Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? In (...) this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project ‘Bioethics in Theory and Practice’. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics. (shrink)
I introduce a mathematical account of expectation based on a qualitative criterion of coherence for qualitative comparisons between gambles (or random quantities). The qualitative comparisons may be interpreted as an agent’s comparative preference judgments over options or more directly as an agent’s comparative expectation judgments over random quantities. The criterion of coherence is reminiscent of de Finetti’s quantitative criterion of coherence for betting, yet it does not impose an Archimedean condition on an agent’s comparative judgments, it does not require the (...) binary relation reflecting an agent’s comparative judgments to be reflexive, complete or even transitive, and it applies to an absolutely arbitrary collection of gambles, free of structural conditions (e.g., closure, measurability, etc.). Moreover, unlike de Finetti’s criterion of coherence, the qualitative criterion respects the principle of weak dominance, a standard of rational decision making that obliges an agent to reject a gamble that is possibly worse and certainly no better than another gamble available for choice. Despite these weak assumptions, I establish a qualitative analogue of de Finetti’s Fundamental Theorem of Prevision, from which it follows that any coherent system of comparative expectations can be extended to a weakly ordered coherent system of comparative expectations over any collection of gambles containing the initial set of gambles of interest. The extended weakly ordered coherent system of comparative expectations satisfies familiar additivity and scale invariance postulates (i.e., independence) when the extended collection forms a linear space. In the course of these developments, I recast de Finetti’s quantitative account of coherent prevision in the qualitative framework adopted in this article. I show that comparative previsions satisfy qualitative analogues of de Finetti’s famous bookmaking theorem and his Fundamental Theorem of Prevision.The results of this article complement those of another article (Pedersen, Strictly coherent preferences, no holds barred, Manuscript, 2013). I explain how those results entail that any coherent weakly ordered system of comparative expectations over a unital linear space can be represented by an expectation function taking values in a (possibly non-Archimedean) totally ordered field extension of the system of real numbers. The ordered field extension consists of formal power series in a single infinitesimal, a natural and economical representation that provides a relief map tracing numerical non-Archimedean features to qualitative non-Archimedean features. (shrink)
Jean-Philippe Deranty, Beyond Communication: A Critical Study of Axel Honneth's Social Philosophy Content Type Journal Article Category Book Review Pages 497-500 Authors Jørgen Pedersen, The Centre for the Study of the Sciences and the Humanities, Bergen, Norway Journal Critical Horizons: A Journal of Philosophy & Social Theory Online ISSN 1568-5160 Print ISSN 1440-9917 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / 2010.
Robert Sokolowski: Phenomenology of the Human Person Content Type Journal Article DOI 10.1007/s10746-010-9145-x Authors Hans Pedersen, Department of Philosophy, Indiana University of Pennsylvania, Indiana, PA USA Journal Human Studies Online ISSN 1572-851X Print ISSN 0163-8548 Journal Volume Volume 33 Journal Issue Volume 33, Numbers 2-3.
