approaches this issue from the hermeneutical perspective of our need to make sense of our experiences and to articulate their meaning. His confrontation with social constructivism and his effort to salvage something from its relativizing acid lead him, however, into the direction of a highly abstract and empty concept of wilderness.Richard Kover shows that perception is, indeed, the key to a radical critique of social constructivism. He does this with the help of the ecological anthropology of Paul Shepard, the structuralist anthropology of Claude Levi-Strauss and the phenomenology of Maurice Merleau-Ponty. It needs to be said here that Kover takes his leave from an unpublished paper by Martin Drenthen with the title “How to appropriate wilderness appropriately?” – the paper is accessible though on Drenthen’s web-site - in which Drenthen comments and reflects upon three contemporary wilderness-tales, one of them being Werner Herzog’s much-discussed documentary on Timothy Treadwell, an American environmentalist drop-out who lived thirteen summers among wild grizzlies in the Alaskan wilderness before being killed together with his girlfriend by a grizzly bear.Kover tries to show that we are not imprisoned in the mirror-cabinet of our mind or of our human sociality. To make his case, he starts from Paul Shepard’s thoughtful observation that the evolutionary emergence of the mind did not remove us from the natural world but actually connected us deeper with it. Through our mind we evolved more fully into it because our mind is primordially in our senses and in the ability to articulate a perceptual world. The natural world in the form of the system of natural species and their relations is the primary model for perceptual discriminations, for the fundamental discovery of order with its twin-aspects of distinction and discontinuity on the one side and relations and continuity on the other side. Our cognition is essentially perceptually based, our subjectivity is primordially informed by our inherence in the sensible world. Perceptual cognition is inherently intentional and relational, it is not an autonomous mental construction, it is rather in the world and informed by that which is perceived. The other is always intertwined with the subject. We are always already hooked up with the world, with the others, before we start reflecting, thinking, and conceptualizing. This is one of the major themes in Shepard’s work: what this insight means with regard to our relations to non-human otherness, in particular to our perceptual encounter with wild animals. In our encounter with non-human otherness, we are confronted with an essentially ambiguous sense of both affinity and disjuncture. Wild animals demonstrate to us that we are not homeless or alien to this world, that we fundamentally belong to it and are part of it. Their difference, however, shows us that there are different perspectives and ways of being in the world. “Thus the encounter with non-human others inform humans that we are both of the world and simultaneously not the world and there are horizons of significance beyond our own perspective.”Nathan Edward Kowalski comes to a similar conclusion when he situates our morality in the larger moral order of wild nature. According to Kowalski it is indeed a moral order though not our own, an Other to our morality but not simply a negative one. It is, as Drenthen says, a highly paradoxical amoral morality. But what can it mean to speak of morality here? For Kowalski it means that the issue is not merely the theoretical recognition and acknowledgment of axiological transcendence, of non-human values out there, but whether we will appropriately conform to and comport ourselves towards that axiological transcendence so that we can find a human homeland in wild nature instead of turning it into a wasteland. The question then is, how to fit our own human morality into this larger order and greater reality, to subordinate it to that greater reality as a part of it and encompassed but not denied by it so that we can be moral and natural at the same time, tender carnivores hunting the sacred game. Indigenous people follow a moral protocol in their relationship with non-human others which acknowledge and respects their autonomy, their alterity, and the sacred mystery of their different ways of being. They are not befriended but some of them are hunted and eaten – as an exchange in the gift-economy of nature.The problem of the homelessness and alienation from nature is discussed by Wim Bollen from the radically different vantage point of critical theory. In Adorno’s and Horkheimer’s Dialectic of Enlightenment the human story unfolds as a tragic effort to liberate ourselves from nature and to become fully human through rational control when in the end this effort turns against ourselves and instead of liberation and human flourishing we get social domination and repression of our natural needs. The frustrations and mutilations imposed upon us by a repressive civilization give rise to the regressive desire for a return to a natural existence. Referring to the myth of Odysseus and Circe as interpreted by Adorno and Horkheimer, Wim Bollen equates such a natural existence with animal life. In the light of contemporary knowledge about primitive existence, however, this equation is highly problematic. Palaeolithic foragers were already fully human in all respects. A life without civilization need not be an animal-existence.According to Adorno/Horkheimer, our subjectivity and autonomy have to be wrested from animal-nature through an exertive struggle that cannot but proceed by a threefold strategy of domination: the domination of non-human otherness, of human others, and of our own inner nature. The siren song of nature consists in the temptation to give up that struggle for the promise of an unreflective, non-alienated natural existence without toil.When Odysseus’ men give in to Circe’s seduction they are, however, not transformed into wild animals but into swine. According to Bollen this signifies that we cannot re-wild ourselves, that we remain imprisoned in civilization, either as master-subjects