The Practices of Global Ethics takes a unique look at global ethics: not as mere written statements but as a set of practices undertaken by thousands of organisations and hundreds of thousands of people to shape the normative trajectory of human affairs. It looks at statements of global ethical principles including The Universal Declaration of Human Rights, the Earth Charter and the Rio Documents and positions them as the outcomes and expression of ongoing practices. Offering innovative, critical and thoughtful analyses (...) of ethical practices since World War II, the book examines efforts to promote human rights; foster ecological responsibility; end genocide; reduce global poverty; encourage responsible and sustainable international business practices; cultivate understanding and collaboration amongst the world's religions among other worldwide endeavours. (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)

This paper focuses on the importance of wonder in human flourishing and is orientated towards the dynamics between the two, but with an emphasis on how the former is important for illuminating the latter. It begins with a preliminary sketch of both wonder and human flourishing and subsequently moves on to highlight three aspects of human flourishing: 1) ‘Individuality’, 2) ‘Relations’ and 3) ‘The political’, and why these play to wonderment.

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)

From a cultural-historical perspective, the impairments of a child with a condition like cerebral palsy have biological origins, but the disability evolves from the mismatch between the child and his/her social conditions for development. One example of this dialectical production of disability can be seen in the challenge of the 21st-century welfare state: How to provide economically feasible health and educational services anchored in evidence-based methods and practices. Standardized social service pathways for children with CP illustrates an attempt to address (...) this challenge and moderate the mismatch by acting in the intersection between impairment and society. The aim of the article is to analyze challenges in the practice of connecting research and practice-based knowledge with societal practices in order to diminish the disability of the child. A multidisciplinary group assembled by the Danish National Board of Social Services engaged in a practice of developing a guideline for a social service pathway. Agendas and minutes from their series of meetings provide insight in how the work evolved through conflictual discussions. Rather than a neutral transformation of knowledge into practice, the practice revealed itself as a value-laden process in which the needs of the child and family were at times decentred and the focus shifted to how social services could be realised in complex, structured social practices. While the group managed to overcome several conflicts and agree of a social service pathway, a socio-economic analysis was unable to argue for the comprehensive social service pathway as an economic sound choice for municipal decision-makers. The conflict between the welfare ideology and economic feasibility remains unresolved and can be expected to limit the extent that impairments can be remedied and the mismatch decreased. Overcoming or diminishing the mismatch might never become economic worthwhile. As the political pendulum oscillates between welfare and economic concerns, the experience of disability will likewise diminish or expand. (shrink)

Over the last decades, it has become evident that highly complex networks of regulators govern post‐transcriptional regulation of gene expression. A novel class of Argonaute (Ago)‐associated RNA molecules, the agotrons, was recently shown to function in a Drosha‐ and Dicer‐independent manner, hence bypassing the maturation steps required for canonical microRNA (miRNA) biogenesis. Agotrons are found in most mammals and associate with Ago as ∼100 nucleotide (nt) long RNA species. Here, we speculate on the functional and biological relevance of agotrons: (i) (...) agotrons could serve as non‐promiscuous miRNA‐like regulators with reduced off‐targeting or (ii) agotrons could encompass other putative functions, such as protecting Ago proteins from taking up aberrant short RNAs or by rescuing and stabilizing otherwise unloaded Ago‐proteins from degradation. Collectively, agotrons have emerged as a novel class of interesting non‐coding RNA molecules, but their full functional potential and biological impact still remain to be disclosed. (shrink)

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

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)

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.

