BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

This article is a response to Thomas David Riisfeldt’s paper entitled ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’. It is shown that as far as euthanasia and palliative sedation are concerned, Riisfeldt has not established that a common ground, or a similarity, between the two is the relief of suffering. Quite the contrary, this is not characteristic of euthanasia, neither by definition nor from a clinical point of view. Hence, the argument hinges on a conceptually (...) and empirically erroneous premise and is accordingly a non-starter. (shrink)

This article gives brief results of a Norwegian empirical project where the main purpose has been to study the burial rite versus bereavement and the role of religiousness in relation to the disposing of the dead. The theoretical perspective is that loss of a significant close, as well as religiousness are primary life experiences which flow together in the bereaved person's grieving conduct during the burial rite. 70 bereaved persons who had lost a close relative during a certain time period (...) have filled in questionnaires with information about the death, the funeral, religiousness and bereavement. The sample is treated statistically by means of indexes for grieving conduct during the burial week, religiousness, and grief. The sample is coherent and unambiguous, and shows that those who let the burial rite be a time to mourn experienced more benefit from the funeral service and had less anxiety, depression and intrusive experiences during the first year of bereavement. But sadness was independent of the grieving conduct during the burial rite, a result which makes sadness an aspect of mourning which qualitatively differs from the other aspects described. External conditions as urbanity and institutionalizing, as well as internal matters as the dramatical character of the loss, and personal religiousness affected the bereaved person's grieving conduct during the burial rite. (shrink)

The aim of this study was to explore which group-based emotion regulation goals and strategies are offered in the group culture of Jehovah's Witnesses (JWS). Based on interviews with 29 group-active JWS in Norway, a thematic analysis was conducted in which an overall pattern of cognition taking precedence over emotions was found. Due to endtime expectations and a long-term goal of eternal life in Paradise, future emotions were prioritized. The emotion regulation strategies identified among JWS were social sharing and the (...) interconnected cognitive reappraisal. A new concept, emotional forecasting, was introduced, describing a reappraisal tactic of regulation using prospects of future emotions to regulate the here and now. It was concluded that the prospection of the future is a strong regulator of emotions of the here and now and should be included in psychological models of emotion regulation. (shrink)

Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make (...) oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews (...) with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life. (shrink)

BackgroundSurveys on attitudes towards assisted dying play an important role in informing public debate, policy and legislation. Unfortunately, surveys are often designed with insufficient attention to framing effects; that is, effects on the respondents’ stated attitudes caused by question wording and context. The purpose of this study was to demonstrate and measure such framing effects. MethodsSurvey experiment in which an eight-question survey on attitudes towards assisted dying was distributed to Norwegian citizens through a web-based panel. Two variations of question wording (...) as well as two variations of question order were employed. Respondents were randomized to receive one of four questionnaire versions. ResultsThree thousand and fifty responses were received. There were moderate to large question wording and question order effects. A majority of Norwegian citizens favour the legalization of assisted dying for patients with terminal or chronic disease. ConclusionsStakeholders in the assisted dying debate need to acknowledge potential framing effects, and accordingly should interpret survey results with caution. The same holds for researchers who conduct attitude surveys in the field of bioethics. (shrink)

Meaning in life has become an important topic in empirical research in the psychology of religion. Although it has been studied and found applicable in many different contexts, research on meaning in life and sources of meaning in African countries is scarce. This study qualitatively investigates understandings and experiences of meaning in life and sources of meaning among urban and village dwellers with different educational backgrounds in Zambia. Seven focus group interviews (total N = 52) were conducted and analysed, drawing (...) on Schnell’s model of meaning in life and sources of meaning. The results indicate that the concept of meaning in life is relevant to both urban and village dwellers in Zambia. Meaning experiences and sources of meaning are associated with certain life domains: relationships; religion; education and work; leisure activities; and health and survival. Each life domain includes several fundamental sources of meaning, which can be related to Schnell’s four dimensions of sources of meaning: self-transcendence, self-actualisation, order and well-being and relatedness. The results are discussed in light of extant studies on meaning and cultural characteristics in Africa. (shrink)

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational (...) and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference. (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)

