In this study, we build on a recent social data scientific mapping of Danish environmentalist organizations and activists during the COVID-19 lockdown in order to sketch a distinct genre of digital social research that we dub a quali-quantitative micro-history of ideas in real-time. We define and exemplify this genre by tracing and tracking the single political idea and activist slogan of grøn genstart across Twitter and other public–political domains. Specifically, we achieve our micro-history through an iterative and mutual attuning between (...) computational and netnographic registers and techniques, in ways that contribute to the nascent field of computational anthropology. By documenting the serial ways in and different steps through which our inquiry was continually fed and enhanced by crossing over from ethnographic observation to computational exploration, and vice versa, we offer up our grøn genstart case account as exemplary of wider possibilities in this line of inquiry. In particular, we position the genre of micro-history of ideas in real-time within the increasingly wide and heterogeneous space of digital social research writ large, including its established concerns with ‘big and broad’ social data, the repurposing of computational ‘interface’ techniques for socio-cultural research, as well as diverse aspirations for deploying digital data within novel combinations of qualitative and quantitative methods. (shrink)

The era of ‘big data’ studies and computational social science has recently given rise to a number of realignments within and beyond the social sciences, where otherwise distinct data formats – digital, numerical, ethnographic, visual, etc. – rub off and emerge from one another in new ways. This article chronicles the collaboration between a team of anthropologists and sociologists, who worked together for one week in an experimental attempt to combine ‘big’ transactional and ‘small’ ethnographic data formats. Our collaboration is (...) part of a larger cross-disciplinary project carried out at the Danish Technical University, where high-resolution transactional data from smartphones allows for recordings of social networks amongst a freshman class. With a parallel deployment of ethnographic fieldwork among the DTU students, this research set-up raises a number of questions concerning how to assemble disparate ‘data-worlds’ and to what epistemological and political effects? To address these questions, a specific social event – a lively student party – was singled out from the broader DTU dataset. Our experimental collaboration used recordings of Bluetooth signals between students’ phones to visualize the ebb and flow of social intensities at the DTU party, juxtaposing these with ethnographic field-notes on shifting party atmospheres. Tracing and reflecting on the process of combining heterogeneous data, the article offers a concrete case of how a ‘stitching together’ of digital and ethnographic data-worlds might take place. (shrink)

Background:Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities.Objectives:To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities.Research design:Two online questionnaires about the municipal ethics activities.Participants and research context:A total of 137 municipal contact persons for the ethics project answered the first survey, whereas 217 ethics facilitators responded to the second survey.Ethical considerations:Based on informed consent, the study was (...) approved by the Data Protection Official of the Norwegian Social Science Data Services.Findings:Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision.Discussion:This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators.Conclusion:It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of (...) ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout. (shrink)

The rise of Big Data in the social realm poses significant questions at the intersection of science, technology, and society, including in terms of how new large-scale social databases are currently changing the methods, epistemologies, and politics of social science. In this commentary, we address such epochal questions by way of a experiment: at the Danish Technical University in Copenhagen, an interdisciplinary group of computer scientists, physicists, economists, sociologists, and anthropologists is setting up a large-scale data infrastructure, meant to continually (...) record the digital traces of social relations among an entire freshman class of students. At the same time, fieldwork is carried out on friendship relations amongst the same group of students. On this basis, the question we pose is the following: what kind of knowledge is obtained on this social micro-cosmos via the Big and Small Data, respectively? How do the two relate? Invoking Bohr’s principle of complementarity as analogy, we hypothesize that social relations, as objects of knowledge, depend crucially on the type of measurement device deployed. At the same time, however, we also expect new interferences and polyphonies to arise at the intersection of Big and Small Data, provided that these are, so to speak, mixed with care. These questions, we stress, are important not only for the future of social science methods but also for the type of societal knowledge that may be expected from new large-scale social databases. (shrink)

How may clinical ethics committees inspire ethical reflection among healthcare professionals? How may they deal with organizational ethics issues? In recent years, Norwegian CECs have attempted different activites that stretch or go beyond the standard trio of education, consultation, and policy work. We studied the novel activities of Norwegian CECs by examining annual reports and interviewing CEC members. Through qualitative analysis we identified nine categories of novel CEC activities, which we describe by way of examples. In light of the findings, (...) we argue that some novel working methods may be well suited to promote ethical reflection among clinicians, and that the CEC may be a suitable venue for discussing issues of organizational ethics. (shrink)

BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities (...) in the Norwegian municipalities and the ethical topics addressed.ResultsOne hundred and thirty-seven municipal contact persons answered the first survey, whereas 217 ethics facilitators from 48 municipalities responded to the second. The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions whilst seldom reaching others. Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The “ethics reflection group” was the most common venue for ethics deliberation.ConclusionsThe Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large scale implementation of CES structures for the municipal health and care services is complex, yet feasible. (shrink)

BackgroundHow should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and theimplementationof the CEC should be considered as ‘complex interventions’.Main textWe present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of (...) consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors.ConclusionThe conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact. (shrink)

A central task for clinical ethics consultants and committees (CEC) is providing analysis of, and advice on, prospective or retrospective clinical cases. However, several kinds of biases may threaten the integrity, relevance or quality of the CEC's deliberation. Bias should be identified and, if possible, reduced or counteracted. This paper provides a systematic classification of kinds of bias that may be present in a CEC's case deliberation. Six kinds of bias are discussed, with examples, as to their significance and risk (...) factors. Possible remedies are suggested. The potential for bias is greater when the case deliberation is performed by an individual ethics consultant than when an entire clinical ethics committee is involved. (shrink)

This article has two objectives. In the first part, I present a critical overview of the extensive anthropological literature that may be deemed “phenomenological.” Following this critique, which is built up around a classification into four different varieties of phenomenological anthropology, I discuss the relationship between phenomenological anthropology and the ontological turn (OT). Contrary to received wisdom within the anthropological discipline, I suggest that OT has several things in common with the phenomenological project. For the same reason, I argue, it (...) is not accurate to posit OT and phenomenology as opposing or antagonistic projects, as they are often depicted among critics and advocates of OT alike. On the contrary, I go as far as suggesting, OT may be understood as one of the most concerted attempts anthropology has produced to realize a distinctly anthropological version of Husserl’s method of phenomenological bracketing, namely what could be called the ontological epoché. (shrink)

Secretion is a fundamental cellular process involving the regulated release of intracellular products from cells. Physiological functions such as neurotransmission, or the release of hormones and digestive enzymes, are all governed by cell secretion. Anomalies in the processes involved in secretion contribute to the development and progression of diseases such as diabetes and other hormonal disorders. To unravel the mechanisms that govern such diseases, it is essential to understand how hormones, growth factors and neurotransmitters are synthesized and processed, and how (...) their signals are recognized, amplified and transmitted by intracellular signaling pathways in the target cells. Here, we discuss diverse aspects of the detailed mechanisms involved in secretion based on mathematical models. The models range from stochastic ones describing the trafficking of secretory vesicles to deterministic ones investigating the regulation of cellular processes that underlie hormonal secretion. In all cases, the models are closely related to experimental results and suggest theoretical predictions for the secretion mechanisms. (shrink)

BackgroundDecisions about appropriate treatment at the end of life are common in modern healthcare. Non-treatment decisions (NTDs), comprising both withdrawal and withholding of (potentially) life-prolonging treatment are in principle accepted in Norway. However, in practice they may give rise to significant moral problems for health professionals, patients and next of kin. Here, patient values must be considered. It is relevant to study the moral views and intuitions of the general population on NTDs and special areas of contention such as the (...) role of next of kin in decision-making.MethodsElectronic survey to members of a nationally representative panel of Norwegian adults. Respondents were presented with vignettes describing patients with disorders of consciousness, dementia, and cancer where patient preferences varied. Respondents answered ten questions about the acceptability of non-treatment decision making and the role of next of kin.ResultsWe received 1035 complete responses (response rate 40.7%). A large majority, 88%, supported the right of competent patients to refuse treatment in general. When an NTD was in line with the patient’s previously expressed preferences, more respondents tended to find NTDs acceptable. More respondents would accept NTDs for themselves than for the vignette patients. In a scenario with an incompetent patient, clear majorities wanted the views of next of kin to be given some but not decisive weight, and more weight if concordant with the patient’s wishes. There were, however, large variations in the respondents’ views.ConclusionThis survey of a representative sample of the Norwegian adult population indicates that attitudes to NTDs are often in line with national laws and guidelines. However, the high variance among the respondents and relatively large weight given to next of kin’s views, indicate a need for appropriate dialogue among all stakeholders to prevent conflicts and extra burdens. Furthermore, the emphasis given to previously expressed opinions indicates that advance care planning may increase the legitimacy of NTDs and prevent challenging decision-making processes. (shrink)

