Background:Less sedated and more awake patients in the intensive care unit may cause ethical challenges.Research objectives:The purpose of this study is to describe ethical challenges registered nurses experience when patients refuse care and treatment.Research design:Narrative individual open interviews were conducted, and data were analysed using a phenomenological hermeneutic method developed for researching life experiences.Participants and research context:Three intensive care registered nurses from an intensive care unit at a university hospital in Norway were included.Ethical considerations:Norwegian Social Science Data Services approved the (...) study. Permission was obtained from the intensive care unit leader. The participants’ informed and voluntary consent was obtained in writing.Findings:Registered nurses experienced ethical challenges in the balance between situations of deciding on behalf of the patient, persuading the patient and letting the patient decide. Ethical challenges were related to patients being harmful to themselves, not keeping up personal hygiene and care or hindering critical treatment.Discussion:It is made apparent how professional ethics may be threatened by more pragmatic arguments. In recent years, registered nurses are faced with increasing ethical challenges to do no harm and maintain dignity.Conclusion:Ethically challenging situations are emerging, due to new targets including conscious and aware critical care patients, leaving an altered responsibility on the registered nurses. Reflection is required to adjust the course when personal and professional ideals no longer are in harmony with the reality in the clinical practice. RNs must maintain a strong integrity as authentic human beings to provide holistic nursing care. (shrink)

O objetivo central neste artigo é o de explicar o que é testemunho e como ele produz conhecimento e justificação. Conforme essa concepção, o testemunho é uma importante e habitual fonte de conhecimento e de justificação, bem como um conceito relevante em epistemologia social, comunicação e psicologia da aquisição de crença. Apesar de o testemunho, nessa concepção, não ser considerado uma fonte básica de conhecimento e justificação, é alegado que ele é uma fonte de conhecimento básico pois crenças básicas não (...) precisariam derivar de uma fonte básica. Assim, novas crenças podem ser geradas a partir do testemunho, mas novo conhecimento não pode ser produzido a não ser a partir de conhecimento anterior. Apesar disso, a posição defendida neste artigo considera que, mesmo que a justificação com base no testemunho seja, em última instância, dependente de outras fontes de justificação, o testemunho constitui uma fonte essencial tanto de conhecimento como de justificação. (shrink)

Secondary use of clinical data in research or learning activities (SeConts) has the potential to improve patient care and biomedical knowledge. Given this potential, the ethical question arises whether physicians have a professional duty to support SeConts. To investigate this question, we analyze prominent international declarations on physicians’ professional ethics to determine whether they include duties that can be considered as good reasons for a physicians’ professional duty to support SeConts. Next, we examine these documents to identify professional duties that (...) might conflict with a potential duty of physicians to support SeConts. (shrink)

BackgroundResearch using data from medical care promises to advance medical science and improve healthcare. Academia is not the only sector that expects such research to be of great benefit. The research-based health industry is also interested in so-called ‘real-world’ health data to develop new drugs, medical technologies or data-based health applications. While access to medical data is handled very differently in different countries, and some empirical data suggest people are uncomfortable with the idea of companies accessing health information, this paper (...) aims to advance the ethical debate about secondary use of medical data generated in the public healthcare sector by for-profit companies for medical research (ReuseForPro).MethodsWe first clarify some basic concepts and our ethical-normative approach, then discuss and ethically evaluate potential claims and interests of relevant stakeholders: patients as data subjects in the public healthcare system, for-profit companies, the public, and physicians and their healthcare institutions. Finally, we address the tensions between legitimate claims of different stakeholders in order to suggest conditions that might ensure ethically sound ReuseForPro.ResultsWe conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients’ informational rights and their actions need to be compatible with the public’s interest in health benefit from ReuseForPro. (shrink)