The era of ‘big data’ studies and computational social science has recently given rise to a number of realignments within and beyond the social sciences, where otherwise distinct data formats – digital, numerical, ethnographic, visual, etc. – rub off and emerge from one another in new ways. This article chronicles the collaboration between a team of anthropologists and sociologists, who worked together for one week in an experimental attempt to combine ‘big’ transactional and ‘small’ ethnographic data formats. Our collaboration is (...) part of a larger cross-disciplinary project carried out at the Danish Technical University, where high-resolution transactional data from smartphones allows for recordings of social networks amongst a freshman class. With a parallel deployment of ethnographic fieldwork among the DTU students, this research set-up raises a number of questions concerning how to assemble disparate ‘data-worlds’ and to what epistemological and political effects? To address these questions, a specific social event – a lively student party – was singled out from the broader DTU dataset. Our experimental collaboration used recordings of Bluetooth signals between students’ phones to visualize the ebb and flow of social intensities at the DTU party, juxtaposing these with ethnographic field-notes on shifting party atmospheres. Tracing and reflecting on the process of combining heterogeneous data, the article offers a concrete case of how a ‘stitching together’ of digital and ethnographic data-worlds might take place. (shrink)

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

The aim of this study was to get a deeper understanding of student nurses’ experiences of personal caring ethics by reflection on caring encounters with patients in clinical practice, ethical caring ideals, ethical problems, and sources for inner strength that give courage to practice good caring. In all, 24 Scandinavian student nurses participated voluntarily in an interview study. The interviews were analyzed within a phenomenological–hermeneutical approach and revealed three themes. The students found themselves in two different states of vulnerability: one (...) in which they were overwhelmed by their vulnerability and began to suffer themselves and the other where their vulnerability became a source of development with focus on the patient. The students’ ethical caring ideals served as fixed reference points in their ethical development, but their ideals were at risk of decline. The students reflected on the barriers for performing ethical care and nurtured their ethical ideals by providing ethical care in secret. Caring in secret occurred also when student nurses did not experience a shared ethos. (shrink)

Howard Phillips Lovecraft’s work of fiction can roughly be grouped into three distinct categories, each evoking a singular extraordinary state of mind. Poe-inspired tales of the macabre such as “The Tomb” (1917) and “The Statement of Randolph Carter” (1919) produce terror because of the atmosphere they convey and because of the particular end the main characters meet. Lovecraft’s later “Yog-Sothothery” or work in the Cthulhu Mythos tradition, including his signature pieces of weird fiction “The Call of Cthulhu” (1926) and “The (...) Shadow over Innsmouth” (1931), inspires ‘horror’ because the life-worlds of the protagonists in these stories are utterly destroyed. However, the gentleman of Providence is also known for a different sort of fiction. His Dunsanian tales—among them short stories such as “The White Ship” (1919), “Celephaïs” (1920), and the three works“ The Silver Key” (1926), The Dream-Quest of Unknown Kadath (1926–27), and “Through the Gates of the Silver Key” (1932–33; with E. Hoffmann Price), centered on the exploits of Lovecraft’s recurring character and alter ego Randolph Carter—are epitomes to this feat. These prehistoric or dreamland tales do not inspire ‘terror’ or ‘horror’; rather, they predominately seek to evoke the extraordinary state of mind called ‘wonder. This article offers a preliminary exploration of Lovecraft’s relationship with wonder, highlights what wonder is, how Lovecraft was exposed to wonder at an early age, and argues that he developed a lifelong positive relationship with this particular state of mind. (shrink)

One of the vexed questions in the philosophy of wonder and indeed education is how to ensure that the next generation harbours a sense of wonder. Wonder is important, we think, because it encour- ages inquiry and keeps us as Albert Einstein would argue from ‘being as good as dead’ or ‘snuffed-out candles’ (Einstein 1949, 5). But how is an educator to install, bring to life, or otherwise encourage a sense of wonder in his or her stu- dents? Biologist Rachel (...) Carson suggests that exploring nature and specifically undertaking walks along the rocky coast of Maine would keep alive a person’s inborn sense of wonder (Carson 1984). Philosopher Jesse Prinz thinks that exposure to art will encourage wonderment because artworks, as he puts it, are “inventions for feeding the appetite that wonder excites in us” (Prinz 2013). Weird fiction (a subgenre of speculative fiction) – and in particular the work of one of its greatest exponents, the early-20th-century American author How- ard Phillips Lovecraft – is likewise a catalyst for wonder. The reason behind this is that Lovecraft’s ‘wonder-stories’ are densely packed with wonder per design; and in support of this claim I shall in what is to come 1) provide a brief introduction to Lovecraft and weird fiction; 2) present a working definition of wonder; and 3) clarify what is meant by something being ‘densely packed with wonder’ via bringing to the fore evidence of Lovecraft’s literary wonder- mongery. The paper ends with some reflections on the notion of ‘dark wonder’, why this peculiar label might be suitable for the kind of wonder we find in Lovecraft’s work, and why exposure to ‘dark wonder’ can be edifying, and in that sense educational. (shrink)

