Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled (...) conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others (...) view them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)

Machine generated contents note: -- Acknowledgements -- Disrupting the Impression of Stability in the Gender-Technology Relation -- Changing Images of Computers and its Users since 1980 -- Discursive Developments Within Computer Education -- Variations in Gender-ICT Relations Among Male and Female Computer Students -- Stories About Individual Change and Transformation -- Layered Meanings and Differences Within -- Is there an Elsewhere? -- References -- Endnotes -- Index.

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

This publication presents a selection of photographic work by Hilde Honerud, made in collaboration with Yoga and Sports with Refugees (YSR) in Lesbos, Greece. It is introduced by a text coauthored with Jon Honerud. In order to engage with the experiences and the vulnerable position of the refugees involved, this project used increasingly apparent formal manipulations to convey an experience beyond the documentary image and to push observers to question the objectivity of images; to move from representation to immediate (...) experience. This entailed a kind of violence to the images that could only be done after spending a long time getting to know the organization and its context. The process raised a number of ethical questions, which we attempt to address in the text accompanying these images. The selection of images published here were part of the exhibition Reality Slipped into a Symbol, at the Vestfold Art Centre, Tonsberg, Norway (9 June–10 July 2022). (shrink)

Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)

This book explores the social practice of holding each other in our identities, beginning with pregnancy and on through the life span. Lindemann argues that our identities give us our sense of how to act and how to treat others, and that the ways in which we we hold each other in them is of crucial moral importance.

In the Eudemian Ethics II 1, 1219a34–b8, Aristotle defines happiness as ‘the activity of a complete life in accordance with complete virtue’. Most scholars interpret a complete life as a whole lifetime, which means that happiness involves virtuous activity over an entire life. This article argues against this common reading by using Aristotle’s notion of ‘activity’ (energeia) as a touchstone. It argues that happiness, according to the Eudemian Ethics, must be a complete activity that reaches its end at any and (...) every moment. The upshot of this reading is that life reaches completeness within a lifetime and that death cannot be the requirement for making life complete. (shrink)

Narratives have always played a prominent role in both bioethics and medicine; the fields have attracted much storytelling, ranging from great literature to humbler stories of sickness and personal histories. And all bioethicists work with cases--from court cases that shape policy matters to case studies that chronicle sickness. But how useful are these various narratives for sorting out moral matters? What kind of ethical work can stories do--and what are the limits to this work? The new essays in Stories and (...) Their Limits offer insightful reflections on the relationship between narratives and ethics. (shrink)

All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals' responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation (...) of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals' attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance' and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer. (shrink)

The essays in this volume critically analyze and revitalize agrarian philosophy by tracing its evolution in the classical American philosophy of key figures such as Franklin, Jefferson, Emerson, Thoreau, Dewey, and Royce.

An Invitation to Feminist Ethics is a hospitable approach to the study of feminist moral theory and practice. Designed to be small enough to be used as a supplement to other books, it also provides the theoretical depth necessary for stand-alone use in courses in feminist ethics, feminist philosophy, and women's studies. The "overviews" section introduces important concepts in feminist ethical theory and contrasts that theory with the standard moral theories. The "close-ups" section looks at three topics--bioethics, violence, and the (...) globalized economy--to help students put the theories presented in the Overviews section to practical use. (shrink)

Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired (...) of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. Results The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64–74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. Conclusions An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously. (shrink)

Introducing the main theories of distributional justice the book covers utilitarianism and welfare economics, moving on to Rawls's social contract and the Sen/Nussbaum capability approach with a refreshingly readable style. There is a chapter covering the position of mothers and children in theories of justice. The book then studies empirical methods used in analysing the distribution of economic goods, covering Lorenz curves and inequality measures. The concepts of income, wealth and economic goods are comprehensively discussed, with a particular view to (...) their role in theories of justice. This book is an important read for economists and other social scientists, as well as philosophers who want to quantify social and economic justice. (shrink)

In this article, I want to reflect on the patient’s voice and why it is sometimes faint or goes altogether unheard. The patient may be too ill to speak or too incapacitated for her voice to express her autonomous wishes. She may speak a foreign language. She may be deaf and lacking an interpreter qualified to sign medical terminology. Her own views may be outshouted by a patient association that presumes to speak for her. Or she may be the target (...) of prejudice that makes it easy for socially privileged people to discount or ignore or not hear what she says.In this article, I examine a rather different, more subtle kind of voicelessness—one that is pervasive, causes moral... (shrink)