Background Changes in health needs led to an increase in virtual care practices such as telemedicine. Nursing plays an essential role in this practice as it is the key to accessing the healthcare system. It is important that this branch of nursing is developed considering all the ethical aspects of nursing care, and not just the legal concepts of the practice. However, this question has not been widely explored in the literature and it is of crucial relevance in the new (...) concept of care. Objective The purpose of this scoping review is to identify the ethical aspects of the development of telemedicine from a nursing practice perspective. Methods A scoping review of the literature based on Arksey and O’Malley’s framework. The search was conducted in Scopus, PubMed/MEDLINE and CINAHL databases, from 2012 to 2022. A total of 1322 articles were retrieved, of which 12 met the inclusion criteria. Ethical considerations The research was conducted in accordance with the best scientific practices. Findings The most relevant aspects were the safety of the patient, the benefits for the user and the digital competence of the professionals. Informed consent and patient’s willingness to use new technologies were relevant to the practice, as was person-centered care and how telemedicine can influence the quality of the therapeutic relationship. Another relevant issue was the concern about professional competence for optimal outcomes. Conclusion It is necessary to further explore and develop the ethical aspects of the new practices, disassociating them from the legal aspects only. Professionals demand more training providing them with more competence and confidence. (shrink)

This chapter contains section titled: Gender in Canonical Philosophical Writings The Emergence of Contemporary Feminist Philosophy Reflexive Critique within Philosophy Refl exive Critique within Feminist Philosophy Feminist Philosophy as a Research Program Feminist Philosophy as Transformative Notes.

Die Sekundärnutzung klinischer Daten für Forschungs- und Lernaktivitäten hat das Potenzial, medizinisches Wissen und klinische Versorgung erheblich zu verbessern. Zur Realisierung dieses Potenzials bedarf es einer ethischen und rechtlichen Grundlage für die Datennutzung, vorzugsweise in Form der Einwilligung von Patient*innen. Damit stellt sich die grundsätzliche Frage: Haben Patient*innen eine moralische Pflicht, ihre klinischen Daten für Forschungs- und Lernaktivitäten zur Verfügung zu stellen?Auf Basis eines ethischen Ansatzes, der als „sorgender Liberalismus“ bezeichnet werden kann, werden folgende Argumente zur Begründung einer Pflicht von (...) Patient*innen zur Bereitstellung ihrer klinischen Daten für Forschungs- und Lernaktivitäten auf Plausibilität und moralisches Gewicht untersucht: die allgemeine Hilfspflicht; Solidarität; die Pflicht zu gemeinwohlförderlichem Handeln; das Trittbrettfahrerargument; transgenerationale Gerechtigkeit; das Prinzip des Zurückgebens; das Prinzip des Nicht-Schädigens; die Forschungsfreiheit und der Wert der Wissenschaft.Die allgemeine Hilfspflicht und die Pflicht zu gemeinwohlförderlichem Handeln sind gewichtige Gründe für eine moralische Pflicht von Patient*innen zur Bereitstellung ihrer klinischen Daten für Forschungs- und Lernaktivitäten. Das Argument der transgenerationalen Gerechtigkeit und das Prinzip des Zurückgebens sind ethisch schwache Gründe für eine solche Pflicht, können jedoch eine motivationale Rolle spielen. Die anderen Gründe sind nicht geeignet, eine Pflicht zu begründen. Das Ergebnis ist in mehrfacher Hinsicht relevant: für Patient*innen, die um die Einwilligung in die Sekundärnutzung ihrer klinischen Daten gebeten werden; für die ethische Diskussion der Frage, ob und inwieweit Abstriche von der klassischen spezifischen Einwilligung unter bestimmten Bedingungen ethisch akzeptabel sind; für die rechtwissenschaftliche Diskussion der Bedingungen für eine juristisch verhältnismäßige Sekundärnutzung klinischer Daten für Forschungs- und Lernaktivitäten. (shrink)