Experimental studies investigating the contribution of conscious intention to the generation of a sense of agency for one’s own actions tend to rely upon a narrow definition of intention. Often it is operationalized as the conscious sensation of wanting to move right before movement. Existing results and discussion are therefore missing crucial aspects of intentions, namely intention as the conscious sensation of wanting to move in advance of the movement. In the present experiment we used an intentional binding paradigm, in (...) which we distinguished between immediate intention, as usually investigated, and longer standing intention. The results showed that the binding effect was significantly enhanced for distal intentions compared to proximal intentions, indicating that the former leads to stronger sense of agency. Our finding provides empirical support for a crucial distinction between at least two types of intention when addressing the efficacy of conscious intentions. (shrink)

Rapid individual cognitive phenotyping holds the potential to revolutionize domains as wide‐ranging as personalized learning, employment practices, and precision psychiatry. Going beyond limitations imposed by traditional lab‐based experiments, new efforts have been underway toward greater ecological validity and participant diversity to capture the full range of individual differences in cognitive abilities and behaviors across the general population. Building on this, we developed Skill Lab, a novel game‐based tool that simultaneously assesses a broad suite of cognitive abilities while providing an engaging (...) narrative. Skill Lab consists of six mini‐games as well as 14 established cognitive ability tasks. Using a popular citizen science platform (N = 10,725), we conducted a comprehensive validation in the wild of a game‐based cognitive assessment suite. Based on the game and validation task data, we constructed reliable models to simultaneously predict eight cognitive abilities based on the users’ in‐game behavior. Follow‐up validation tests revealed that the models can discriminate nuances contained within each separate cognitive ability as well as capture a shared main factor of generalized cognitive ability. Our game‐based measures are five times faster to complete than the equivalent task‐based measures and replicate previous findings on the decline of certain cognitive abilities with age in our large cross‐sectional population sample (N = 6369). Taken together, our results demonstrate the feasibility of rapid in‐the‐wild systematic assessment of cognitive abilities as a promising first step toward population‐scale benchmarking and individualized mental health diagnostics. (shrink)

This commentary on Marilyn Strathern's article, “Binary License,” discusses certain implications of her assertion that intertribal relationships among urban migrants in Papua New Guinea are not “ethnic.” For if such social encounters do not involve a conventional politics of identity, what then might its politics be? By comparing Strathern's Melanesian case with ethnographic examples in Corsica and Mongolia, a novel relational modality of “intensive ethnicity” may be identified, one that differs qualitatively from the “extensive ethnicity” with which anthropologists have usually (...) been concerned. The two forms of ethnicity are equally relative, in that a given group's self-understanding and self-designation are in both cases the result of its relations with other groups. However, ethnically extensive relations of the standard anthropological variety involve symbolic processes of boundary making and boundary maintenance whereby contrasting cultural traits or contents are arbitrarily assigned to and distributed among preexisting social forms and social scales (whether individuals, communities, or nations). Conversely, the more intensive intertribal engagements described by Strathern and certain other anthropologists are relational all the way down, given that everything about the terms of these relations (including their form, scale, and dimensioning) is defined by the particular quality in question. Thus a contrast may be established between the politics of identity and what might be called non-identity politics. If the former amounts to an ethnic economy in which subjectivities are exchanged in a commodity-like, alienable way, then, in the latter, stereotypical naming and other seeming “ethnic” practices amount to gift-like, non-alienable insertions of selves into others. (shrink)

As part of a Common Knowledge symposium on the “consequence of blur,” this article reassesses the anthropologist E. B. Tylor’s famous but vague concept of the animist soul as an optimal reflection of the soul’s fuzzy ontological status among animist peoples. Unlike the Platonic body/soul dichotomy, with its fixed appearance/essence distinction, indigenous conceptions of the soul among North Asian peoples, such as the Chukchi of Siberia and the Darhads of Mongolia, are reversible: persons can turn themselves inside-out as their inner (...) souls and outer bodies cross over and become one another. (shrink)

An amendment to this paper has been published and can be accessed via the original article.

Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO worksheet. A total of (...) 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted. (shrink)

This introduction to the Common Knowledge symposium titled “Comparative Relativism” outlines a variety of intellectual contexts where placing the unlikely companion terms comparison and relativism in conjunction offers analytical purchase. If comparison, in the most general sense, involves the investigation of discrete contexts in order to elucidate their similarities and differences, then relativism, as a tendency, stance, or working method, usually involves the assumption that contexts exhibit, or may exhibit, radically different, incomparable, or incommensurable traits. Comparative studies are required to (...) treat their objects as alike, at least in some crucial respects; relativism indicates the limits of this practice. Jensen argues that this seeming paradox is productive, as he moves across contexts, from Lévi-Strauss's analysis of comparison as an anthropological method to Peter Galison's history of physics, and on to the anthropological, philosophical, and historical examples offered in symposium contributions by Barbara Herrnstein Smith, Eduardo Viveiros de Castro, Marilyn Strathern, and Isabelle Stengers. Comparative relativism is understood by some to imply that relativism comes in various kinds and that these have multiple uses, functions, and effects, varying widely in different personal, historical, and institutional contexts that can be compared and contrasted. Comparative relativism is taken by others to encourage a “comparison of comparisons,” in order to relativize what different peoples—say, Western academics and Amerindian shamans—compare things “for.” Jensen concludes that what is compared and relativized in this symposium are the methods of comparison and relativization themselves. He ventures that the contributors all hope that treating these terms in juxtaposition may allow for new configurations of inquiry. (shrink)

Background:Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection.Objectives:To examine what the staff experience as promoters or as barriers to successful ethics reflection.Research design:The study has a qualitative design, where 56 participants in (...) municipal healthcare participated in 10 different focus-group interviews.Ethical considerations:The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data.Results:The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection.Discussion:The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group.Conclusion:Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups. (shrink)

Abstract2020 saw the rapid onset of a global pandemic caused by the SARS‐CoV‐2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to (...) “being a nurse” during the COVID‐19 pandemic was experienced and understood by Danish hospital‐based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands. (shrink)

One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease.The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in (...) the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality. (shrink)

Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Descriptions of activities involving priority setting in annual reports from Norwegian CECs were studied and categorized through qualitative content analysis. Three hundred thirty-nine reports from 38 CECs were studied. (...) We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests. (shrink)

Background Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Method Descriptions of activities involving priority setting in annual reports from Norwegian CECs were studied and categorized through qualitative content analysis. Results Three hundred thirty-nine reports from 38 (...) CECs were studied. We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. Discussion In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. Conclusions The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests. (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)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

As is the case with other concepts about mental affairs, the concept of introspection has many different interpretations. Some seem to consider introspecting a perceptive act and others see it as a thinking activity . For the present purpose, we will claim it as a common understanding in all such theories that introspection presupposes consciousness . States of consciousness, broadly discussed in the philosophical and empirical literature as first order states of consciousness, are states in which a subject is aware (...) of some or other object, thought, or feeling. Introspective states, however, are states in which a subject directs his or her attention towards their own conscious state. According to this understanding which we claim is a widespread one introspection can exist only in conscious subjects, and, furthermore, it is by way of introspection that a subject can learn about having this or that experience. To avoid misunderstandings, we wish to underline that the claim is not that experiencing as such is dependent upon such acts of introspection. On the contrary, we believe that a subject can have all kinds of intero- and exteroceptive experiences, directing attention towards the represented object . It is only when the subject directs attention not towards the object as such but towards the very state of being conscious of the object that he or she is introspective. (shrink)

Secular change in sex ratios is examined in relation to experience in the family. Two theoretical perspectives are outlined: Guttentag and Secord’s (1983) adaptation of social exchange theory, and sexual selection theory. Because of large-scale change in number of births and typical age differentials between men and women at marriage, low sex ratios at couple formation ages existed in the U.S. between 1965 and the early 1980s. The currently high sex ratios, however, will persist until the end of the century. (...) High sex ratios appear to be associated with lower divorce rates, male commitment to careers that promise economic rewards, male willingness to engage in child care, higher fertility, and higher rates of sexual violence. Sexual selection theory calls attention to intrasexual competition in the numerically larger sex. (shrink)