This article details Cultural DeCoding, a humanities based high school extension program for gifted and talented Year 11 and 12 students in Western Australia. The brainchild of Dr Annette Pedersen and Dr Angela McCarthy, the program runs for four days across the summer holidays before the start of the school term. The program fills a gap that exists in the education of gifted and talented secondary students who are interested in the humanities. It is comprised of sessions run by academics (...) who facilitate discussion and activities based on their area of research and teaching expertise. The group is deliberately kept small in order to give students a chance to engage deeply and respectfully with like-minded others. The intention is to give these students an experience of what university will be like, and to have a chance to think philosophically; namely, critically, creatively and morally, in collaboration with others. (shrink)
Table of Contents -/- 1. Introduction and Overview: Two Entitlement Projects, Peter J. Graham, Nikolaj J.L.L. Pedersen, Zachary Bachman, and Luis Rosa -/- Part I. Engaging Burge's Project -/- 2. Entitlement: The Basis of Empirical Warrant, Tyler Burge 3. Perceptual Entitlement and Scepticism, Anthony Brueckner and Jon Altschul 4. Epistemic Entitlement Its Scope and Limits, Mikkel Gerken 5. Why Should Warrant Persist in Demon Worlds?, Peter J. Graham -/- Part II. Extending the Externalist Project -/- 6. Epistemic Entitlement and Epistemic (...) Competence, Ernest Sosa 7. Extended Entitlement, Adam Carter and Duncan Pritchard 8. Moorean Pragmatics, Social Comparisons and Common Knowledge, Allan Hazlett 9. Internalism and Entitlement to Rules and Methods, Joshua Schecter -/- Part III. Engaging Wright's Project -/- 10. Full Bloodied Entitlement, Martin Smith 11. Pluralist Consequentialist Anti-Scepticism, Nikolaj Jang Lee Linding Pedersen 12. Against (Neo-Wittensteinian) Entitlements, Annalisa Coliva 13. The Truth Fairy and the Indirect Consequentialist, Daniel Elstein and Carrie S. I. Jenkins 14. Knowledge for Nothing, Patrick Greenough . (shrink)
In Balanced Wonder, Jan B. W. Pedersen digs deep into the alluring topic of wonder, in dialogue with Neo-Aristotelian philosophers, arguing that the experience of wonder, when balanced, serves as a strong contributor to human flourishing.
Dilation occurs when an interval probability estimate of some event E is properly included in the interval probability estimate of E conditional on every event F of some partition, which means that one’s initial estimate of E becomes less precise no matter how an experiment turns out. Critics maintain that dilation is a pathological feature of imprecise probability models, while others have thought the problem is with Bayesian updating. However, two points are often overlooked: (1) knowing that E is stochastically (...) independent of F (for all F in a partition of the underlying state space) is sufficient to avoid dilation, but (2) stochastic independence is not the only independence concept at play within imprecise probability models. In this paper we give a simple characterization of dilation formulated in terms of deviation from stochastic independence, propose a measure of dilation, and distinguish between proper and improper dilation. Through this we revisit the most sensational examples of dilation, which play up independence between dilator and dilatee, and find the sensationalism undermined by either fallacious reasoning with imprecise probabilities or improperly constructed imprecise probability models. (shrink)
We review the "Entitlement" projects of Tyler Burge and Crispin Wright in light of recent work from and surrounding both philosophers. Our review dispels three misunderstandings. First, Burge and Wright are not involved in a common “entitlement” project. Second, though for both Wright and Burge entitlement is the new notion, “entitlement” is not some altogether third topic not clearly connected to the nature of knowledge or the encounter with skepticism. Third, entitlement vs. justification does not align with the externalism vs. (...) internalism distinction. (shrink)
Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The (...) aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (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)
Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to (...) clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services. (shrink)
Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.
Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers’ needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these (...) challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices. (shrink)