Inherited wealth will be of increasing importance in years to come. Yet inheritance taxation is unpopular, and part of this unpopularity is due to family concerns. Such taxation is seen by many as morally problematic because it is taken to violate important family values. In this article, we explore five family arguments against inheritance taxation: firstly, whether we have a right to benefit our children; secondly, whether it is a virtue to benefit one's children; thirdly, whether children have a right (...) to their parent's belongings, due to common ownership; fourthly, whether inheritance taxation may impair a vital sense of continuity and belonging; and lastly, an argument from incentives that appeals specifically to the relation between parents and children. We conclude that none of the arguments provide strong objections against a moderate or even a high inheritance tax rate, at least not when special provisions are made for things like family houses or farms. However, since the arguments all introduce concerns that should be assigned some weight, it would be unjust to abolish inheritance entirely. (shrink)

This article questions whether enmity is always bad and trust always good. In the borderlands between Ikland in northern Uganda and Turkanaland in Kenya, sometimes violent enmity combines with friendly barter relations between the Ik, a subsistence agricultural people that also hunts, and their goat-and-cattle herding neighbors, the Turkana and Dodoth peoples. “Half-trust,” as some of the Ik call it, works to prevent the escalation of conflict. While the Ugandan groups have been disarmed by their government, the Kenyan Turkana, armed (...) with AK-47s, are allowed into Ugandan territory for pasture during drought, and some Turkana take violent advantage of this power imbalance as they leave. Paradoxically, intervention by Ugandan state institutions that, in the name of peaceful coexistence, welcome the Turkana in Uganda has led to the escalation of conflict, while tribal “half-trust” has kept it relatively limited. (shrink)

In earlier writings, I have sought to establish a link between Howard Phillips Lovecraft and Romanticism, and this paper adds to that body of work. -/- The essay begins with a preliminary sketch of the use of gardens in Romantic thought and the highlighting of six themes: contemplation, joy, the dramatic, the strange, the foreign, and the beautiful, that all underpins Romanticism. -/- This is followed by an elucidation of Lovecraft’s fascination with gardens, his dealings in Romantic themes, and what (...) role they play in his short 1917 poem “A Garden”. -/- The essay concludes that given Lovecraft’s love of gardens and that his poem “A Garden” is imbued with Romantic themes and involves ‘wondrous contemplation’ and ‘poetic knowledge’, the case for his Romanticism has been strengthened. (shrink)