In the generative tradition, the language faculty has been shrinking—perhaps to include only the mechanism of recursion. This paper argues that even this view of the language faculty is too expansive. We first argue that a language faculty is difficult to reconcile with evolutionary considerations. We then focus on recursion as a detailed case study, arguing that our ability to process recursive structure does not rely on recursion as a property of the grammar, but instead emerges gradually by piggybacking on (...) domain-general sequence learning abilities. Evidence from genetics, comparative work on non-human primates, and cognitive neuroscience suggests that humans have evolved complex sequence learning skills, which were subsequently pressed into service to accommodate language. Constraints on sequence learning therefore have played an important role in shaping the cultural evolution of linguistic structure, including our limited abilities for processing recursive structure. Finally, we re-evaluate some of the key considerations that have often been taken to require the postulation of a language faculty. (shrink)

Including empirical examples and theoretical clarifications on many of the analytical issues raised in his recently published Down to Earth, this conversation with Bruno Latour and his collaborator, Danish sociologist Nikolaj Schultz, offers key insights into Latour’s recent and ongoing work. Revolving around questions on political ecology and social theory in our ‘New Climatic Regime’, Latour argues that in order to have politics you need a land and you need a people. This interview present reflections on such politics, such land (...) and such people, and it ends with a call for a sociology that takes up the task of connecting the three by investigating what he and Schultz call ‘geo-social classes’. The interview was conducted by Jakob Stein in Paris in November 2018. (shrink)

Blindsight is classically defined as residual visual capacity, e.g., to detect and identify visual stimuli, in the total absence of perceptual awareness following lesions to V1. However, whereas most experiments have investigated what blindsight patients can and cannot do, the literature contains several, often contradictory, remarks about remaining visual experience. This review examines closer these remarks as well as experiments that directly approach the nature of possibly spared visual experiences in blindsight.

Previous research on lexical development has aimed to identify the factors that enable accurate initial word-referent mappings based on the assumption that the accuracy of initial word-referent associations is critical for word learning. The present study challenges this assumption. Adult English speakers learned an artificial language within a cross-situational learning paradigm. Visual fixation data were used to assess the direction of visual attention. Participants whose longest fixations in the initial trials fell more often on distracter images performed significantly better at (...) test than participants whose longest fixations fell more often on referent images. Thus, inaccurate initial word-referent mappings may actually benefit learning. (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)

In a recent article, [Sergent, C. & Dehaene, S. . Is consciousness a gradual phenomenon? Evidence for an all-or-none bifurcation during the attentional blink, Psychological Science, 15, 720–729] claim to give experimental support to the thesis that there is a clear transition between conscious and unconscious perception. This idea is opposed to theoretical arguments that we should think of conscious perception as a continuum of clarity, with e.g., fringe conscious states [Mangan, B. . Sensation’s ghost—the non-sensory “fringe” of consciousness, Psyche, (...) 7, 18]. In the experimental study described in this article, we find support for this opposite notion that we should have a parsimonious account of conscious perception. Our reported finding relates to the hypothesis that there is more than one perceptual threshold [Merikle, P.M., Smilek, D. & Eastwood, J.D. . Perception without awareness: perspectives from cognitive psychology, Cognition, 79, 115–134], but goes further to argue that there are different “levels” of conscious perception. (shrink)

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)

We present here the hypothesis that the unique microenvironmental pH landscape of acid‐base transporting epithelia is an important factor in development of epithelial cancers, by rendering the epithelial and stromal cells pre‐adapted to the heterogeneous extracellular pH (pHe) in the tumor microenvironment. Cells residing in organs with net acid‐base transporting epithelia such as the pancreatic ductal and gastric epithelia are exposed to very different, temporally highly variable pHe values apically and basolaterally. This translates into spatially and temporally non‐uniform intracellular pH (...) (pHi) patterns. Disturbed pHe‐ and pHi‐homeostasis contributes to essentially all hallmarks of cancer. Our hypothesis, that the physiological pHe microenvironment in acid‐base secreting epithelia shapes cancers arising in these tissues, can be tested using novel imaging tools. The acidic tumor pHe in turn might be exploited therapeutically. Pancreatic cancers are used as our prime example, but we propose that this concept is also relevant for other cancers of acid‐base transporting epithelia. (shrink)