The aim of this paper is to provide an overview of various forms of alethic pluralism. Along the way we will draw a number of distinctions that, hopefully, will be useful in mapping the pluralist landscape. Finally, we will argue that a commitment to alethic disjunctivism, a certain brand of pluralism, might be difficult to avoid for adherents of the other pluralist views to be discussed. We will proceed as follows: Section 1 introduces alethic monism and alethic pluralism. Section 2 (...) presents a distinction between strong and moderate versions of monism and pluralism, understood as theses about the existence of truth properties. Section 3 introduces four pluralist positions: strong alethic pluralism, alethic disjunctivism, second-order functionalism and manifestation functionalism. These positions are classified using the basic framework from Section 2, and a further distinction between pure and mixed versions of pluralism is drawn. Interestingly, alethic disjunctivism and the two kinds of functionalism—i.e. three out of four positions— have a mixed character. They incorporate a monist thesis. The only pure form of pluralism is strong alethic pluralism. Section 4 adds another distinction to the stock: one-level and two-level views. Each of the mixed positions operates with two levels, locating certain “alethically potent”—or grounding—properties at a lower level and others at a higher level. We briefly discuss the nature of grounding. In Section 5, we answer a question about mixed, two-level views, viz. whether they are as much monist as pluralist in nature, or more. They are not. Section 6 is devoted to the task of arguing that the strong pluralist, the second-order functionalist, and the manifestation functionalist will find it hard to deny a commitment to alethic disjunctivism. (shrink)
The first clinical ethics committees in Norway were established in 1996. This started as an initiative from hospital clinicians, the Norwegian Medical Association, and health authorities and politicians. Norwegian hospitals are, by and large, publicly funded through taxation, and all inpatient treatment is free of charge. Today, all the 23 hospital trusts have established at least one committee. Center for Medical Ethics , University of Oslo, receives an annual amount of US$335,000 from the Ministry of Health and Care Services to (...) coordinate the committees and to facilitate competency building for committee members. (shrink)
Alethic pluralism is the view that the nature of truth is not uniform across domains. There are several ways of bang true $(T_1 ...\,T_n )$ A simple argument, the 'instability challenge', purports to show that this view is inherently unstable. One can simply say that something is uniformly true if and only if it is T₁ or ... or $\,T_n $ . Being uniformly true is a single truth property that applies across the board, and so the nature of truth (...) is uniform across domains, contra pluralism. I defend pluralism against the instability challenge. I show that the challenge bifurcates: one Challenge is formulated in terms of predicates, and the other is formulated in terms of properties. Vie pluralist has the resources to defuse both of these. The sparse/abundant property distinction and considerations of explanatory asymmetry play a crucial role in my argument. (shrink)
Here is a well-known thought about truth: Truth consists in correspondence with reality. A sentence is true just in case what it says corresponds with how the world is. Theories of truth that incorporate this thought are naturally regarded as robust or “heavyweight”. Truth is to be understood in a realist fashion. The world decides what is true and what is not. A recent incarnation of the correspondence view is found in truth-maker theories, whose adherents maintain that truths are true (...) in virtue of there being something – a truth-maker – in the world that makes them so.2. (shrink)
The objective of this paper is to examine the relationship between business model innovation, corporate sustainability, and the underlying organisational values. Moreover, the paper examines how the three dimensions correlate with corporate financial performance. It is concluded that companies with innovative business models are more likely to address corporate sustainability and that business model innovation and corporate sustainability alike are typically found in organisations rooted in values of flexibility and discretion. Business model innovation and corporate sustainability thus seem to have (...) their origin in the fundamental principles guiding the organisation. In addition, the study also finds a positive relationship between the core organisational values and financial performance. The analysis of the paper is based on survey responses from 492 managers within the Swedish fashion industry. (shrink)
This paper offers a discussion of metaphysical pluralism, alethic pluralism, and logical pluralism. According to the metaphysical pluralist, there are several ways of being. According to the alethic pluralist, there are several ways of being true, and according to the logical pluralist, there are several ways of being valid. Each of these three forms of pluralism will be considered on its own, but the ambition of the paper is to explore possible connections between them. My primary objective is to present (...) and develop a positive account according to which the different forms of pluralism are intimately related. I will proceed in two steps. First, I will investigate the connection between alethic pluralism and logical pluralism. I will argue that a certain version of alethic pluralism supports logical pluralism. Second, I will connect alethic pluralism and logical pluralism to metaphysical pluralism. I will suggest that the former two are at least partly founded on the latter. (shrink)
In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?
