This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...) deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life. (shrink)

It is well known that close relatives of terminally ill patients endure great emotional stress. Many factors, such as existential concerns, contribute to the distress of these relatives. In this study, interviews were conducted to explore experiences concerning life restrictions, emotional distress, and limited support, in a group of close relatives of patients with amyotrophic lateral sclerosis (ALS). The purpose was to identify, illuminate and clarify ethical problems related to these experiences. The results indicate that close relatives of patients with (...) ALS need someone to talk to, as well as more information about the disease and its process. Furthermore, the study illustrates how ethical problems are related to choices and conflicts, and that a process including shared decision making is often an ideal when trying to find a solution to ethical problems. (shrink)

Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the (...) views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons and interviews with their significant others, as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: Meaningless waiting in contrast to lack of activities, Longing for a deeper connectedness in contrast to not participating in a social environment and Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person. (shrink)

In Sweden, efforts to govern end-of-life care through policies have been ongoing since the 1970s. The aim of this study is to analyse how policy narratives on palliative care in Sweden have been formulated and have changed over time since the 1970s up to 2018. We have analysed 65 different policy-documents. After having analysed the empirical material, three policy episodes were identified. In Episode 1, focus was on the need for norms, standards and a psychological end-of-life care with the main (...) goal of solving the alleged deficiencies within end-of-life care in hospital settings. Episode 2 was characterised by an emphasis on prioritising end-of-life care and dying at home, and on the fact that the hospice care philosophy should serve as inspiration. In Episode 3, the need for a palliative care philosophy that transcended all palliative care and the importance of systematic follow-ups and indicators was endorsed. Furthermore, human value and freedom of choice were emphasised. In conclusion, the increase of policy-documents produced by the welfare-state illustrate that death and dying have become matters of public concern and responsibility. Furthermore, significant shifts in policy narratives display how notions of good palliative care change, which in turn may affect both the practice and the content of care at the end of life. (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)

In Sweden, palliative care has, over the past decades, been object to policies and guidelines with focus on how to achieve “good palliative care”. The aim of this study has been to analyse how experts make sense of the development and the current state of palliative care. Departing from this aim, focus has been on identifying how personal experiences of ‘the self’ are intertwined with culturally available meta-level concepts and how experts contribute to construct new scripts on palliative care. Twelve (...) qualitative interviews were conducted. Four scripts were identified after analysing the empirical material: 1. script of paths towards working within palliative care; 2. script of desirable and deterrent reference points; 3. script of tensions between improvement and bureaucracy; and 4. script of low status and uncertain definitions. The findings of this study illustrate how experts in complex ways intertwine experiences of ‘the self’ with meta-levels concepts in order to make sense of the field of palliative care. The participants did not endorse one “right way” of “good” deaths. Instead, palliative care was considered to be located in a complex state where the historical development, consisting of both desirable ideals, death denials and lack of guidelines, and more recent developments of strives towards universal concepts, “improvement” and increased bureaucracy altogether played a significant role for how palliative care has developed and is organised and conducted today. (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)

Hamilton’s Rule, named after the evolutionary biologist Bill Hamilton, and the related concepts of inclusive fitness and kin selection, have been the bedrock of the study of social evolution for the past half century. In ’The Philosophy of Social Evolution’, Jonathan Birch provides a comprehensive introduction to the conceptual foundations of the Hamiltonian view of social evolution, and a passionate defence of its enduring value in face of the recent high profile criticism. In this review essay, I first outline the (...) version of Hamilton’s Rule defended by Birch, dubbed Hamilton’s Rule General, and its derivation. With this in place, I then navigate through the fierce disagreements that Hamilton’s Rule generates among social evolution researchers and evaluate Birch’s central argument of the book that HRG serves as an organizing framework for social evolution research under which we can compare and interpret more detailed causal models. I then spend the remainder of the review discussing what I take to be three of the most exciting implications of Hamilton’s thinking raised by Birch: the extension of Hamilton’s Rule to mobile genetic elements, maximization of inclusive fitness models and the idea of adaptation as organism design, and the relationship between Hamilton’s approaches to social behaviour and the gene’s-eye view of evolution. (shrink)

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility (...) of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (shrink)