or as domesticated animals. Bollen, by the way, like Drenthen, does not distinguish conceptually between civilization and culture. Since re-wilding for Bollen means the impossibility of returning to animal-existence, which is actually the impossibility of becoming another species since biologically we are animals already, to be imprisoned in civilisation means nothing else than to be imprisoned in our humanity. The fact that we cannot become wild animals again – according to Paul Shepard, however, we are still wild animals – is indeed, as Bollen stresses, a trivial form of alienation. A more meaningful concept of alienation which can be put to critical use must refer to a culturally and historically determined frustration and deficit inside the cultural order that is to be overcome not by an impossible regression but by progressive politics leading beyond the three intertwined forms of domination. Not back to nature but forward towards a reconciliation of culture with nature! Such a reconciliation would neither collapse culture into the immanence of nature nor submerge nature into the transcendence of culture. According with the three forms of domination it would be a three-dimensional form of reconciliation.Odysseus’ men did not got what they thought were promised them: the complete liberation from the burden of being autonomous subjects, of being civilized, but they got something worthwhile, namely a certain from of pleasure, a limited and provisional relief and escape. Bollen sees a critical potential in these piggish pleasures after all and consequently even in the siren song of nature since these pleasures were only experienced because Odysseus’ men gave in to it. But one has to give in to this siren song critically if it is to unfold its liberating potential. The problem with pleasure though in bourgeois society is that it is necessarily betrayed, instrumentalized and sold.Kingsley Goodwin’s paper starts by defending deep ecology against the charge of asserting a naïve and dogmatic metaphysics of nature. For convenience sake, but not quite unproblematically, he identifies deep ecology with the environmental thought of Arne Naess. A metaphysics of nature for Naess is always part of a personal worldview. Worldviews which are partly inspired by ecology Naess calls ecosophies. Naess always stresses the personal character of such a worldview and the irreducible plurality of them. It used to be a common misunderstanding of the platform of deep ecology which Naess conceived together with George Sessions that it expressed in a condensed form the metaphysical beliefs of deep ecology. Naess’ intention, however, was to try to articulate in a general fashion the basic viewpoints on which the supporters of the deep ecology movement agreed. It would be possible then to derive these viewpoints from quite different worldviews. In light of this, I think, that Goodwin’s characterisation of the platform as “pragmatic and activist” is not quite appropriate.Goodwin goes on to compare Drenthen’s conception of wilderness and wildness with the similar position developed by Neil Evernden in his book The Social Creation of Nature. He like Naess in his personal ecosophy stresses the crucial role of perceptual experience of wild otherness to find an antidote to the relativity and contingency of our interpretations of nature. Evernden refers to studies on child development to argue for a non-dualistic and relational conception of the self, similar to Naess’ relational ontology. According to Goodwin, Drenthen, in spite of his hermeneutical approach remains too much indebted to the Western subject/object-dualism. The object, in this case wild nature, is pure otherness.With regard to a compost heap, Goodwin shows that we are not separated from nature by an inseparable gulf, that nature is close at hand, and that we can experience and explore it, appreciate the complex play of identity and difference it consists of, the exchanges and transformations and that we can identify with the organisms involved in these exchanges.*The proceeding remarks only highlight some of the prominent themes and considerations in the various contributions to this topical issue of Ethical Perspectives. Hopefully the reader will feel invited and enticed to read the articles themselves, starting, preferably of course, with the essay by Martin Drenthen, who sparked off this lively discussion on the moral meaning of wild nature. I am honoured and pleased to be able to introduce these rich explorations by such talented young environmental philosophers who are eager to develop environmental philosophy further and lead it into new directions. They all have to wrestle with and find answers to the challenge postmodern deconstruction and social constructivism pose for environmental philosophy. In the face of that challenge, it is even more difficult than it already was to provide solid and convincing arguments for the defence of wild and free nature beyond merely pragmatic arguments in terms of its utilitarian value for us. The reason for that defence is not clear-cut and proves to be just as evasive as the moral meaning of nature itself. But neither that reason nor that meaning are mere phantoms and mirages that vanish when we approach them and try to grasp them. They are more substantial, even if they will never have the solidity of a mathematical proof or a scientific measurement. Their locale is the lifeworld which from the point of view of scientific and logical precision and clarity is a messy place where subject and object, reason and heart, fact and value, experience and thought and, yes, nature and culture cannot be clearly separated. This has important consequences for environmental philosophy and its methodology. Conceptual analysis and logical argumentation have to become sensitive to the richness of experience in the lifeworld and to the diverse efforts of its articulation: i.e., they have to open themselves up and maybe even to subordinate themselves to phenomenological and hermeneutical approaches. For me personally this is one of the most important conclusions I draw from the discussion presented here. (shrink)