Research question The secondary use of clinical data for research and learning activities has the potential to significantly improve medical knowledge and clinical care. To realize this potential, an ethical and legal basis for data use is needed, preferably in the form of patient consent. This raises the question: Do patients have a moral duty to provide their clinical data for research and learning activities? Methods On the basis of an ethical approach that we call “caring liberalism,” we evaluate plausibility (...) and moral weight of the following arguments in favor of a duty on patients to provide their clinical data for research and learning activities: the general duty to help; solidarity; the duty to act in the public interest; the free-rider argument; transgenerational justice; the principle of giving back; the do-not-harm principle; freedom of research and the value of science. Results The general duty to help and the duty to act in the public interest are strong reasons for a moral duty of patients to provide their clinical data for research and learning activities. Transgenerational justice and the principle of giving back are ethically weak reasons for such a duty but might be motivational factors. The other reasons are not appropriate to justify a duty. The results are relevant in several respects: for patients who are asked to consent to the secondary use of their clinical data; for the ethical discussion of the question whether and to what extent deviations from the classical specific consent are ethically justifiable under certain conditions; for the legal discussion of the conditions for a proportionate secondary use of clinical data for research and learning activities. (shrink)

Die sekundäre Forschungsnutzung von Behandlungsdaten hat großes Potenzial, biomedizinisches Wissen zu erweitern und die Patientenversorgung zu verbessern. Gleichzeitig sind für eine bessere Ausschöpfung dieses Potenzials diverse Herausforderungen zu bewältigen. Dies gilt insbesondere in Deutschland, wo im Vergleich zu anderen Ländern, wie z.B. Dänemark oder Finnland, die sekundäre Forschungsnutzung von Behandlungsdaten unterentwickelt ist. Die Intensivierung der Nutzung der Daten aus Diagnose und Therapie von Patienten und die Entwicklung der dafür notwendigen Strukturen in Deutschland ist ethisch und politisch geboten: für die Verbesserung (...) der Gesundheitsversorgung durch neue Erkenntnisse, Therapien und Qualitätssicherung. Aus diesem Grund fordern die Autor:innen alle Akteure des Gesundheitssystems, von der Bundes- und den Landesregierungen über die Krankenkassen, Kliniken, Ärzt:innen und Patient:innen dazu auf, einen Beitrag dazu leisten, eine Kultur der sekundären Forschungsnutzung von Behandlungsdaten zu etablieren. Basierend auf den Ergebnissen eines dreijährigen Verbundprojekts beantworten die Autor:innen aus den Bereichen Medizin, Rechtswissenschaften, Ethik und Sozialwissenschaften die Frage was notwendig ist, damit in Deutschland die Daten von Patient:innen systematisch für medizinische Forschung und die Analyse der klinischen Versorgungsqualität verwendet werden können und wirklich auch verwendet werden. Sie nennen zehn zentrale Forderungen und legen eine Liste von 23 Empfehlungen mit konkreten Maßnahmen vor, welche von den genannten Akteuren umgesetzt werden sollten. (shrink)

_The Blackwell Guide to Feminist Philosophy_ is a definitive introduction to the field, consisting of 15 newly-contributed essays that apply philosophical methods and approaches to feminist concerns. Offers a key view of the project of centering women’s experience. Includes topics such as feminism and pragmatism, lesbian philosophy, feminist epistemology, and women in the history of philosophy.

Biobanks are important resources for improving public health and individual care. Some legal frameworks can be more or less conducive to advancing the potential benefits of biobanks. The purpose of this article is to assess biobanking legislation and practices in Spain to determine how well they fare in such a regard. We focus here on some of the primary ethical values that ground relevant legislation and that we believe are consistent with promoting biobanking benefits: the value of scientific research; efficient (...) use of scarce resources; and respect for the dignity of donors. We argue that although Spanish regulations advance these values in important ways, they also have provisions that undermine them and thus risk limiting the potential benefits of biobanks. We offer some suggestions for improvement. (shrink)

