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)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports from (...) the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (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)

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)

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

In this article, Herrie and Sørensen examine the mediation of typing indicators (“…”) in online messaging. Their point of departure is a scene from the contemporary novel Exciting Times by Naoise Dolan (2020), in which the ‘dots’ play a prominent role. Their analysis shows how typing indicators, as interface design, mediate the complex communication situation in which they take part: from being mere signals, they have slipped into our emotional lives. From a semiotic perspective (Charles S. Peirce), the authors define (...) typing indicators as uncertain indices which through unknowability and suspense establish an attentional presence. In continuation hereof, the authors argue that the acts of writing and waiting in contemporary attentional ecologies (Yves Citton) through the mediation of typing indicators as indicators of attentional presence, could be considered a mode of caring (Bernard Stiegler). (shrink)

In this article, I critically assess Hélène Landemore's new model of Open Democracy, asking whether it requires of citizens to blindly defer to the decisions of the mini-public. To address this question, I, first, discuss three institutional mechanisms in Open Democracy, all of which can be read to grant citizens democratic control. I argue that neither the capacity to authorize the selection mechanism (random sortition), nor the lottocratic conception of political equality, nor the self-selection mechanisms of Landemore's model deliver the (...) form of control that would insulate Open Democracy from the charge of blind deference. I then discuss the direct democracy mechanisms that Landemore incorporates into her model. Although these devices grant citizens control and, by extension, offer the resources for repudiating the charge of blind deference, they also, I argue, subvert the logic of Landemore's lottocratic model, rendering Open Democracy predictably unstable. Given the deliberative asymmetries between the mini-public and the citizenry, a high frequency of bottom-up challenges is to be expected that would throw the whole system into jeopardy. Thus, the challenge for lottocrats is to show how democratic control can be achieved in a lottocratic system without undermining the benefits of the legislature by lot. (shrink)

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

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)

(1999). Love, politics, and the Victorians: Liberal feminism and the politics of social integration. The European Legacy: Vol. 4, Ideas and Beliefs of the Victorians, pp. 42-57.

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)

The discussion on mandatory turnout, which controversially introduces coercion at the heart of the electoral process, illustrates a dilemma between increasing voter turnout on the one hand and avoiding coercion on the other. If successful, a recent proposal by Elliott solves this dilemma as it removes the compulsory element of mandatory turnout. Specifically, Elliot reinterprets the policy’s purpose as (a) a pre-commitment device for those who believe that they have a duty to vote and (b) a nudge to the surveillance (...) of politics for those who do not believe this. We critically evaluate Elliott’s novel intervention in the debate and argue that it is ultimately unsuccessful. Mandatory turnout can be interpreted as neither a pre-commitment device nor a nudge. Moreover, we present a more promising and novel solution to the dilemma: a genuine state-administered pre-commitment device with respect to voting that also nudges citizens to vote and seems _prima facie_ attractive. (shrink)

The Covid-19 pandemic creates an unprecedented threatening situation worldwide with an urgent need for critical reflection and new knowledge production, but also a need for imminent action despite prevailing knowledge gaps and multilevel uncertainty. With regard to the role of research ethics in these pandemic times some argue in favor of exceptionalism, others, including the authors of this paper, emphasize the urgent need to remain committed to core ethical principles and fundamental human rights obligations all reflected in research regulations and (...) guidelines carefully crafted over time. In this paper we disentangle some of the arguments put forward in the ongoing debate about Covid-19 human challenge studies and the concomitant role of health-related research ethics in pandemic times. We suggest it might be helpful to think through a lens differentiating between risk, strict uncertainty and ignorance. We provide some examples of lessons learned by harm done in the name of research in the past and discuss the relevance of this legacy in the current situation. (shrink)

In this critical comment, we argue that nondemocratic, but decent regimes fail to constitute legitimate governance under Applbaum’s free group agency account. To make this case, we first introduce the three principles of liberty, equality and agency that Applbaum takes to flow directly from his free agency conception of legitimacy. Against this backdrop, we discuss Applbaum’s claim that a nondemocratic regime along the lines of a Rawlsian decent consultation hierarchy could meet the threshold of legitimacy. Contrary to this suggestion, we (...) argue that nondemocratic, but decent regimes cannot claim legitimacy under Applbaum’s account because they are constitutively inegalitarian, thus failing to adequately grant citizens the equal normative power without which legitimacy is unattainable under the free group agency account. (shrink)

At the top of his ethical system Aristotle placed, as the supreme value, eudai- monia (happiness). But what does this really mean? ...

Within the caring science paradigm, variations of a method of interpretation inspired by the French philosopher Paul Ricoeur's theory of interpretation are used. This method consists of several levels of interpretation: a naïve reading, a structural analysis, and a critical analysis and discussion. Within this paradigm, the aim of this article is to present and discuss a means of creating distance in the interpretation and the text structure by using narration in a poetic language linked to the meaning of the (...) text. Ricoeur's ‘Hermeneutical function of distanciation’ will be introduced, and this concept of distanciation will be illustrated with reference to narrations from a study of patient's life experiences living with chronic illness and home mechanical ventilation in Denmark. Distanciation in the interpretation objectifies the text, and narration in a poetic language creates a particular kind of mediation in the interpretation. That narration represents an interpreted understanding of the whole, which facilitates an appropriate and evocative presentation of the interpreted data. This way of objectifying the text through narration can contribute yet another perspective to Ricoeur's rich and varied theory of interpretation. (shrink)