The ecological crisis is more than a threat to our physical survival. It is also a metaphysical or moral crisis. With the human imprint on the natural environment growing ever larger and deeper, we face the prospect of a world without true non-human otherness. Maybe as Bill McKibben argues, we have crossed the threshold already and, without being fully aware of it, live already in a postnatural world. Nature, then, is not only exhausted as a physical but also as a (...) metaphysical and moral resource.How do we respond to the end of wild nature? What does it mean for our human self-understanding? And why should we care? What is so horrifying about a completely humanized world, a world of only human meanings? Why should we not rejoice at our liberation from the prison of nature? The meaning of nature is evasive and fragile. It is located in concrete experiences in the lifeworld and its articulation is poetic rather than scientific but “in wildness is the preservation of the world” and the sanity of our minds. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

stufe oder Unterstufe im emporsteigenden Gang zur absoluten Er kenntnis gewinnen. Man kann sagen, daB das philosophisehe Interesse in vollbe wuBter Weise als leitendes Ziel das vor Augen hat, was sieh in jedem 5 rein theoretisehen Interesse als gleiehsam verborgene Tendenz be kundet: Die Tendenz auf vollkommene Erkenntnis liegt in allem rein theoretisehen Bestreben. a) Immerfort ftihlt es sieh fortgetrieben im Sinne mOgliehster Verdeutliehung, Klarung, mogliehst vollkom mener Begriindung. b) Immerfort ftihlt es sieh mit der vereinzelten 10 Tatsaehe, mit dem (...) vereinzelten Gesetz unbefriedigt; es kann daran nieht haften bleiben. Es ftihlt sich gedrangt, von dem Besonderen emporzusteigen zum Allgemeineren, von der Tatsaehe zum Gesetz, von der niederen Allgemeinheit zu der hoheren. Damit nieht zufrie den, muB es aIle mogliehen theoretisehen Lehren durehlaufen, um- 15 spannende Theorien bauen, die Theorien zu umfassenden Theorien verbinden, und so immer weiter. Dabei erweitert sieh der enge Kreis der yom theoretisehen Interesse zunaehst ins Auge gefaBten Gegen standliehkeiten; Einheit der theoretisehen Erkenntnis greift immer weiter von Gebiet zu Gebiet, ohne Grenze. 20 Bringen wir uns diese Tendenzen zur Klarheit, so sehen wir, daB sie im Verborgenen dem Ziel der hoehsten Vereinheitliehung die nen, daB sie verstreuten, zusammenhangslosen Erkenntnissen feind sind, daB sie gleiehsam niehts Untheoretisehes, Unvereinheitlichtes dulden wollen ebensowenig als ein Ende, soweit irgend noeh ein plus 25 ultra denkbar ist. Und zu alledem gehort offenbar aueh die Tendenz zu voll ausweisender Klarheit. (shrink)