_ Source: _Volume 39, Issue 3, pp 312 - 343 The aim of this study was to explore which group-based emotion regulation goals and strategies are offered in the group culture of Jehovah’s Witnesses. Based on interviews with 29 group-active JW s in Norway, a thematic analysis was conducted in which an overall pattern of cognition taking precedence over emotions was found. Due to end-time expectations and a long-term goal of eternal life in Paradise, future emotions were prioritized. The emotion (...) regulation strategies identified among JW s were _social sharing_ and the interconnected _cognitive reappraisal_. A new concept, _emotional forecasting_, was introduced, describing a reappraisal tactic of regulation using prospects of future emotions to regulate the here and now. It was concluded that the prospection of the future is a strong regulator of emotions of the _here and now_ and should be included in psychological models of emotion regulation. (shrink)

This paper examines the effectiveness of public enforcement by studying the effects of regulatory intervention to curb tunneling through intercorporate loans in China. Specifically, we explore whether public enforcement efforts in 2006 resulted in less tunneling, and ultimately in increased performance for tunneling firms. We show that tunneling is among the dominant factors increasing the likelihood of becoming blacklisted. We also find that firms’ tunneling mechanisms decreased significantly after the regulatory shock, and that their performance increased significantly compared to non-tunneling (...) firms after the regulatory shock. Finally, we find a positive market reaction to the public announcement of tunneling both for firms that have been blacklisted and other tunneling firms that are not blacklisted. Collectively, these results suggest that public enforcement in the presence of a credible threat succeeds in deterring the effect on tunneling behavior in China. (shrink)

This paper examines the relationship between performance persistence and corporate governance. We document systematic differences in performance persistence across listed companies in China during 2001–2011, and empirically demonstrate that firms with better corporate governance show higher performance persistence. The results are robust over both the short and long terms. We also find that performance persistence is an important factor in refinancing, and it can lower companies’ costs of borrowing. Overall, our findings offer important implications for business ethics, as we demonstrate (...) how corporate governance can lower companies’ costs of debt. (shrink)

One important distinction in psychology is between inferences based on associative memory and inferences based on analysis and rules. Much previous empirical work conceive of associative and analytical processes as two exclusive ways of addressing a judgment task, where only one process is selected and engaged at a time, in an either-or fashion. However, related work indicate that the processes are better understood as being in interplay and simultaneously engaged. Based on computational modeling and brain imaging of spontaneously adopted judgment (...) strategies together with analyses of brain activity elicited in tasks where participants were explicitly instructed to perform similarity-based associative judgments or rule-based judgments ( n = 74), we identified brain regions related to the two types of processes. We observed considerable overlap in activity patterns. The precuneus was activated for both types of judgments, and its activity predicted how well a similarity-based model fit the judgments. Activity in the superior frontal gyrus predicted the fit of a rule-based judgment model. The results suggest the precuneus as a key node for similarity-based judgments, engaged both when overt responses are guided by similarity-based and rule-based processes. These results are interpreted such that similarity-based processes are engaged in parallel to rule-based-processes, a finding with direct implications for cognitive theories of judgment. (shrink)

In Parkinson’s disease, the fronto-striatal network is involved in motor and cognitive symptoms. Working memory updating training engages this network in healthy populations, as observed by improved cognitive performance and increased striatal BOLD signal. This two-part study aimed to assess the feasibility of WM updating training in PD and measure change in cognition, movement and functional brain response in one individual with PD after WM updating training. A feasibility and single-subject study were performed in which patients with PD completed computerized (...) WM updating training. The outcome measures were the pre-post changes in criterion and transfer cognitive tests; cognitive complaints; psychological health; movement kinematics; and task-related BOLD signal. Participants in the feasibility study showed improvements on the criterion tests at post-test. FL displayed the largest improvements on the criterion tests and smaller improvements on transfer tests. Furthermore, FL reported improved cognitive performance in everyday life. A shorter onset latency and smoother upper-limb goal-directed movements were measured at post-test, as well as increased activation within the striatum and decreased activation throughout the fronto-parietal WM network. This two-part study demonstrated that WM updating training is feasible to complete for PD patients and that change occurred in FL at post-test in the domains of cognition, movement and functional brain response. (shrink)