ZusammenfassungDie rechtliche Regelung der Fortpflanzungsmedizin ist dringend reformbedürftig. Das Embryonenschutzgesetz von 1990 erfasst die neuesten technischen Entwicklungen nicht, ist in manchen Bereichen unstimmig und lückenhaft, setzt die betroffenen Frauen, Paare und Kinder unnötigen gesundheitlichen Risiken aus, erschwert paradoxerweise die Durchsetzung von Kinderrechten und erzeugt Gerechtigkeitsprobleme und Rechtsunsicherheit für die betroffenen Paare und die behandelnden Ärztinnen und Ärzte.Das Embryonenschutzgesetz enthält zudem nur strafrechtliche Verbote. Diese erlauben keine angemessene Reaktion auf die medizinische Entwicklung und den gesellschaftlichen Wandel und werden der Komplexität der (...) Materie nicht gerecht.Diese Probleme müssen gelöst werden. Der Bundesgesetzgeber verfügt seit mehr als 20 Jahren über die Kompetenz zur Regelung der Fortpflanzungsmedizin. Er sollte in der kommenden Legislaturperiode ein umfassendes Fortpflanzungsmedizingesetz schaffen. (shrink)

_The Blackwell Guide to Feminist Philosophy_ is a definitive introduction to the field, consisting of 15 newly-contributed essays that apply philosophical methods and approaches to feminist concerns. Offers a key view of the project of centering women’s experience. Includes topics such as feminism and pragmatism, lesbian philosophy, feminist epistemology, and women in the history of philosophy.

Due to improvements in medicine, the figures of patients with disorders of consciousness (DoC) are increasing. Diagnostics of DoC and prognostication of rehabilitation outcome is challenging but necessary to evaluate recovery potential and to decide on treatment options. Such decisions should be made by doctors and patients’ surrogates based on medico-ethical principles. Meeting information needs and communicating effectively with caregivers as the patients´ most common surrogate-decision makers is crucial, and challenging when novel tech-nologies are introduced. This qualitative study aims to (...) explore information needs of informal DoC caregivers, how they manage the obtained information and their perceptions and experiences with caregiver-physician communication in facilities that implemented innovative neurodiagnostics studies. In 2021, we conducted semi-structured interviews with nine caregivers of clinically stable DoC patients in two rehabilitation centers in Italy and Germany. Participants were selected based on consecutive purposeful sampling. Caregivers were recruited at the facilities after written informed consent. All interviews were recorded, transcribed verbatim and translated. For analysis, we used reflexive thematic analysis according to Braun & Clarke (2006). Caregivers experienced the conversations emotionally, generally based on the value of the information provided. They reported to seek positive information, comfort and empathy with-in the communication of results of examinations. They needed detailed information to gain a deep understanding and a clear picture of their loved-one’s condition. The results suggest a mismatch between the perspectives of caregivers and the perspectives of medical profession-als, and stress the need for more elaborate approaches to the communication of results of neu-rodiagnostics studies. (shrink)

Balancing Change and Tradition in Global Education Reform is an invaluable resource for policymakers, faculty, students, and anyone interested in how decisions made about the education system ultimately affect the quality of education, educational access, and social justice.

The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted (...) PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories. Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork. (shrink)

Although many of the factors that may influence donation have been identified, the timing of the interview in which families are asked for their authorisations seems to be decisive. However, there are few studies that analyse this process when the interview takes place. Qualitative techniques such as Participant Observation could help to better understand this process. One of the most recurring arguments against carrying out this type of study is the difficulty in complying with all the ethical requirements for any (...) research as defined in biomedical research guidelines and committees. This article aims to contribute to a discussion on the ethical viability of conducting an in situ study on family interviewing and proposes a strategy for minimising possible risks in designing a study of these characteristics. (shrink)

In this chapter, I discuss arguments for the claim that a subject can both have an experience with a certain content and not be in possession of all the concepts needed to specify this content. If she does not possess all the relevant concepts, then she cannot exercise them. So, she can undergo such an experience without being required to exercise all the concepts needed to specify its content. The argument from memory experience goes back to Martin (Philos Rev (...) 101:745763, 1992). Since we can extract new information from memories of previous experiences when we acquire new concepts, the content of these previous experiences cannot have been fully conceptual. The argument from animal and infant perception presupposes that some subjects who lack concepts of any kind nonetheless have perceptual experiences with the same kind of content as human perception. So, the content of human perception must be nonconceptual just like the perceptual contents of these subjects. The third argument, the argument from concept acquisition (Roskies, Philos Phenomenol Res 76:633659, 2008; Noûs 44:112134, 2010), shows that we cannot explain how subjects acquire some of their first concepts, particularly perceptual-demonstrative concepts, unless we assume that experience content is nonconceptual. The question of whether a subject can have a conscious perceptual experience only if she is able to cognitively appreciate its content is a recurrent theme in the chapter; it is answered in the negative by Modest Nonconceptualism. (shrink)