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played (...) the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be. (shrink)

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

Pragmatic difficulties are considered a hallmark of autism spectrum conditions (ASC), but remain poorly understood. We discuss and evaluate existing hypotheses regarding the literalism of ASC individuals, that is, their tendency for literal interpretations of non‐literal communicative intentions. We present evidence that reveals a developmental stage at which neurotypical children also have a tendency for literalism and suggest an explanation for such behaviour that links it to other behavioural, rule‐following, patterns typical of that age. We discuss evidence showing that strict (...) adherence to rules is also widespread in ASC, and suggest that literalism might be linked to such rule‐following behaviour. (shrink)

Journal of Economic Methodology, Volume 19, Issue 2, Page 159-163, June 2012.

In lieu of an abstract, here is a brief excerpt of the content:Wandering the Magnetosphere*Ingrid Koenig (bio)Navigation notes: These emergent drawings–excerpts from a visual essay–take up the complex network of impacts across physical forces entangled with bio-geo-political time. A key element for this work is a living cosmography to depict movement across time, and to visualize wandering on a planet, in the magnetosphere, and between the internal energy of Earth and the solar energy of the cosmos. Physicists say there (...) are no things, there are only relations between things.Q: Hello ancient stone - may I unfold you like a book? Do you carry a message from deep time? A: Yes, what you’re holding is not a thing, but a process. Click for larger view View full resolutionDrawing from Svalbard, Day 17 expedition, 2019[End Page 97]Drifting on a rocky planet, between the internal energy of Earth and the solar energy of the cosmos–we live within a “cosmo-tectonic circulation” —Jerome Gaillardet, geo-chemist. Click for larger view View full resolutionGeocosmic Logic[End Page 98] Click for larger view View full resolutionHow Entropy is Time (detail) Click for larger view View full resolutionMagnetic Story[End Page 99] Click for larger view View full resolutionMessage From Deep Time 3 Click for larger view View full resolutionMessage From Deep Time 1[End Page 100] Click for larger view View full resolutionLooping Matters 1 (Litli-Hrutur, Iceland) Click for larger view View full resolutionLooping Matters 2[End Page 101] Click for larger view View full resolutionMother Rock Waves (Miradalir Valley, Iceland) Click for larger view View full resolutionMother Rock in Time[End Page 102] Click for larger view View full resolutionVolcanic Logic (Miradalir Valley, Iceland) Click for larger view View full resolutionSonic Lava (Miradalir Valley, Iceland)[End Page 103] Click for larger view View full resolutionWaves Across Time (Miradalir Valley, Iceland) Click for larger view View full resolutionDisorientations[End Page 104] Click for larger view View full resolutionMessage From Deep Time 2 Click for larger view View full resolutionGravitational Thought[End Page 105] Click for larger view View full resolutionMagnetic Thought (Miradalir Valley, Iceland) Click for larger view View full resolutionDistance Ladder Collapse[End Page 106] Click for larger view View full resolutionMattering Logic 3 Click for larger view View full resolutionMattering Logic 4[End Page 107] Click for larger view View full resolutionHow We Make Time into Space Click for larger view View full resolutionHow Entropy is Time (detail 2–Svalbard)[End Page 108]Ingrid Koenig Ingrid Koenig is Associate Professor at Emily Carr University of Art + Design, Vancouver, Canada. She was the inaugural Artist in Residence (2011 to 2021) at TRIUMF, Canada’s particle accelerator center, and co-organizes processes of collaboration between artists and physicists in a project called Leaning Out of Windows. Her studio and research practices traverse the fields of physics, social history, feminist theory, and narratives of science. Her drawings explore the complex phenomena of physics and involve intuitive responses to specific sites through fieldwork in Canada’s Rocky Mountains, Germany, Iceland, Arctic Circle art + science expeditions, and through collaborations with physicists. She has received grants from the Canada Council for the Arts, the Goethe Institute, and the Social Science and Humanities Research Council. She co-edited the recently published book, Leaning Out of Windows: An Art and Physics Collaboration (Figure 1 Publishing, 2023).Footnotes* Excerpts from Wandering the Magnetosphere–drawings by Ingrid Koenig, 2019 to 2023, and ongoingCopyright © 2023 Johns Hopkins University Press and SubStance, Inc... (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