The end-state comfort effect refers to the consistent tendency of healthy adults to end their movements in a comfortable end posture. In children with and without developmental coordination disorder, the results of studies focusing on ESC planning have been inconclusive, which is likely to be due to differences in task constraints. The present pilot study focused on the question whether children with and without DCD were able to change their planning strategy and were more likely to plan for ESC when (...) demanded by complex object manipulations at the end of a task. To this end, we examined ESC planning in 18 children with and without DCD using the previously used sword-task and the newly developed hammer-task. In the sword-task, children had to insert a sword in a wooden block, which could be relatively easily completed with an uncomfortable end-posture. In the hammer-task, children had to strike down a nail in a wooden pounding bench, which required additional force and speed demands, making it relatively difficult to complete the movement with an uncomfortable end-posture. In line with our hypothesis, the results demonstrated that children with and without DCD were more likely to plan for ESC on the hammer-task compared with the sword-task. Thus, while children with and without DCD show inconsistent ESC planning on many previously used tasks, the present pilot study shows that many of them are able to take into account the end-state of their movements if demanded by task constraints. (shrink)

The primary contribution of feminism to bioethics is to note how imbalances of power in the sex‐gender system play themselves out in medical practice and in the theory surrounding that practice. I trace the ten‐year history of feminist approaches to bioethics, arguing that while feminists have usefully critiqued medicine's biases in favor of men, they have unmasked sexism primarily in the arena of women's reproductive health, leaving other areas of health care sorely in need of feminist scrutiny. I note as (...) well that feminist bioethicists have contributed very little to bioethical theory. In the second part of the paper I suggest two future directions for feminist bioethics. The first is to expand its critique of gender bias beyond reproductive medicine, devoting attention to the same issues raised by advances in biomedical technology as are taken up by mainstream bioethicists. The second is to develop bioethical theory that is more responsive than are mainstream moral theories to the social practices that subordinate women and minority groups. (shrink)

This paper is a revised version of the essay that won the Zapffe Prize in 2017. -/- In «The Last Messiah» and On the tragic, Peter Wessel Zapffe suggests that humankind should cease to reproduce, as the meaning of life cannot be found and human life at its best is tragic. The theory has been criticized for assuming that the meaning of life must be explained by an external cause and implicitly asks for an infinite causal chain. In this paper, (...) I argue that it is possible to escape this critique by adding a new element to the definition of the tragic: namely, the insight that the tragic cannot come into existence if the subject does not demonstrate its greatness. Precisely because a human, on Zapffe’s understanding, must prove its brilliance if tragedy is to arise, I argue that the tragic cannot be devoid of meaning. In contrast, the individual seems to be provided with a tragic meaning of life, rather than being deprived of it. Furthermore, the new definition of the tragic affects Zapffe’s antinatalism, because a tragic meaning of life does not necessitate that humankind should cease to reproduce. Yet, the definition does not suggest that humans should reproduce either. Instead, it confronts us with the following question: Should one bring new life into the world, when the meaning of life only can be found in the tragic? (shrink)

In Poetics 13, Aristotle claims that the protagonist in the most beautiful tragedies comes to ruin through some kind of ‘failure’—in Greek, hamartia. There has been notorious disagreement among scholars about the moral responsibility involved in hamartia. This article defends the old reading of hamartia as a character flaw, but with an important modification: rather than explaining the hero's weakness as general weakness of will (akrasia), it argues that the tragic hero is blinded by temper (thumos) or by a pursuit (...) for fine, good and desirable things—that is, by what may be labelled ‘qualified’ weakness of will. The upshot is that hamartia ends up as being less blameworthy than ‘proper’ akrasia, but still explains why morally outstanding people are unsuitable for the most beautiful tragedies. (shrink)