THEN GO TO YOUR WORK WITH JOY - SOCIALITY AND SACRAMENTAILITY IN MARTIN LUTHER'S TEACHING OF THE CALLINGThe article investigates Martin Luther’s teaching of the calling in a social perspective. In the tradition following the pioneering work of Max Weber, the Reformation has often been interpreted a steppingstone towards processes of disenchantment, secularization and rationalization. In recent years, a growing body of literature has argued that this tradition overlooks crucial elements of reformation spirituality such as sacramentality, sociality and (...) the affirmation of ordinary life. With his conceptualization of work as a calling, Luther elevated and sanctified the everyday life and activities as a central component of the Christian life and the constitution of society. Here we might find the seed for the exceptionally high value ascribed to work in contemporary, Lutheran Nordic societies. (shrink)

This article is about young children’s morality and their concern for others’ wellbeing. Questions of what the value of others’ wellbeing can signify, how this value becomes visible to children and how it is expressed in their interaction will be posed. In this analysis, children’s commitment to others’ wellbeing is discussed in terms of two theories, namely the philosopher Maurice Merleau-Ponty’s theory of intersubjectivity and the psychologist Martin Hoffman’s theory of empathy. The interaction between children and adults in pre-school, (...) drawn from different studies of morality, constitutes the empirical basis. In the discussion, it is claimed that children’s care for others’ wellbeing can be understood in a fruitful way as experiences of, approaches to and ways of being involved in the other’s life-world rather than as expressions of empathy. (shrink)

Giovanni Sartori (1924-2017) was a founder and icon of contemporary political science. A number of his books and articles have become part of the theoretical and conceptual basis of the field, and of social science in general. This volume brings together selected essays that examine Sartori as a scholar, university professor and intellectual. It is unique in covering all three aspects of Sartori's academic work: comparative politics, social science methodology and political theory. General overviews of Sartori's (...) contribution to political science are complemented by chapters that focus on specific areas of his interest; and Sartori's theoretical and methodological contributions are examined alongside his extensive public appearances, which remain little known outside Italy. (shrink)

The volume of essays, edited by Mike Martin, is a valuable contribution to the interdisciplinary interest in the topic. Martin has produced a helpful, if not penetrating, general introduction to the volume, and has prefaced each of the four parts of the book with a short orienting essay. The book is completed with an extensive bibliography that will well serve the student interested in pursuing the topic.

Vor 50 Jahren veröffentlichten Gretel Adorno und Rolf Tiedemann erstmals eine aus dem Nachlass edierte Ausgabe von Theodor W. Adornos Ästhetischer Theorie. Obgleich das von Adorno selbst als opus magnum verstandene Werk unvollendet blieb und nur als posthumes Kompilat erschien, entfaltete es in der zweiten Hälfte des 20. Jahrhundert eine enorme Wirkung, die weit über den Bereich der philosophischen Ästhetik hinausging. Renommierte Autoren und Autorinnen unterschiedlicher Disziplinen nehmen das Jubiläum des erstmaligen Erscheinens der Ästhetischen Theorie zum Anlass, diesen Klassiker aus (...) verschiedenen Perspektiven noch einmal neu in den Blick zu nehmen. Neben Essays zur Relevanz und Aktualität der Ästhetischen Theorie für die philosophische Ästhetik im 21. Jahrhundert stehen persönliche Texte, die die Bedeutung des Buches für das je eigene Denken schildern. Darüber hinaus finden sich Beiträge, die der Frage nachgehen, in welcher Weise einetextkritische Neuedition zu einer Relektüre dieses kanonisch gewordenen Textes führen und die Rezeption verändern könnte. Zu den Autor/innen gehören unter anderen Horst Bredekamp, Bazon Brock, Eva Geulen, Lydia Goehr, Robert Pippin, Martin Saar, Martin Seel und Beat Wyss. (shrink)