Dette kapitel fokuserer på ’etik og patientinddragelse’, men søger med afsæt i devisen ‘sapere aude’ også at skabe interesse for filosofi og etik blandt sygeplejestuderende. Kapitlet er en opfordring til sygeplejestuderende om at betjene sig af egen forstand og finde mod til at filosofere over problematikker i forbindelse med patientinddragelse frem for at falde tilbage i umyndighedens bekvemmelighed og vente på at andre træder til. Kapitlet starter med at se nærmere på, hvordan patientinddragelse italesættes i vor tid efterfulgt af en (...) kort eksposition af to af oplysningstidens vigtigste libera- le filosoffer, herunder pligtetikeren Immanuel Kant og nytteetikeren John Stuart Mill, hvis syn på henholdsvis autonomi og frihed influerer debatten om patientinddragelse. Efterfølgende præsenteres og diskuteres to eksempler, hvor patientinddragelse og etik er i rampelyset. Mere specifikt rettes fokus på 1) etik, patientinddragelse og den psykiatriske patient og 2) etik, patientinddragelse og unge mennesker. Eksemplerne er udvalgte med henblik på at belyse, hvad der kan komme på spil i sundhedsfaglige situationer udspændt mellem individuel frihed, herunder også ideen om autonomi; sygehusvæsenet, inklusive personale, som autoritær vi- dens-institution/aktør og det etiske, herunder ideen om ’det gode’ eller efterstræbelsesværdige. Afslutningsvis argumenteres der for, at sundhedsarbejdere med blik for etik og patientinddragelse kan udgøre en positiv kraft for den inddragede patient, men at det kræver, at denne vover at være vis. Afsnit: Resume Patientinddragelse i vor tid Autonomi, frihed og patientinddragelse Etik, patientinddragelse og den psykiatriske patient Etik, patientinddragelse og den unge Afslutning . (shrink)

Howard Phillips Lovecraft can be viewed as a Romantic based on his lifelong relationship with wonder. This short essay gathers further evidence of Lovecraft’s Romanticism, beginning with a brief exploration of what Romanticism is and then moving on to highlight elements of Romanticism in Lovecraft’s poem “Fact and Fancy” (1917). The essay concludes that, as much as Lovecraft can be labelled a Romantic based on his affinity with wonder, he can also be classified as such based on his aversion to (...) the cold light of reason, which to him was an insufficient antidote to the otherwise dreary world in which he found himself. (shrink)

Lovecraft’s teetotalism is well known among Lovecraftians, but the lengths to which he went to incorporate his views and how he sought to influence the people around him via his various writing remain relatively unexplored. This essay focuses on Lovecraft’s teetotalism and opens with a brief sketch of the historical background from which his dry outlook emerged. It continues by providing evidence for Love- craft’s advocacy of abstinence and Prohibition from a variety of sources, including biographical material, philosophical essays, letters, (...) poetry, and fiction, with a view to showing how he communicated his dry philosophy and how it softened as he advanced into middle age. The essay ends by arguing that although there can be no doubt that Lovecraft was a teetotaler par excellence, his later softened position is more balanced and rooted partly in the realization of his own idiosyncrasy and anachronism. (shrink)

I dette bogkapitel skrevet sammen med Ingeborg Ilkjær fremlægges tre etiske positioner herunder dydsetik, pligtetik og konsekvensetik. Disse teorier er sammen med eksempler på etiske principper og værdier det grundlag, som sygeplejersker kan benytte sig af i arbejdet med patientinvolvering og etiske dilemma, hvor der skal foretages et valg, der har betydning for patienter, pårørrende og de klinisk involverede. -/- For at kunne træffe valg af denne art er det vigtigt at kunne gøre det på et oplyst grundlag samt at (...) kunne påtage sig et klinisk lederskab. Derfor er det nødvendigt at benytte sig af en etisk refleksionsmodel. Dette arbejde kan være med til at skabe klarhed over en given situation, der rummer vanskelige etiske dilemmaer. -/- Bogkapitlet findes i bogen Sygepleje & Patientinvolvering Bind 3 redigeret af Steen Hundborg og udgivet på FADL’s Forlag I 2019. (shrink)

I joined Trevelyan College (Trevs), Durham University in 2011 as a mature student under former professor and principle of the college Martyn Evans. It was to be the beginning of a transformative journey culminating in my doctoral thesis: Balanced Wonder: A Philosophical Inquiry into the Role of Wonder in Human Flourishing. -/- In 2020 Trevs kindly asked me to contribute to the Alumni Magazine Hippocampus and in particular to the ‘Where Are They Now’ section. -/- “You Haven’t Done Anything” is (...) my contribution and it highlights in a humorous fashion some of the things I have achieved since I left Trevs. -/- Sections: -/- Standing still is rarely a good strategy in life -/- If One Lives Wisely Sometimes Less is More and Infinately More Valuable. (shrink)