From Stoicism to Platonism describes the change in philosophy from around 100 BCE, when monistic Stoicism was the strongest dogmatic school in philosophy, to around 100 CE, when dualistic Platonism began to gain the upper hand - with huge consequences for all later Western philosophy and for Christianity. It is distinguished by querying traditional categories like 'eclecticism' and 'harmonization' as means of describing the period. Instead, it highlights different strategies of 'appropriation' of one school's doctrines by philosophers from the other (...) school, with all philosophers being highly conscious of their own identity. The book also sets out to break down the traditional boundaries between, on the one hand, the study of Greco-Roman philosophy in the period and, on the other hand, that of contemporary Hellenistic Jewish and early Christian writings with a philosophical profile. In these ways, the book opens up an immensely fruitful period in the history of philosophy. (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)

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)

Various authors see human flourishing as the overarching aim to which education should contribute. We ask whether fostering _wonder_ can help education attain this aim. We discuss two possibilities: firstly, it may be that having a sense of wonder as adults (possibly fostered by and/or refined due to education) contributes to flourishing itself. Secondly, it may be that fostering wonder in education increases the likelihood that education promotes flourishing, which it might do simply by increasing children’s intrinsic interest in what (...) they learn. We argue that there are many plausible connections between wonder and human flourishing (relating to its epistemic and aesthetic dimensions, among others), and that we have reason to believe that early experiences can influence adults’ capacity for wonder. Furthermore, wonder increases the likelihood that education ‘succeeds’; and it supports people’s ability to live well by heightening their appreciation for the world, helping to uncover baseless beliefs, and increasing their awareness of possible goods. In sum, while having a sense of wonder may not be a constitutive element of human flourishing, it is hard to imagine education for human flourishing that is not also wonder-full education. (shrink)

Managing aggression in mental health hospitals is an important and challenging task for clinical nursing staff. A majority of studies focus on the perspective of clinicians, and research mainly depicts aggression by referring to patient-related factors. This qualitative study investigates how aggression is communicated in forensic mental health nursing records. The aim of the study was to gain insight into the discursive practices used by forensic mental health nursing staff when they record observed aggressive incidents. Textual accounts were extracted from (...) the Staff Observation Aggression Scale-Revised (SOAS-R), and Fairclough’s Critical Discourse Analysis was used to identify short narrative entries depicting patients and staffs in typical ways. The narratives contained descriptions of complex interactions between patient and staff that were linked to specific circumstances surrounding the patient. These antecedents, combined with the aggression incident itself, created stereotyping representations of forensic psychiatric patients as deviant, unpredictable and dangerous. Patient and staff identities were continually (re)produced by an automatic response from the staff that was solely focused on the patient’s behavior. Such response might impede implementation of new strategies for managing aggression. (shrink)

This article elaborates on foundational issues in the social sciences and their impact on the contemporary theory of belief revision. Recent work in the foundations of economics has focused on the role external social norms play in choice. Amartya Sen has argued in [Sen93] that the traditional rationalizability approach used in the theory of rational choice has serious problems accommodating the role of social norms. Sen's more recent work [Sen96, Sen97] proposes how one might represent social norms in the theory (...) of choice, and in a very recent article [BS07] Walter Bossert and Kotaro Suzumura develop Sen's proposal, offering an extension of the classical theory of choice that is capable of dealing with social norms. The first part of this article offers an alternative functional characterization of the extended notion of rationality employed by Bossert and Suzumura in [BS07]. This characterization, unlike the one offered in [BS07], represents a norm-sensitive notion of rationality in terms of a pure functional constraint unmediated by a notion of revealed preference (something that is crucial for the application developed in the second part of this article). This functional characterization is formulated for general domains (as is Bossert and Suzumura's characterization) and is therefore empirically more applicable than usual characterizations of rationality. Interestingly, the functional constraint we propose is a variant of a condition first entertained in [AGM85] by Carlos Alchourrón, Peter Gärdenfors and David Makinson in the area of belief change. The second part of this article applies the theory developed in the first part to the realm of belief change. We first point out that social norms can be invoked to concoct counterexamples against some postulates of belief change (like postulate (*7)) that are necessary for belief change to be relational. These examples constitute the epistemological counterpart of Sen's counterexamples against condition α in rational choice (as a matter of fact, Rott has showed in [Rot01] that condition and postulate (*7) are mutually mappable). These examples are variants of examples Rott has recently presented in [Rot04]. One of our main goals in this article consists in applying the theory developed in the first part to develop a theory of norm-inclusive belief change that circumvents the counterexamples. We offer a new axiomatization for belief change and we furnish correspondence results relating constraints of rational choice to postulates of belief change. (shrink)

A growing number of consumer technology companies are aiming to convince older people that humanoid robots make helpful tools to support aging-in-place. As hybrid devices, socially assistive robots (SARs) are situated between health monitoring tools, familiar digital assistants, security aids, and more advanced AI-powered devices. Consequently, they implicate older people’s privacy in complex ways. Such devices are marketed to perform functions common to smart speakers (e.g., Amazon Echo) and smart home platforms (e.g., Google Home), while other functions are more specific (...) to older people, including health and safety monitoring and serving as companions to mitigate loneliness. Privacy is a key value central to debates about the ethics of using SARs in aged care, yet there has been very little interchange between these debates and the robust theoretical discussion in the legal literature about the future of privacy and AI governance. Drawing on two qualitative studies of older people’s views on consumer SARs, the paper contributes novel findings about older people’s thinking on privacy and data governance at the intersection of their experiences with present day digital technologies and projections for future AI systems, and places their views in dialogue with debates about the future of privacy protection and AI governance. (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)