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)
Pluralistic ignorance is a socio-psychological phenomenon that involves a systematic discrepancy between people’s private beliefs and public behavior in certain social contexts. Recently, pluralistic ignorance has gained increased attention in formal and social epistemology. But to get clear on what precisely a formal and social epistemological account of pluralistic ignorance should look like, we need answers to at least the following two questions: What exactly is the phenomenon of pluralistic ignorance? And can the phenomenon arise among perfectly rational agents? In (...) this paper, we propose answers to both these questions. First, we characterize different versions of pluralistic ignorance and define the version that we claim most adequately captures the examples cited as paradigmatic cases of pluralistic ignorance in the literature. In doing so, we will stress certain key epistemic and social interactive aspects of the phenomenon. Second, given our characterization of pluralistic ignorance, we argue that the phenomenon can indeed arise in groups of perfectly rational agents. This, in turn, ensures that the tools of formal epistemology can be fully utilized to reason about pluralistic ignorance. (shrink)
Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)
An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)
Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, (...) conflict, and 'outsiders' are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well-known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. (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: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)
In this paper I discuss two fundamental challenges concerning Crispin Wright's notion of entitlement of cognitive project: firstly, whether entitlement is an epistemic kind of warrant since, seemingly, it is not underwritten by epistemic reasons, and, secondly, whether, in the absence of such reasons, the kind of rationality associated with entitlement is epistemic in nature. The paper investigates three possible lines of response to these challenges. According to the first line of response, entitlement of cognitive project is underwritten by epistemic (...) reasons – and thus supports epistemic rationality – because, when P is an entitlement, trust in P is a dominant strategy with respect to promotion of epistemic value. The second line of response replaces dominance with maximization of expected utility. I argue that both of these proposals are flawed and develop an alternative line of response. (shrink)
The relative merits and demerits of historically prominent views such as the correspondence theory, coherentism, pragmatism, verificationism, and instrumentalism have been subject to much attention in the truth literature and have fueled the long-lived debate over which of these views is the most plausible one. While diverging in their specific philosophical commitments, adherents of these historically prominent views agree in at least one fundamental respect. They are all alethic monists. They all endorse the thesis that there is only one property (...) in virtue of which propositions can be true, and so, in this sense, take truth to be one. The truth pluralist, on the other hand, rejects this idea. There are several properties in virtue of which propositions can be true. The literature on truth pluralism has been growing steadily for the past twenty years. This volume, however, is the first of its kind—the first collection of papers focused specifically on pluralism about truth. Part I is dedicated to the development, investigation, and critical discussion of different forms of pluralism. An additional reason to look at truth pluralism with interest is the significant connections it bears to other debates in the truth literature—the debates concerning traditional theories of truth and the deflationism/inflationism divide being cases in hand. Parts II and III of the volume connect truth pluralism to these two debates. (shrink)
We offer a critical survey of the most discussed accounts of epistemic peer disagreement that are found in the recent literature. We also sketch an alternative approach in line with a pluralist understanding of epistemic rationality.
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)
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)
Artificial intelligence receives attention in media as well as in academe and business. In media coverage and reporting, AI is predominantly described in contrasted terms, either as the ultimate solution to all human problems or the ultimate threat to all human existence. In academe, the focus of computer scientists is on developing systems that function, whereas philosophy scholars theorize about the implications of this functionality for human life. In the interface between technology and philosophy there is, however, one imperative aspect (...) of AI yet to be articulated: how do intelligent systems make inferences? We use the overarching concept “Artificial Intelligent Behaviour” which would include both cognition/processing and judgment/behaviour. We argue that due to the complexity and opacity of artificial inference, one needs to initiate systematic empirical studies of artificial intelligent behavior similar to what has previously been done to study human cognition, judgment and decision making. This will provide valid knowledge, outside of what current computer science methods can offer, about the judgments and decisions made by intelligent systems. Moreover, outside academe—in the public as well as the private sector—expertise in epistemology, critical thinking and reasoning are crucial to ensure human oversight of the artificial intelligent judgments and decisions that are made, because only competent human insight into AI-inference processes will ensure accountability. Such insights require systematic studies of AI-behaviour founded on the natural sciences and philosophy, as well as the employment of methodologies from the cognitive and behavioral sciences. (shrink)
The Norwegian Parliament has decided to give priority to ethics in municipal health services. This priority is supposed to raise competence in ethics within municipal health services. As part of the national project, the participating municipalities were encouraged to develop and carry out local projects. In this article, we present a local ethics project in one of the participating municipalities in central eastern Norway. The local project for raising competence in ethics was carried out in cooperation with researchers at the (...) Centre for Medical Ethics (CME) at the University of Oslo. Most people agree that ethics are important in health services. However, there are many ways to increase competence in ethics and to stimulate ethical reflection. In this article we present a broad overview of this local ethics project, but special focus will be put on presenting the actions that have been used for increasing the level of ethical competence and stimulating ethical reflection among the participants. We describe our evaluation of the project and the research we carried out. Explanations will be given for the thought process behind the decisions that were made. (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)
Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.