A common objection to paternalism concerns its expressive content. Many reject paternalistic policies and actions on the ground that they arguably involve insulting expressions of disrespect toward those subjected to them. The paper challenges this view. It argues that refraining from acting paternalistically can be disrespectful. Specifically, the paper argues that there is a relevant way in which A disregards the moral worth of B if A stands idly by when B is about to act very imprudently. If true, treating (...) others with equal respect and concern, as relational egalitarians and others rightly ask us to do, will somewhat surprisingly sometimes involve treating them paternalistically. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Drawing on both anthropology and philosophy, this paper argues that the profiled form of the human hand is a universally recognizable image; one whose significance transcends temporally and geographically defined cultural divisions, and represents the earliest known artistic symbol of the human form. The unique co-occurrence of five properties in the image of the human hand and the way it is recognized support this argument, including that it is: (1) unmistakably a hand, (2) unmistakably human, (3) a universal point of (...) interface, (4) a universal referent of scale, and (5) an easy way of making a complex shape. This underappreciated aspect of hand art makes these images among the most important forms of early artistic expression encountered in the prehistoric record. (shrink)

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

In this introduction to part 4 of the Common Knowledge symposium “Peace by Other Means,” the journal's editor assesses the argument made by Peace, the spokesperson of Erasmus in his Querela Pacis, that the desire to impute and avenge wrongs against oneself is insatiable and at the root of both individual and social enmities. He notes that, in a symposium about how to resolve and prevent enmity, most contributions have to date expressed caveats about how justice and truth must take (...) precedence over peace, how recovery from ill treatment may be impossible, how quietism is not a moral option, and how realism demands a national policy and a personal strategy of, at best, contingent forgiveness. He concedes that the attitudes of those opposed to quietism are healthy but suggests that there may be goods worthier than health of human devotion. This essay concludes that the main differences between what it terms “judgmental” and “irenic” regimes are disagreements over anthropology and metaphysics. The presumptions that truths are objectively knowable and that human beings are moral and rational agents characterize judgmental regimes; irenic regimes are characterized by disillusionment with those assumptions. (shrink)

Kliniske etikkomiteer har vært etablert i norske helseforetak siden 1996, først som et prøveprosjekt, senere som et permanent tiltak med et nasjonalt mandat. I forbindelse med det nasjonale etikkprosjektet «Samarbeid om etisk kompetanseheving» har det også i noen kommuner blitt etablert KEK. Senter for medisinsk etikk ved Universitetet i Oslo er tildelt ansvaret for oppfølging av KEK i helseforetakene og er i tillegg gitt et langsiktig ansvar for etikkarbeid og forskning i den kommunale helse- og omsorgstjenesten. Hensikten med denne studien (...) har vært å fremskaffe kunnskap om hvordan det står til med KEK som er etablert i kommunene. Hva jobber de med, hvilken betydning erfarer de at KEK har og hvilke ressurser har de? Studien har et kvalitativt design. Materialet er basert på telefonintervjuer med ledere for KEK og gjennomgang av komiteenes årsrapporter. Det er gjennomført en kvalitativ innholdsanalyse av datamaterialet. Komiteene arbeider både med enkeltsaker, saker av mer prinsipiell karakter og etikkskolering. Arbeidet vurderes som betydningsfullt og gjennomføres til tross for få ressurser og svak forankring. Kanskje vil en styrket forankring og ressurssituasjon og et nasjonalt mandat bidra positivt til komiteenes arbeid. Nøkkelord: Kliniske etikkomiteer, kommunal helse- og omsorgstjeneste, evaluering English Summary: Are clinical ethics committees in the municipal health and care services sustainable? Clinical ethics committees have been established in Norwegian hospital trusts since 1996, first as a pilot project, later on a permanent basis with a national mandate. As part of the national ethics project "Cooperation on ethical competence" some municipalities have also established a CEC. Centre for Medical Ethics at the University of Oslo is given the responsibility to support CECs in hospital trusts, and is also given a long-term responsibility for ethics support and research in municipal health care services. The purpose of this study was to obtain knowledge about the situation of CECs established in municipalities. What are they working on, what impact do they find that CEC has, and what resources do they have? The study has a qualitative design. The material is based on telephone interviews with CEC chairs, and reviews of the committees' annual reports. We have carried out a qualitative content analysis of the data. The committees work with individual cases, issues of a more principle character, and ethics training. The work is considered to be significant, and is carried out despite limited resources and weak anchoring. Perhaps a stronger anchoring, resource situation and a national mandate could strengthen the committees’ situation. Keywords: Clinical ethics committees, municipal health and care services, evaluation. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

