This article reports a follow-up study of Norwegian nursing students entitled ‘The helping motive -an important goal for choosing nursing education’. It presents and discusses a significant ambiguity within the altruistic helping motive of 301 nursing students in the light of classical and modern virtue ethics. A quantitative longitudinal survey design was used to study socialization and building professional identity. The follow-up study began after respondents had completed more than two-and-a-half years of the three-year educational programme. Data were collected using (...) a questionnaire with closed questions, supplemented by 18 semi-structured, in-depth, audiotaped interviews. A motive such as ‘desire for human contact/to help others’ appeared to be highly significant. The research questions employed were: What motivates nursing students at the end of their studies to help other people? What does helping others mean for nursing students? Factor analysis revealed two factors. Factor 1 can be expressed as an altruism factor and factor 2 can be interpreted as an ‘acknowledgement-from-the-patient factor’ that in fact indicates an ambiguity within the helping motive itself. Findings from the interviews also reveal ambiguous helping motives. On one hand the students want to be altruistic and on the other they wish to receive positive feedback from patients when giving help. The findings indicate that this positive feedback is essential to the students in order for them to provide altruistic care. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...) tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (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 (i.e. experiencing moral dou...

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...) variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (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)

Ethics in business and economics is often attacked for being too superficial. By elaborating the conclusions of two such critics of business ethics and welfare economics respectively, this article will draw the attention to the ethics behind these apparently well-intended, but not always convincing constructions, by help of the fundamental ethics of Emmanuel Levinas. To Levinas, responsibility is more basic than language, and thus also more basic than all social constructions. Co-operation relations in organizations, markets and value networks are generated (...) from personal relations and personal responsibilities. It is not sufficient to integrate ethics in an impersonal, rational system, neither in business organizations nor in the world economy. Ethics has its source not in rationality, but in the personal. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including business ethics, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including ‘business ethics’, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Cosmological narratives like the creation story in the book of Genesis or the modern Big Bang are popularly understood to be descriptions of how the universe was created. However, cosmologies also say a great deal more. Indeed, the majority of cosmologies, ancient and modern, explore not simply how the world was made but how humans relate to their surrounding environment and the often thin line which separates humans from gods and animals. Combining approaches from classical studies, anthropology, and philosophy, this (...) book studies three competing cosmologies of the early Greek world: Hesiod's Theogony; the Orphic Derveni theogony; and Protagoras' creation myth in Plato's eponymous dialogue. Although all three cosmologies are part of a single mythic tradition and feature a number of similar events and characters, Olaf Almqvist argues they offer very different answers to an ongoing debate on what it is to be human. Engaging closely with the ontological turn in anthropology and in particular with the work of Philippe Descola, this book outlines three key sets of ontological assumptions - analogism, pantheism, and naturalism - found in early Greek literature and explores how these competing ontological assumptions result in contrasting attitudes to rituals such as prayer and sacrifice. (shrink)

Models of illness causation play a crucial role in medicine and public health. In their recent paper on this topic, Michael Kelly, Rachel Kelly, and Federica Russo state that the integration of social, biological, and behavioral causes in one and the same etiologic mechanism remains to be clarified. In particular, they think that current models of illness causation do not appreciate "the truly integrated nature of bio-social-behavioral pathogenesis". In brief, Kelly, Kelly, and Russo suggest that two levels of explanation are (...) at work in medicine and public health, biological and social; that integration is difficult because of resistance to including social determinants of disease in both the... (shrink)

Theory of illness causation is an important issue in all biomedical sciences, and solid etiological explanations are needed in order to develop therapeutic approaches in medicine and preventive interventions in public health. Until now, the literature about the theoretical underpinnings of illness causation research has been scarce and fragmented, and lacking a convenient summary. This interdisciplinary book provides a convenient and accessible distillation of the current status of research into this developing field, and adds a personal flavor to the discussion (...) by proposing the etiological stance as a comprehensive approach to identify modifiable causes of illness. (shrink)

Mit rein rationalen Mitteln können wir keine Entscheidung über die transzendenten Sätze der Religion herbeiführen; ob es außerhalb unseres physischen Universums einen Gott gibt oder ob wir nach dem Tod erlöst werden, muss rein naturwissenschaftlich offenbleiben. Daher suche ich nach Zugkräften, die im Leben des religiös Unentschiedenen einen Umschwung bewirken könnten. Wer seine Überzeugungen und Gefühle in eine harmonische Balance bringen will, ist gut beraten, mit bestimmten Erlebnissen (die wir alle kennen) nicht allzu rabiat umzuspringen. Diese Erlebnisse scheinen auf Gott (...) zu verweisen; und statt sie fortzuwischen, könnten wir versuchen auszuprobieren, was mit uns geschieht, wenn wir sie zulassen. Was das heißen kann, springt besonders deutlich bei unserem Umgang mit großer religiöser Musik ins Ohr. Während dem hartgesottenen Atheisten der Zugang zu wichtigen Schichten dieser Musik (etwa der Matthäuspassion) versperrt bleibt, könnte darin für den religiös Unentschiedenen mehr stecken, als man gemeinhin denkt. (shrink)