En quoi le corps participe-t-il de l'entente que l'homme a du monde? Que signifie dès lors écouter? Comment établir un rapport juste à l'animal? Quel sens prêter aux couleurs? Pourquoi la tonalité décisive de notre rapport au monde peut-elle advenir à la faveur d'expériences olfactives et gustatives? En quoi la tactilité incite-t-elle à considérer le corps vif comme une donnée originaire et à reconnaître qu'il est bien une vulnérabilité dotée d'aptitudes qui nous dispose au monde? Comment l'angoisse, révélée et cachée (...) tout à la fois par la maladie, est-elle chevillée au corps de l'être-au-monde, le Dasein? Qu'en est-il du corps dans la nostalgie, dans la mélancolie, dans l'ennui et dans la joie? Pourquoi la coexistence, supposant relations et rencontres, implique-t-elle l'articulation des corporéités vives comme dans le tact sensitif ou dans la jalousie amoureuse et dans l'amour pensé en terme de tonalité érotique? Comment comprendre la mobilité et parvenir ainsi jusqu'à l'éminente dignité ontologique du mouvement? De quoi la pensée est-elle redevable au corps? Telles sont les questions qui jalonnent cet ouvrage. Par son orientation résolument phénoménologique, l'Intelligence du corps entend renouveler l'entente du phénomène le plus proprement humain et, cependant, le plus malmené par la métaphysique. Prenant librement appui sur les vues inouïes de Martin Heidegger, consciente de l'actuelle soumission du corps de l'homme à l'arraisonnement technique, Ingrid Auriol ouvre une voie d'accès à l'intelligence du corps libérée de cette violence. (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)

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)

The main purpose of this dissertation is to examine critically and discuss the role of imagination in science and religion, with particular emphasis on its possible epistemic, creative, and meaning-making functions. In order to answer my research questions, I apply theories and concepts from contemporary philosophy of mind on scientific and religious practices. This framework allows me to explore the mental state of imagination, not as an isolated phenomenon but, rather, as one of many mental states that co-exist and interplay (...) in our cogntive architecture. Based on the philosophical discourse of philosophy of mind, four types of imagination are indentified and conceptualized: sensory, propositional, experiential, and creative imagination. These categories are then employed on five phenomena that can be found in scientific and religious environments: metaphors, models, thought experiments, aspect perception, and - in the religious case - rituals. In relation to the concept of religious "seeing" I consider how imaginings may influence visionary experiences and visualization, and compare these phenomena with cases of scientific visualization and eureka experiences. In regard to scientific and religious models, a distinction is made between, on the one hand, two notions of truth and, on the other hand, truth-independent meaning-making. In light of these categories, I differentiate between, and critically discuss, the use of imagination in doxastic, non-doxastic and fictionalist accounts. In light of this investigation, I formulate and defend the position of interactivism, which acknowledges a constant interplay between different attitudes and mental states. In my examination of rituals and scientific and religious thought experiments, special attention is given to the mental capacity to recreate the experiences that are entailed in an imagined scenario. At the end of the investigation, I consider the possible impact that my study might have on how we view science and religion as well as the dialogue bewteen these two fields. (shrink)

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

A IDENTIFICAÇÃO DO DIREITO AMBIENTAL MARÍTIMO.

A IMPORTÂNCIA DE TRATAMENTO DE ÁGUAS RESIDUAIS ATRAVÉS DA BIORREMEDIAÇÃO: UMA ANÁLISE PRINCIPIOLÓGICA.

Against the background of high demand for protein-rich feed in the EU and the environmental degradation associated with intensive livestock farming, insect-based feed is discussed as a potential sustainable alternative to conventional feed. However, the establishment of such an innovation depends not only upon technical and economic feasibility, but also on social factors impacting acceptability. The aim of this paper was to determine the acceptability of different social actor groups towards the use of insects as livestock feed, and to gain (...) insights into value-based arguments leading to positive or negative attitudes and perceived benefits and risks. By means of qualitative content analysis, we analysed responses of an EU public consultation process linked to the authorization of insect protein in pig and poultry feed. We found a broad range of value-based arguments that influence the complex judgement process of acceptability that have been neglected in prior quantitative surveys. In particular, our results bring forward more critical voices, such as animal welfare concerns and scepticism that insect-based feed can contribute to a more sustainable livestock system. Based on these findings, we discuss whether insects as feed are a viable contribution to a sustainability-oriented transformation of the agri-food system. We conclude that under certain conditions (when raised on low-value organic side streams such as manure) insect-based livestock feed may contribute to incremental sustainability improvements. Overall, however, the innovation has limitations, not only in terms of regulatory conditions but especially with regard to ethical concerns. (shrink)

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

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)

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)

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

Throughout the ages, the mystery of what happens when we die and the nature of the human mind has fascinated humankind. In this collection of essays, leading scientists and authors contemplate the nature of consciousness, quantum mechanics, string theory, dimensions, space and time, non-local space, the hologram, and the effect of death on the consciousness"--Provided by publisher.

