According to T. M. Scanlon's 'buck-passing' analysis of value, x is good means that x has properties that provide reasons to take up positive attitudes vis-à-vis x. Some authors have claimed that this idea can be traced back to Franz Brentano, who said in 1889 that the judgement that x is good is the judgement that a positive attitude to x is correct ('richtig'). The most discussed problem in the recent literature on buckpassing is known as the 'wrong kind of (...) reason' problem (the WKR problem): it seems quite possible that there is sometimes reason to favour an object although that object is not good and possibly very evil. The problem is to delineate exactly what distinguishes reasons of the right kind from reasons of the wrong kind. In this paper we offer a Brentano-style solution. We also note that one version of the WKR problem was put forward by G. E. Moore in his review of the English translation of Brentano's Vom Ursprung sittlicher Erkenntnis. Before getting to how our Brentano-style approach might offer a way out for Brentano and the buck-passers, we briefly consider and reject an interesting attempt to solve the WKR problem recently proposed by John Skorupski. (shrink)
Honesty is essential for the care of seriously ill and dying patients. The current study aimed to describe how nurses experience honesty in their work with patients receiving palliative care at home. The interviews in this phenomenological study were conducted with 16 nurses working with children and adults in palliative home-based care. Three categories emerged from analyses of the interviews: the meaning of honesty, the reason for being honest and, finally, moral conflict when dealing with honesty. The essence of these (...) descriptions was that honesty is seen as a virtue, a good quality that a nurse should have. The nurses’ ethical standpoint was shown in the moral character they show in their work and in their intention to do good. This study could help nurses to identify different ways of looking at honesty to promote more consciousness and openness in ethical discussions between colleagues and other staff members. (shrink)
The so-called Wrong Kind of Reason (WKR) problem for Scanlon's account of value has been much discussed recently. In a recent issue of Utilitas Gerald Lang provides a highly useful critique of extant proposed solutions to the WKR problem and suggests a novel solution of his own. In this note I offer a critique of Lang's solution and respond to some criticisms Lang directs at a Brentano-style approach suggested by Sven Danielsson and me.
In a recent article in Utilitas, Gerald Lang suggests a solution to the so-called (WKR problem) for the buck-passing account of value. In two separate replies to Lang, Jonas Olson and John Brunero, respectively, point out serious problems with Lang's suggestion, and at least Olson concludes that the solution Lang opts for is of the wrong kind for solving the WKR problem. I argue that while both Olson and Brunero have indeed identified considerable flaws in Lang's suggestion for a solution (...) to the WKR problem, they have not provided sufficient grounds for dismissing the kind of solution that Lang proposes. I show how a version of this kind of solution can be formulated so as to avoid both Olson's and Brunero's objections. I also raise some worries concerning an alternative solution to the WKR problem suggested by Sven Danielsson and Jonas Olson. (shrink)
Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were (...) to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction. The procedure included linguistic translation and cultural adaptation of MDS-R’s paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care. To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens. Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients. (shrink)
The paediatric Moral Distress Scale-Revised was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents’ unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish (...) paediatric MDS-R, among healthcare professionals in paediatric oncology. In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach’s alpha and inter-item correlation test. HCPs at all six Swedish paediatric oncology centres participated. The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. Nursing assistants reported higher intensity and lower frequency on all added items; registered nurses reported a higher frequency on item 22–25; medical doctors reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology. (shrink)
Contributing Authors: Lilli Alanen & Frans Svensson, David Alm, Gustaf Arrhenius, Gunnar Björnsson, Luc Bovens, Richard Bradley, Geoffrey Brennan & Nicholas Southwood, John Broome, Linus Broström & Mats Johansson, Johan Brännmark, Krister Bykvist, John Cantwell, Erik Carlson, David Copp, Roger Crisp, Sven Danielsson, Dan Egonsson, Fred Feldman, Roger Fjellström, Marc Fleurbaey, Margaret Gilbert, Olav Gjelsvik, Kathrin Glüer & Peter Pagin, Ebba Gullberg & Sten Lindström, Peter Gärdenfors, Sven Ove Hansson, Jana Holsanova, Nils Holtug, Victoria Höög, Magnus Jiborn, Karsten Klint (...) Jensen, Sigurður Kristinsson, Isaac Levi, Kasper Lippert-Rasmussen, David Makinson, Anna-Sofia Maurin, Philippe Mongin, Kevin Mulligan, Lennart Nordenfelt, Jonas Olson, Erik J. Olsson, Ingmar Persson, Johannes Persson, Björn Petersson, Philip Pettit, Hans Rott, Toni Rønnow-Rasmussen, Krister Segerberg, John Skorupski, Howard Sobel, Fredrik Stjernberg, Fred Stoutland, Caj Strandberg, Pär Sundström, Folke Tersman, Torbjörn Tännsjö, Peter Vallentyne, Bruno Verbeek, Stella Villarmea, and Michael J. Zimmerman. (shrink)
The Hospital Ethical Climate Survey was developed in the USA and later shortened. HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. (...) In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from ‘almost never true’ to ‘almost always true’; while the Swedish HECS labels range from ‘never’ to ‘always’. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals, employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected ‘never’ and ‘always’. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word ‘respect’ was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients’ wishes implied always complying with them. The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use. (shrink)