In this essay, I argue that Ted Poston's theory of explanatory coherentism is well-suited as a tool for causal explanation in the health sciences, particularly in epidemiology. Coherence has not only played a role in epidemiology for more than half a century as one of Hill's viewpoints, it can also provide background theory for the development of explanatory systems by integrating epidemiologic evidence with a diversity of other error-independent data. I propose that computational formalization of Hill's viewpoints in an explanatory (...) coherentist framework would provide an excellent starting point for a formal epistemological (knowledge-theoretical) project designed to improve causal explanation in the health sciences. As an example, I briefly introduce Paul Thagard's ECHO system and offer my responses to possible objections to my proposal. (shrink)

Microphotography was one of the earliest applications of photography in science: The first monograph on tissue organization illustrated with microphotographs was published in 1845. In the 1860s, a large number of introductions to scientific microphotography were published by anatomists. They argued that microphotography was a means of documenting the results of microscopic analysis, uncontaminated by the subjectivity of the observer. In the early decades of the 19th century, before the general acceptance of cell theory, such a technique was of special (...) importance, as no criteria were available to distinguish between important and superficial characters in the description of tissue microstructures. Microphotography was praised as the method of choice for documenting the scientific observations of microscopic material. Some of the microphotographic practices described in these early manuals, however, did not conform with the idea of a purely mechanical process of documentation. The authors of these manuals saw photography not as a technique which produced artifacts, but as a complete and reliable substitute for the original preparations. Thus, according to these authors, the artificial world of photography was seen as the actual representation of the microworld. Consequently, they tried to understand the microcosm by analyzing photographs instead of the microscopic preparation themselves. Such attitudes discredited the use of microphotography in the sciences. Consequently, the definitive breakthrough of scientific microphotography was delayed until the 1880s and was largely due to the efforts of Robert Koch, who made microphotography a central tool of bacteriology. (shrink)

In this article the authors focus on the emergence, or disappearance, of notions of responsibility in social dynamic processes. Hence, the starting point in this article is concrete behavior within organisational settings. This article presents a systematic overview of mechanisms related to acting upon a sense of moral responsibility. Some of these mechanisms are based on individual characteristics, others are embedded in the social context wherein responsible behaviour emerges or disappears. In this article, various mechanisms are identified and labelled in (...) order to analyse what types of processes are behind the mechanisms. In this way, the article yields important understandings for the conscious use of these mechanisms to strengthen responsible behavior within organisations. (shrink)

This book covers the overlap between informatics, computer science, philosophy of causation, and causal inference in epidemiology and population health research. Key concepts covered include how data are generated and interpreted, and how and why concepts in health informatics and the philosophy of science should be integrated in a systems-thinking approach. Furthermore, a formal epistemology for the health sciences and public health is suggested. -/- Causation in Population Health Informatics and Data Science provides a detailed guide of the latest thinking (...) on causal inference in population health informatics. It is therefore a critical resource for all informaticians and epidemiologists interested in the potential benefits of utilising a systems-based approach to causal inference in health informatics. (shrink)

Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in (...) 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems. (shrink)

In order to support health interventions, biomedical and population health researchers need to collect solid evidence. This article asks what type of evidence this should be and expands on previous work that focused on etiological explanations, or causal-mechanical explanations of why and how illness occurs. The article proposes adding predictive evidence to the explanatory evidence, in order to form a joint evidence set, or JES = [A,B,C,D], which consists of four different types of evidence: association [A], biology [B], confirmation [C], (...) and difference-making [D]. The article discusses explanatory coherence as a backbone for this proposal, suggests criteria for each type of evidence, and offers a rubric for multi-evidence mapping. (shrink)

Goethe's objections to Newton's theory of light and colours are better than often acknowledged. You can accept the most important elements of these objections without disagreeing with Newton about light and colours. As I will argue, Goethe exposed a crucial weakness of Newton's methodological self-assessment. Newton believed that with the help of his prism experiments, he could prove that sunlight was composed of variously coloured rays of light. Goethe showed that this step from observation to theory is more problematic than (...) Newton wanted to admit. By insisting that the step to theory is not forced upon us by the phenomena, Goethe revealed our own free, creative contribution to theory construction. And Goethe's insight is surprisingly significant, because he correctly claimed that all of the results of Newton's prism experiments fit a theoretical alternative equally well. If this is correct, then by suggesting an alternative to a well-established physical theory, Goethe developed the problem of underdete... (shrink)

Bradford Hill (1965) highlighted nine aspects of the complex evidential situation a medical researcher faces when determining whether a causal relation exists between a disease and various conditions associated with it. These aspects are widely cited in the literature on epidemiological inference as justifying an inference to a causal claim, but the epistemological basis of the Hill aspects is not understood. We offer an explanatory coherentist interpretation, explicated by Thagard's ECHO model of explanatory coherence. The ECHO model captures the complexity (...) of epidemiological inference and provides a tractable model for inferring disease causation. We apply this model to three cases: the inference of a causal connection between the Zika virus and birth defects, the classic inference that smoking causes cancer, and John Snow’s inference about the cause of cholera. (shrink)