Having Too Much is the first academic volume devoted to limitarianism: the idea that the use of economic or ecosystem resources should not exceed certain limits. This concept has deep roots in economic and political thought. One can find similar statements of such limits in thinkers such as Plato, Aquinas, and Spinoza. But Having Too Much is the first time in contemporary political philosophy that limitarianism is explored at length and in detail. Bringing together in one place the best writing (...) from key theorists of limitarianism, this book is an essential contribution to political philosophy in general, and theories of distributive justice in particular. Including some of the key published articles as well as new chapters, Having Too Much is necessary reading for scholars and students of political theory and philosophy, as well as anyone interested in questions of distributive justice. (shrink)

A IDENTIFICAÇÃO DO DIREITO AMBIENTAL MARÍTIMO.

Background: Studies from Western countries show that doctors working in neonatal intensive care units find withdrawal of treatment to be their most difficult ethical dilemma. There is less knowledge of how this is experienced in other economic, cultural, religious and educational contexts.Objectives: To explore and describe how Indian doctors experience ethical dilemmas concerning the withdrawal of treatment among critically sick and/or premature neonates.Method: Qualitative data from interviews was analysed according to Giorgi's phenomenological approach. The subjects were 14 doctors with various (...) levels of neonatal experience, recruited from two state‐owned NICUs in India. Main outcome measures: description reflecting the nature of ethical dilemmas and how they are experienced.Results: All doctors reported situations where the question of withdrawal of treatment was experienced as the worst part of their job. They felt that they lacked training in how to handle such dilemmas, and some had never talked about ethics before. They were especially concerned about non‐medical considerations that do not feature in current treatment guidelines. In describing their personal experiences, the informants mentioned their sense of responsibility in situations where they were aware that their decisions would influence a family's economy and reputation, availability of food and education for siblings, other children's access to equipment in the unit, and the use of resources in an underprivileged population. Sometimes lack of resources, usually ventilators, forced them to make decisions about which babies should get the chance to live. Other reported dilemmas included difficulties co‐operating with uneducated and poor parents.Conclusion: While Western doctors seem to focus on the rights and problems of the individual child, Indian doctors tend to refer to consequences for other children, for parents and society. There is a need for further research in this field, and for the development of guidelines on how to cope with differences in resources, and how to handle different patient groups’ cultural and religious concerns. (shrink)

The point of departure of any ethical theory is the anthropological fact that normally developed humans must lead their own lives themselves. This means that their conduct is neither programmed nor determined by instincts. Human beings must on every occasion engage the circumstances of a practical situation by their own choice and decision. Even when they find themselves delivered over to the stimuli and powers of particular circumstances in a completely passive manner, this does not occur in the way that (...) it does for a robot, but rather, on the basis of a background of an essential possibility that they can conduct themselves otherwise than they are now behaving. Where there is the possibility of a choice, then the question inevitably arises regarding the principle of the choice. On what do we base our decision to choose one possibility rather than another? We can let fate decide, we can consult astrological charts, we can appeal to an authority, or we can try to find out what we truly want, what are our deepest desires and what choice agrees best with these desires. Finally, we can also inquire into what decision is the objectively correct and rational one, i.e. which decision is good independent of our subjective preferences. This latter case, of course, presupposes a standard of the objectively good and rational, in regard to which we can be responsible for and evaluate our decisions as well as our ensuing actions. (shrink)

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent (...) that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must (...) call bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)