This paper explores moral sensitivity in a learning perspective, and a framework is developed for the understanding of how moral sensitivity can be developed through reiterative problem solving in the face of diverse ethical problems. Factors that may inhibit the individual's ability to conceive of moral issues are discussed, and perspectives from moral psychology are integrated with theory on problem formulation. It is argued that (1) the individual's moral sensitivity is pivotal for ethical problem solving, because problem formulation is paramount (...) for further reflection and behaviour; (2) ethical behaviour must be understood both (a) in terms of the individual's psychological make‐up that determines psychological response to moral features and (b) in terms of external constraints on the individual's moral sensitivity; and (3) the development of moral sensitivity can be promoted by actively and consciously pursuing disciplined imagination in multi‐perspective formulations of problems. (shrink)

As part of a Common Knowledge symposium on the “consequence of blur,” this article reassesses the anthropologist E. B. Tylor’s famous but vague concept of the animist soul as an optimal reflection of the soul’s fuzzy ontological status among animist peoples. Unlike the Platonic body/soul dichotomy, with its fixed appearance/essence distinction, indigenous conceptions of the soul among North Asian peoples, such as the Chukchi of Siberia and the Darhads of Mongolia, are reversible: persons can turn themselves inside-out as their inner (...) souls and outer bodies cross over and become one another. (shrink)

While many aspects of cognition have been shown to be shared between humans and non-human animals, there remains controversy regarding whether the capacity to mentally time travel is a uniquely human one. In this paper, we argue that there are four ways of representing when some event happened: four kinds of temporal representation. Distinguishing these four kinds of temporal representation has five benefits. First, it puts us in a position to determine the particular benefits these distinct temporal representations afford an (...) organism. Second, it provides the conceptual resources to foster a discussion about which of these representations is necessary for an organism to count as having the capacity to mentally time travel. Third, it enables us to distinguish stricter from more liberal views of mental time travel that differ regarding which kind(s) of temporal representation is taken to be necessary for mental time travel. Fourth, it allows us to determine the benefits of taking a stricter or more liberal view of mental time travel. Finally, it ensures that disagreement about whether some species can mentally time travel is not merely the product of unrecognised disagreement about which temporal representation is necessary for mental time travel. We argue for a more liberal view, on the grounds that it allows us to view mental time travel as an evolutionarily continuous phenomenon, and to recognise that differences in the ways that organisms mentally time travel might reflect different temporal representations, or combinations thereof, that they employ. Our ultimate aim, however, is to create the conceptual framework for further discussion regarding what sorts of temporal representations are required for mental time travel. (shrink)

The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified is related to professionals’ normative attitudes regarding the use of coercion. This paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions. Descriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as (...) offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’. Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security. This study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion. (shrink)