In vielen Debatten werden spezifische Vorstellungen über die Geschichte, Kultur oder Werteordnung ›Europas‹ für die Erklärung oder Legitimierung politischer Verhältnisse und Projekte herangezogen. Die vorliegende Studie prüft die Berechtigung solcher Konstruktionen, indem sie der Frage nachgeht, seit wann und warum überhaupt von ›Europa‹ gesprochen wird. Die Analyse der historischen Semantik des Europabegriffs muss, um identitätspolitisch motivierte Anachronismen zu vermeiden, seine materiellen, kulturellen und diskursiven Konstitutionsbedingungen einbeziehen. ›Europa‹ verliert dadurch seinen transhistorischen Charakter, den es erhält, wenn man ihm im Bestreben, es (...) als politische und kulturelle Entität auszuzeichnen und fungibel zu machen, eine mythische Geschichte und Struktur zuschreibt. Demgegenüber zeigt die kritische Analyse: Als politische und kulturelle ›Idee‹ wie als gelebte und erfahrene ›Wirklichkeit‹ gründet Europa nicht in Antike oder Mittelalter, sondern ist das Produkt der Entstehung der modernen Welt seit der frühen Neuzeit. (shrink)

Two decades after the publication of Clifford and Marcus' volume Writing Culture, this collection provides a fresh and diverse reassessment of the debates that ...

Thinking about illness causation has a long and rich history in medicine. After a hiatus in the 1990s, the last one-and-a-half decades have seen a surge of publications on causality in the biomedical sciences. Interestingly, this surge is visible not only in the medical, epidemiological, bioinformatics, and public health literatures, but also among philosophical publications. In this essay, I review and discuss one most recent addition to the literature, "Causality: Philosophical Theory Meets Scientific Practice" written by philosophers Phyllis Illari and (...) Federica Russo about causality in the sciences, and particularly about the health sciences. (shrink)

In this paper, we build upon the model of authenticity proposed by Lehman and colleagues, which includes the dimensions consistency, conformity, and connection. We expand this “3C-view” by adding a fourth dimension, continuity, which results in what we have come to call “4C-view of authenticity.” We discuss our proposal from a process perspective and emphasize that congruence might be a reasonable candidate for a concept that unifies the four dimensions of authenticity.

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in populations, (...) (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage. (shrink)

The purpose of this paper is to survey the correspondence between bounded arithmetic and propositional proof systems. In addition, it also contains some new results which have appeared as an extended abstract in the proceedings of the conference TAMC 2008 [11].Bounded arithmetic is closely related to propositional proof systems; this relation has found many fruitful applications. The aim of this paper is to explain and develop the general correspondence between propositional proof systems and arithmetic theories, as introduced by Krajíček and (...) Pudlák [46]. Instead of focusing on the relation between particular proof systems and theories, we favour a general axiomatic approach to this correspondence. In the course of the development we particularly highlight the role played by logical closure properties of propositional proof systems, thereby obtaining a characterization of extensions of EF in terms of a simple combination of these closure properties (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim). (shrink)

The aim of this paper is to reconcile the two modes of description of macrosystems, i.e., to remove certain inconsistencies between the classical phenomenological and the quantum-theoretical descriptions of a macrosystem. Starting from Ludwig's formulation of a general framework for classical theories and his ansatz for a compatibility condition between the quantum theoretical and the classical mode of description for a macrosystem, we try to make clear what the “classical content” of many-body quantum theory really is. It is shown that (...) this classical content may be described by a certain “observable,” i.e., an operator-valued measure over the Borel sets of the classical trajectory space. There exists a reduced time evolution within this classical content which has the structure of a true semigroup in case of an irreversible classical time evolution. (shrink)

The term >catastrophe catastrophe catastrophe< has lost all its positive connotation in twentieth century discourses.

The intention of the article is to offer stakeholders affected by mergers a criterion from which moral arguments may be generated for the organization of each individual case. The criterion: "Any operation causing legitimate interests to suffer vital infringement should be avoided in a merger process." A vital infringement of these interests is assumed when the merger undermines unique positive opportunities or considerable impairment in the future, impossible to overcome for the person affected without an unacceptable level of difficulty. Therefore, (...) we mainly concentrate on implicit contracts – which should be based on the principle pacta sunt servanda as well. These contracts are mandatory to run an economy that produces increasingly more knowledge-based goods. (shrink)

Default logic is one of the most popular and successful formalisms for non-monotonic reasoning. In 2002, Bonatti and Olivetti introduced several sequent calculi for credulous and skeptical reasoning in propositional default logic. In this paper we examine these calculi from a proof-complexity perspective. In particular, we show that the calculus for credulous reasoning obeys almost the same bounds on the proof size as Gentzen’s system LK. Hence proving lower bounds for credulous reasoning will be as hard as proving lower bounds (...) for LK. On the other hand, we show an exponential lower bound to the proof size in Bonatti and Olivetti’s enhanced calculus for skeptical default reasoning. (shrink)