Stories do many different kinds of moral work. Because they can depict time passing, feature certain details while downplaying others, draw connections among their internal elements, display causal relationships, and connect themselves to other stories, they are particularly well suited to the task of modeling a puzzling clinical situation. A story maps the situation's contours, picking out the details that, together, constitute the moral reasons for doing what may or must be done. When moral deliberators construct a story, they come (...) to understand the situation in a certain way, and that, in turn, guides their sense of how they should act in or with respect to it.But stories don't just represent situations‐they can also misrepresent them. For that reason, if we are to use stories as guides to action, we have to be sure we get them right. In what follows I offer three clinical situations that are either about to be or have already been narratively misrepresented. I'll explain how the stories go wrong, point out the undesirable consequences of acting on them, and offer alternative ways of depicting the situations that could bring them to a morally successful resolution. (shrink)

Enthusiasm over technology is found among men. Or, at least, that is the impression we get from the main body of earlier research, which leaves us with an understanding of men as computer enthusiasts, while women are more reluctant and ‘rational’ in their relation to the computer. In this paper I will argue that women do in fact enjoy working with computers. The empirical material is from a study of a group of students taking a computer course. We will meet (...) women who enjoy working with computers, and explore how they express their pleasure in relation to the computer. Contrary to earlier claims that ‘computing is incompatible with being a girl’, we will find that many of the 21 women in this study are not afraid to articulate their pleasure in computing. (shrink)

_ Source: _Volume 39, Issue 2, pp 139 - 164 The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often (...) contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy. (shrink)

During the past thirty years, museums of all kinds have tried to become more responsive to the interests of a diverse public. With exhibitions becoming people-centered, idea-oriented, and contextualized, the boundaries between museums and the “real” world are eroding. Setting the transition from object-centered to story-centered exhibitions in a philosophical framework, Hilde S. Hein contends that glorifying the museum experience at the expense of objects deflects the museum's educative, ethical, and aesthetic roles. Referring to institutions ranging from art museums (...) to theme parks, she shows how deployment has replaced amassing as a goal and discusses how museums now actively shape and create values. (shrink)

ABSTRACTDo physicians have a duty to sustain the pregnancies of women who die during the first or second trimester? Physicians cannot simply assume that the woman would have wished the pregnancy to continue, nor is it clear that the state has any interest in fetal life before viability. The conditions for beneficence‐based duties of fetal rescue will often be unmet, both because sustaining the pregnancy is not always a clear gain to the born child and because it may impose a (...) substantial burden on the benefactor. And duties of special relationship cannot readily be applied in these cases, as it is difficult to see how the relationship between someone who no longer exists and someone who does not yet exist can breed special duties. Further, to draw on Marx's distinction between the architect, who builds purposefully, and the bee, who cannot help what she is doing, I argue that human pregnancy is in a number of respects purposeful, creative, and deliberate, and that postmortem pregnancy, which follows the model of the bee, is a destructive icon that undercuts women's agency. (shrink)

ABSTRACT Do physicians have a duty to sustain the pregnancies of women who die during the first or second trimester? Physicians cannot simply assume that the woman would have wished the pregnancy to continue, nor (in the U. S., at any rate) is it clear that the state has any interest in fetal life before viability. The conditions for beneficence‐based duties of fetal rescue will often be unmet, both because sustaining the pregnancy is not always a clear gain to the (...) born child and because it may impose a substantial burden on the benefactor. And duties of special relationship cannot readily be applied in these cases, as it is difficult to see how the relationship between someone who no longer exists and someone who does not yet exist can breed special duties. Further, to draw on Marx's distinction between the architect, who builds purposefully, and the bee, who cannot help what she is doing, I argue that human pregnancy is in a number of respects purposeful, creative, and deliberate, and that postmortem pregnancy, which follows the model of the bee, is a destructive icon that undercuts women's agency. (shrink)

This essay takes a close look at a species of care that is particularly needed by people with progressive dementias but that has not been much discussed in the bioethics literature: the activity of holding the person in her or his identity. It presses the claim that close family members have a special responsibility to hold on to the demented person's identity for her or him, and offers some criteria for doing this morally well or badly. Finally, it considers how (...) even those with dementia can hold others in their identities, and suggests that this kind of holding too can have great moral worth. (shrink)

Starting from the intuition, shared by many women, that the legal right to an abortion must be defended but that they themselves could never undergo one, I offer an account of why pregnancy is morally valuable and why, nevertheless, it is often permissible to end one. Developing the idea that human pregnancy centrally involves the activity of calling a fetus into personhood, I argue that the permissibility of stopping this activity hinges on the goodness or badness of one's moral luck.