In the 1960’s, Lars Bergström and Hector-Neri Castañeda noticed a problem with alternative acts and consequentialism. The source of the problem is that some performable acts are versions of other performable acts and the versions need not have the same consequences as the originals. Therefore, if all performable acts are among the agent’s alternatives, act consequentialism yields deontic paradoxes. A standard response is to restrict the application of act consequentialism to certain relevant alternative sets. Many proposals are based on (...) some variation of maximalism, that is, the view that act consequentialism should only be applied to maximally specific acts. In this paper, I argue that maximalism cannot yield the right prescriptions in some cases where one can either (i) form at once the intention to do an immediate act and form at a later time the intention to do a succeeding act or (ii) form at once the intention to do both acts and where the consequences of (i) and (ii) differ in value. Maximalism also violates normative invariance, that is, the condition that if an act is performable in a situation, then the normative status of the act does not depend on what acts are performed in the situation. Instead of maximalism, I propose that the relevant alternatives should be the exhaustive combinations of acts the agent can jointly perform without performing any other act in the situation. In this way, one avoids the problem of act versions without violating normative invariance. Another advantage is that one can adequately differentiate between possibilities like (i) and (ii). (shrink)

Can groups really be agents or is group agency just a fiction? Christian List and Philip Pettit argue influentially for group-agent realism by showing how certain groups form and act on attitudes in ways they take to be unexplainable at the level of the individual agents constituting them. Group agency is therefore considered not a fiction or a metaphor but a reality we must account for in explanations of certain social phenomena. In this paper, I challenge this defence of group-agent (...) realism by showing how it is undermined by individual-level analysis of how individuals interact within groups. While group agency can be a useful fiction, real agents are at the individual level, not the collective level. (shrink)

In the debate on how we ought to define political freedom, some definitions are criticized for implying that no one can ever be free to perform any action. In this paper, I show how the possibility of freedom depends on a definition that finds an appropriate balance between absence of interference and protection against interference. To assess the possibility of different conceptions of freedom, I consider the trade-offs they make between these two dimensions. I find that pure negative freedom is (...) clearly possible. Republican freedom might also be possible, though its protection requirement is too vague for a definitive verdict. Finally, the recently proposed ‘freedom as independence’ is impossible since it is an attempt to avoid the unavoidable trade-off. (shrink)

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...) are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

Heidegger has been blamed for being obsolete, irrelevant, ignorant and even dangerous in relation to contemporary philosophy of technology. Based on mainly two texts from Heidegger’s post-war production, “The Question Concerning Technology” and “Only a God can Save Us”, this commentary to Don Ihde’s article tries to show how Heidegger actually makes sense to philosophy of technology. The sheer fact that many postmodern thinkers, among those Don Ihde, are constantly ‘measuring’ their line of thoughts and use of concepts against Heidegger’s (...) original thinking is proof of this relevance. I think that Heidegger, despite his despicable political and moral convictions, is needed when it comes to a critique and understanding of contemporary technological innovation and development in relation to what it means to be human. Most important is to stress that Heidegger was not a technodystopian, which a thorough reading of the two selected texts clearly shows. On the contrary, Heidegger points at the existential dialectical essence in technology, which means that both damnation and redemption can be mediated by technology. (shrink)

Many people who claim to genuinely care about nature still seem reluctant to ascribe intrinsic value to it. Environmentalists, nature friendly people in general, and even environmental activists, often hesitate at the idea that nature possesses value in its own right—value that is not reducible to its importance to human or other sentient beings. One crucial explanation of this reluctance is probably the thought that such value—at least when attached to nature—would be mysterious in one way or another, or at (...) least very difficult to account for. In addition, Bryan Norton’s influential convergence hypothesis states that, from a practical point of view, it makes no or little difference whether we ascribe intrinsic value to nature, given the depth and variety of instrumental value it possesses. In this paper, I argue that people who genuinely care about nature cannot avoid ascribing intrinsic value (in a certain sense) to it, if they want to be able to consistently defend the kind of claims about protecting nature they arguably want to make, i.e., claims to the effect that we ought to protect for instance nature areas and species. The cost of denying intrinsic value in nature is the cost of giving up a crucial resource to philosophically defend such claims. (shrink)

The cosmological argument has enjoyed and still enjoys substantial popularity in various traditions of natural theology. We propose that its enduring appeal is due at least in part to its concurrence with human cognitive predispositions, in particular intuitions about causality and agency. These intuitions seem to be a stable part of human cognition. We will consider implications for the justification of the cosmological argument from externalise and internalise perspectives.