De senere år har pleie- og omsorgstjenesten i mange norske kommuner startet med ulike former for etikkarbeid, oftest initiert av KS’ prosjekt “Samarbeid om etisk kompetanseheving”. Hensikten med vår studie var å evaluere innsatsen i de kommunene som deltok i prosjektet fra starten av, med vekt på hvilke tiltak som var iverksatt, hvilke virksomheter dette omfattet, og om tiltakene har fortsatt utover prosjektperioden. Studien har et kvalitativt design. Materialet er hovedsakelig basert på telefonintervjuer med kontaktpersoner for etikksatsingen i 34 kommuner. (...) Det transkriberte materialet er analysert ved kvalitativ innholdsanalyse. Med unntak av fem kommuner som aldri kom i gang med etikkarbeidet, hadde de fleste startet etikkrefleksjon innenfor flere tjenester, oftest i sykehjem og hjemmetjenester. Noen kommuner hadde imidlertid ikke klart å videreføre etikkarbeidet utover en prosjektperiode. Det var stor variasjon både i etikkarbeidets forankring i kommunen, omfang, hyppighet og metoder. Et gjennomgående funn er vektlegging av behovet for etikkkompetanse og oppfølging av dem som skal lede etikkarbeidet. Flertallet av kommunene som fortsatt gjennomfører etikkrefleksjon, tar utgangspunkt i egen praksis, men et mindretall anvender strukturerte metoder. Dersom etikkarbeidet i kommunen skal være levedyktig over tid, bør arbeidet forankres på flere nivåer i organisasjonen, og de som skal lede dette arbeidet, bør få styrket sin kompetanse i etikk og etikkrefleksjon.Nøkkelord: etikk, evaluering, kommunehelsetjenestenEnglish summary: Building ethical competence in Norwegian municipalities: What has been done and what has been sustainable?“Cooperation for building ethics competence” is a national project aimed to stimulate moral reflection and build competence in ethics in community health services in Norway. This article is based on an evaluation of the activities implemented by the first 34 participating municipalities, exploring which measures were implemented, which services and employees were involved, and if the measures are sustainable. The study has a qualitative design, and the data mainly consists of telephone interviews with “key” persons in 34 municipalities. With the exception of five municipalities that never really started ethics work, the majority had implemented ethical reflection in several areas, most often in nursing homes and home care services. There was great variation with regard to the implementation. Many had tried a variety of reflection models, and only a minority of the municipalities were using a structured method of ethical reflection. A consistent finding is the need for more competence; many of those who run ethical reflection are reported to need more competence both in ethics and methods for systematic reflection. There were also great variations in how well the ethics projects were anchored within the municipality. To make ethical interventions sustainable, this study indicates the importance of strong anchoring within the municipality, the need for ethical competence, as well as good methods for structuring ethical reflection. (shrink)

This collection of essays in honor of Prof. Stig Andur Pedersen's 60th Birthday spans over a broad scope of topics, ranging from mathematical modelling over realism in philosophy of science to an analysis of apology after medical mistakes. The unusually broad range is a fair but still inadequate reflection of the work of Stig Andur Pedersen, a philosopher and scientist whose range of interests, abilities and production is itself unusually broad.

Die deutsch-jüdische Philosophin und Altphilologin Lotte Labowsky (1905-91), 1933/34 mit der Kulturwissenschaftlichen Bibliothek Warburg (K. B.W.) nach England emigriert, zählt zu den bisher weniger bekannten Gelehrten des Warburg-Kreises. Die Auffindung ihres "Nachlasses" im Marbacher Nachlass Raymond Klibanskys ermöglicht indes neue Einblicke in die Geschichte der K.B.W. und ihres philosophiegeschichtlichen Forschungsprogramms im englischen Exil. Auch das Leben der ebenso produktiven wie engagierten Wissenschaftlerin wird nun sichtbar. Über 550 Briefe Labowskys an Klibansky, geschrieben zwischen 1927 und 1991, zeugen von intensiver Arbeitsgemeinschaft (...) und Freundschaft eines transnationalen0Gelehrtenpaars im 20. Jahrhundert. (shrink)