My dissertation, “Love, Self-Constitution, and Practical Necessity,” offers an interpretation of love between people. Love is puzzling because it appears to involve essentially both rational and non-rational phenomena. We are accountable to those we love, so love seems to participate in forms of necessity, commitment, and expectation, which are associated with morality. But non-rational attitudes—forms of desire, attraction, and feeling—are also central to love. Consequently, love is not obviously based in rationality or inclination. In contrast to views that attempt to (...) fit love into existing models of practical reasoning, I argue that love participates in a unique form of practical necessity, different from both moral and psychological necessity, yet bearing resemblances to each. Distinctive to this type of practical necessity is a direct appeal to another particular person that cannot be delivered in third-personal terms—that is, a non-moral yet normative type of expectation on another person. This type of expectation is predominant in loving relationships, but can also make better sense of the experiences of humor and beauty, as well as attitudes like forgiveness, gratitude, and agent-regret. I treat Immanuel Kant’s discussion of the experience of beauty in the Critique of Judgment and Christine Korsgaard’s work on self-constitution as fruitful starting points for this account of love. I conclude that our loving relationships enable us to have distinctive personal selves, and provide support for this account of love by offering a complementary theory of grief. In Part One of the dissertation, I focus on two prominent approaches to love characteristic of the sentimentalist and rationalist traditions. I begin with the work of David Hume, which treats desire (understood as something like a simple impulse or craving) as the paradigmatic mental state, and emphasizes our personal and affective dimensions. Hume has the valuable insight that loving someone affects our sense of ourselves. But Hume’s view becomes unsatisfying when he claims that love is essentially enfeebling, implying that to love is to be passive toward and readily overcome by another person. While this indicates Hume’s awareness that love involves being open and receptive to another person, the problem is that love is also a demanding attitude. Hume lacks the conceptual resources to offer a nuanced view of the self, in which we can—with one attitude—be both demanding of and vulnerable to another person. Hume’s model of a desire-based deliberative process has recently been revived in Harry Frankfurt’s discussions on love and rationality. Frankfurt, however, goes beyond Hume’s picture of the self by introducing a notion of “identification,” which he offers to make sense of our apparent ability to commit ourselves decisively to certain projects or people. I argue that active powers like identification and commitment cannot be accommodated within any basically Humean moral psychology. Such abilities, and with them the possibility of love, depend on something closer to a Kantian conception of rational agency. I next focus on the work of Kant, who provides the substantial counterpart to Humean-inspired moral theories, but is not known for his insight into our emotional lives. In the Metaphysics of Morals, Kant divides love into “practical love”—what we experience when we are morally motivated to help someone—and “pathological love”—what we experience when we feel fond of something. But in reality, we experience love neither as a mere preference for another person, nor as something that generates the kind of demands that would be binding on any rational creature. David Velleman attempts to remedy the deficiency of Kant’s dichotomy. Velleman offers a Kantian theory in which he describes love and respect as two ends of a continuum of attitudes that it is morally appropriate to have toward people. Velleman’s view has the peculiar implication that everyone deserves the love of everyone else, and I argue that this is a fatal flaw. Like Kant and Velleman, Korsgaard characterizes personal love as involving the treatment of other people as Kantian ends-in-themselves to a heightened degree. Korsgaard, though, also contends that our individual identities depend upon our personal relationships, and I take this position seriously for the remainder of the dissertation. Ultimately, however, characterizations of loving relations as subsets of moral relations can account for the authority of the demands of love, but not its particularity. The major conclusion of Part One is that any attempt to understand love primarily on a model of practical reasoning with which we are already familiar is doomed to fail. Our experience of love calls for a theory of a unique type of practical necessity. In Part Two I take seriously the possibility that love is simultaneously inescapable (in something like the way morality is supposed to be), and yet ineluctably personal. In love, we experience an engagement with a person as essentially particular, rather than as an instance of a rational agent in general. To make sense of this direct attachment to an individual, I argue that love involves distinctive forms of expectation and disappointment. When those we love let us down, they hurt our feelings, which is not a response to a failed prediction, but nor is it a reaction to a moral insult or offense. According to Peter Strawson and Stephen Darwall, second-personal moral reactive attitudes (such as resentment) always have third-personal analogues (such as indignation). In contrast, I argue that the type of hurt feelings associated with love is a second-personal reactive attitude that does not have a third-personal corollary. I take this as evidence that the expectations involved in love are not objective in the way that the moral is objective. Nor, however, is love a matter of mere preference. On my interpretation, Kant introduces this different type of expectation in the Critique of Judgment. Whereas he characterizes moral judgments as universally communicable, judgments of beauty implicitly involve only second-personal address: I appeal to your direct experience with a particular object. This provides the conceptual space for an account of love according to which it involves a uniquely second-personal form of practical necessity. I contend that the second-personal addresses we make in love are appeals to strengthen the intimacy implicit in the loving relationship, and I identify three interrelated dimensions of that intimacy. First, those we love have the standing to interpret us in a constitutive manner. We fine-tune and make determinate the character of our concerns and interests in part by accepting the interpretations provided by those we love. In that way, the people we love have the normative power to constitute who we are. Second, we share a perspective with those we love in a way that is not reducible to or derivative of our independent perspectives. Loving someone centrally involves the activity of forming concerns together, and we do this in a mode best understood on the model of playing a spontaneous game or improvising music. Finally, being loved enables us to see ourselves as distinctive and special, because the concern those who love us have for us does not track the objective merit of our characteristics. These dimensions of the intimacy that characterizes a loving relationship reveal what it is that we appeal for in love, and how we are hurt when our appeals are rebuffed. In broad terms, this dissertation advocates the recognition of a non-moral yet normative type of expectation, which is predominant in loving relationships. Humor and beauty, too, make more sense when understood in terms of this non-moral yet normative type of expectation, as they involve appeals to others that are more than mere predictions of, but less than rational demands for, a certain kind of response. Introducing this alternative notion of expectation into the discourse of moral philosophy can shed light on other common attitudes that are clearly normative, but defy translation into objective, third-personal terms. Such attitudes include certain experiences of pride and shame, apology and forgiveness, the bestowing of mercy, gratitude, agent-regret, and perhaps a basic sense of trust we have in others. Ultimately, I situate love in respect to grief, which demonstrates my theory’s ability to make sense of related dimensions of our emotional lives. The people we love and grieve over give us a sense of who we are as distinctive, particular individuals, as the three interrelated dimensions of intimacy in loving relationships reveal. Consequently, grief is best understood as a type of practical disorientation—namely, a disorientation that involves the loss of the personal self. I present my account of grief against the type of account that would draw philosophical conclusions about the nature of love and grief from empirical psychological data alone. In particular, these data indicate that we recover quickly from the deaths of loved ones, and Dan Moller draws the philosophical conclusion that those we love fulfill certain roles in our lives and are replaceable. In contrast, I contend that while we should acknowledge the truth of the objective judgment, made in the third-person, that we will likely recover after the deaths of those we love, it does not follow that we must affirm such a claim from the internal perspective of one person who loves another. As a result, the case of love and grief supports a general claim concerning the proper work of moral philosophy, which is that the understanding of ourselves gained through empirical data is not a substitute for the normative conclusions that are revealed through first-personal reflections on our relationships. (shrink)