In this article, we identify various kinds of injustice at work in the global care chains by looking at the damages they entail and at some of their ties. Taking as our point of reference an invidious privileges dilemma that poses a real challenge to feminist theories, we analyze first the moral harm that, as Eva Kittay maintains, follows the fracturing of central, interpersonal and affective relationships of the women migrant workers. This specific moral harm of care relationships is not (...) reducible to other kinds of social injustice. These other kinds are identified by applying Nancy Fraser’s questioning of the frame problem to the global care chains. We can then talk of an interdependence of several genres or axes of injustice (maldistribution, misrecognition and misrepresentation) that work and intersect at several scales. (shrink)

Martin Hollis, in the introduction to the collection of Rationality and Relativism he edited recently with Steven Lukes, describes himself as the most arch of arch rationalists, “by which we mean, merely, that [we] reject the forthright relativization of truth and reason.” You might suppose that his self-description would place him unambiguously in the army of traditionalists arrayed against what Richard Rorty fondly calls the New Fuzzies. You might suppose, then, that Hollis would indulge in furious letter writing to, (...) say, Harper's, telling us that “we need to stand shoulder to shoulder against the growing army of enemies of rationality. By that I mean the followers of the fashionable cult of absolute relativism, emerging from philosophy, linguistics, semiotics, and deconstructionism.” You might suppose that he would go on in this way equivocating between “rationality” and “rationalism,” identifying the people he dislikes with the enemies of civilization: fascists, Stalinists, bikers, bomb throwing nihilists — Richard Rorty and Wayne Booth and Stephen Toulmin riding into town on their Harley- Davidsons, spurning warrants for belief and good reasons, reading pornographic comic books, and snarling at the townsfolk huddled behind the local syllogism. (shrink)

Contemporary concerns about the increase in untruths in politics have renewed interest in the relationship between truth and politics. Is democracy losing its foundations in a ‘post-truth era’ because it is becoming disconnected from reality? Or are facts, to which a technocratic mindset cannot tolerate alternatives, threatening to suppress political debate? In twelve contributions, political theorists investigate the relationship between truth and politics against the background of the current discussion. With contributions by Floris Biskamp, Oliver Flügel-Martinsen, Eva Marlene Hausteiner, Oliver (...) Hidalgo, Anna Hollendung, Dominik Klein, Gundula Ludwig, Franziska Martinsen, Johannes Marx, Martin Nonhoff, Frank Nullmeier, Samuel Salzborn, Hagen Schölzel, Frieder Vogelmann and Lucas von Ramin. (shrink)

in Undetermined Table d’Hôte Ingar Brinck: Investigating the development of creativity: The Sahlin hypothesis 7 Linus Broström: Known unknowns and proto-second-personal address in photographic art 25 Johan Brännmark: Critical moral thinking without moral theory 33 Martin Edman: Vad är ett missförhållande? 43 Pascal Engel: Rambling on the value of truth 51 Peter Gärdenfors: Ambiguity in decision making and the fear of being fooled 75 Göran Hermerén: NIPT: Ethical aspects 89 Mats Johansson: Roboethics: What problems should be addressed and why? (...) 103 Johan Laserna: Ambivalenta bilder 113 Anna-Sofia Maurin: Metaphysical explanation 161 Kevin Mulligan: Is preference primitive? 169 John D. Norton: How does your garden grow? 181 Johannes Persson & Annika Wallin: The distinction between internal and external validity 187 Johanna Seibt: Becoming our selves 197 Paul Slovic, Robin Gregory, David Frank, and Daniel Vastfjall: Confronting the collapse of humanitarian values in foreignpolicy decision making 209 Peter Sylwan: Det eviga livet 215 Claudine Tiercelin: Chance, love and logic: Ramsey and Peirce on norms, rationality and the conduct of life 221 Epilog 257 Frank Ramsey. (shrink)