Can a group be morally responsible instead of, or in addition to, its members? An influential defense of corporate responsibility is based on results in social choice theory suggesting that a group can form and act on attitudes held by few, or even none, of its members. The members therefore cannot be (fully) responsible for the group’s behavior; the group itself, as a corporate agent, must be responsible. In this paper, I reject this view of corporate responsibility by showing how (...) it pays insufficient attention to individual agency. By accounting for group members’ strategic behavior, we shall see how they control collective attitude formation and are therefore responsible for their group’s behavior. (shrink)

This article demonstrates the broad applicability of the concept of symbol in human communication, beyond but including verbal language. The starting point is Charles Sanders Peirce’s understanding of symbolicity as signification grounded on habits. The goal is to be able to conceptualize mediality in general and media interrelations, particularly in relation to symbolicity. Informed by a multimodal view on media, the author provides a systematic overview of symbolicity within the context of communication among human minds structured around two crossing parameters: (...) symbols being limited or widespread among people and symbols not being part of or being part of systems – languages. Based on this overview, I clarify the role of culture in language notions and conceptualize language in relation to mediality. I also suggest a way of more precisely describing similarities and differences between languages and media types, without either conflating or totally separating the two concepts. Finally, I investigate how the dependence of language and media type conceptions on culture affects the idea of intermediality. Together, these investigations and conceptualizations promote a more comprehensive understanding of symbolicity in general and a deeper knowledge of the role of symbolicity in human communication, including verbal language, and intermedial relations involving all kinds of different media types. (shrink)

Volume 19, Issue 5, May 2019, Page 31-33.

Voluntary actions and their distal effects are intimately related in conscious awareness. When an expected effect follows a voluntary action, the experience of the interval between these events is compressed in time, a phenomenon known as ‘intentional binding’ . Current accounts of IB suggest that it serves to reinforce associations between our goals and our intention to attain these goals via action, and that IB only occurs for self-generated actions. We used a novel approach to study IB in the context (...) of shared intentions and actions. Pairs of participants judged the time of occurrence of actions and events attributed either to oneself or to another agent. We found that IB and subjective agency are not mutually predictive when an action can be attributed to only one of two ‘co-intending’ agents. Our results pose a complication for the prevailing view that IB and subjective agency reflect a common mechanism. (shrink)

An influential view in the ethics of self-defence is that causal responsibility for an unjust threat is a necessary requirement for liability to defensive harm. In this article, I argue against this view by providing intuitive counterexamples and by revealing weaknesses in the arguments offered in its favour. In response, adherents of the causal view have advanced the idea that although causally inefficacious agents are not liable to defensive harm, the fact that they may deserve harm can justify harming them (...) in the course of defending oneself. I argue that this strategy is ad hoc and leads to more problems than it solves. Once we allow normative facts outside our account of liability to affect a person's moral protection against harm, the lieability verdicts cannot tell us whether there is a relevant moral asymmetry between the victim and the target of defence. In conclusion, the causal view is wrong and causal responsibility for an unjust threat is not a necessary requirement for liability to defensive harm. (shrink)

The book works out new perspectives for a philosophy of religion that aims beyond the internal questions of rationality within a theological tradition, on the one hand, and the outer criticism of religion from naturalistic quaters, on the other. Instead it places itself within a wider philosophical view in line with groundbreaking thoughts about culture and a basic human 'conditionality' among interwar philosophers such as Ernst Cassirer, Ludwig Wittgenstein, Walter Benjamin, and Martin Heidegger. The book also offers a concrete interpretation (...) of examples of religious phenomena displaying a human world-relation that centers on issues of 'truth', 'name', and 'habitation'. Finally, lines are drawn to Jean-Luc Nancy's current rethinking of Christianity. (shrink)