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)

For many, the Holocaust made thinking about ethics in traditional ways impossible. It called into question the predominance of speculative ontology in Western thought, and left many arguing that Western political, cultural and philosophical inattention to universal ethics were both a cause and an effect of European civilization's collapse in the twentieth century. Emmanuel Levinas, Elie Wiesel and Richard Rubenstein respond to this problem by insisting that ethics must be Western thought's first concern. Unlike previous thinkers, they locate humanity's source (...) of universal ethical obligation in the temporal world of experience, where human suffering, rather than metaphysics, provides the ground for ethical engagement. All three thinkers contend that Judaism’s key lesson is that our fellow human is our responsibility, and use Judaism to develop a contemporary ethics that could operate with or without God. _Ethics and Suffering since the Holocaust_ explores selected works of Levinas, Wiesel, and Rubenstein for practical applications of their ethics, analyzing the role of suffering and examining the use each thinker makes of Jewish sources and the advantages and disadvantages of this use. Finally, it suggests how the work of Jewish thinkers living in the wake of the Holocaust can be of unique value to those interested in the problem of ethics in the twentieth and twenty-first centuries. Presenting a thorough investigation of the work of Levinas, Wiesel and Rubinstein, this book is of key interest to students and scholars of Jewish studies, as well as Jewish ethics and philosophy. (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)

Social enterprises are seen as innovative towards solving societal problems, but little research exists on possible negative aspects, the so‐called dark sides. In this study, the emphasis is on dark sides of social entrepreneurship, how they are managed, and how systems thinking can contribute towards managing these effects. Dark sides of social entrepreneurship can take many forms, like unethical or insincere motives and unintended outcomes like the negative impact on the well‐being of founders and employees, but they are also a (...) call for a critical reflection on the role of the government in society and the economic system social enterprises have to operate in. This paper aims to contribute to the dark side theory of social entrepreneurship by linking system archetypes to themes of dark side thereby stressing how management strategies act as balancing feedback loops to mitigate or prevent dark sides. A qualitative research was conducted by interviewing 21 respondents who play an important role in the world of social entrepreneurship in Belgium. The results show that dark sides of social enterprises manifest itself mostly in the form of trade‐offs and financial, business, and management related issues. Taking over the habits of profit‐oriented companies emerged as a new dark side element. Management strategies include anchoring goals, transparency, obtaining external views, changing the system, and above all reflection. The latter is an important first step to become aware of these issues to be able to change the negative dynamism of these dark sides. (shrink)

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

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

Research on gender and antimicrobial resistance (AMR) beyond women’s biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people’s diverse identities and experiences, including their gender, socio-economic status, race, disability, age, (...) and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice. (shrink)