Some public health behavioral intervention research studies involve deception. A methodological imperative to minimize bias can be in conflict with the ethical principle of informed consent. As a case study, we examine the specific forms of deception used in three online randomized controlled trials evaluating brief alcohol interventions. We elaborate our own decision making about the use of deception in these trials, and present our ongoing findings and uncertainties. We discuss the value of the approach of pragmatism for examining these (...) kinds of ethical issues that can arise in research on public health interventions. (shrink)

Roughly 80,000 U.S. prisoners are held in solitary confinement at any given time. A significant body of research shows that solitary confinement has severe, long-term effects, and the United Nations has condemned the practice of solitary confinement as torture. For years, prisoners have been organizing hunger strikes in order to protest solitary confinement. But such action is not without consequences, and some inmates have suffered serious injury or death. The question I raise in this paper is whether we ought to (...) force-feed hunger striking prisoners when serious harm is imminent. Both the World Medical Association and the American Medical Association have denounced the practice of force-feeding prisoners on hunger strike, and yet, the practice is common. Such prevalence is likely a result of the tension between the person-as-patient and person-as-prisoner and cannot easily be resolved. Instead, we must take seriously the complaint that solitary confinement is inhumane and avoid placing health professionals in the position where they must choose to force-feed the prisoner against his will or not. I argue that a conventional bioethics debate centering on polarizing principles of prisoner autonomy and a duty-to-protect the prisoner from harm is an inadequate framework for this complex issue. Instead, we must examine the prisoner’s intent and his right to freedom of speech. I argue that when the prisoner’s intent is to raise awareness and communicate with others, his hunger strike is a form of speech. Protest-as-speech is constitutionally protected—even for prisoners—and remains a minimum ethical obligation for society to uphold. (shrink)

Although Denmark managed to stay neutral throughout World War I, it nevertheless generated a heated debate in the country; most people took a clear stand for one side or the other. After the traumatic Danish defeat in the 1864 war with Prussia and Austria, Germany was regarded as the arch enemy and not unexpectedly mostDanes sided against the Central Powers in the public debate. This was not least the case amongst the national-conservative politicians, intellectuals and artists. They form the focus (...) of my article, and the questions I address are: how did the national-conservatives experience the mental watershed of the war? Was it as a blessing or a curse? (shrink)

This article presents a developmental model of phenomenological consciousness in early childhood . A 3-stage developmental model is constructed, based on the understanding of phenomenological consciousness as modeling activity structured by the directedness at/by the world in general and directedness at/by directedness in particular. Thereby, it is demonstrated that it is in the interaction with other people and the structure and content of their phenomenological consciousness, i.e., their directedness and their modeling of the world, that the development of fully accomplished (...) phenomenological consciousness takes place. The developmental model is empirically substantiated on the basis of a review of empirical investigations which traditionally has been framed in terms of the "theory-of-mind"-theory, but which in this article shall be reframed in terms of directedness and phenomenological modeling. 2012 APA, all rights reserved). (shrink)

Attempts to develop a genuine compatabilist model of the free will and to implement this model into psychology. The task of the model is to present an alternative to those versions of the compatabilist notion, which rightly seen are nothing but soft versions of determinism. This alternative is based on an integration of a soft version of determinism with a soft version of indeterminism, and based on a nonmystical and scientific concept of downward causality, and thereby is placed in the (...) domain of science and in a materialist ontology. This leads to a hierarchical multi-layer model, the core notion of which is the soft deterministic concept of bottom-up constituting dynamics and the soft indeterministic concept of top-down organizational dynamics. It is in this existential tension field between constitutional and organizational dynamics that our very human nature in general, and free will in particular, develop. 2012 APA, all rights reserved). (shrink)

Introduction General Anthropology What is it to be human? Human existence means human co-existence; this is an inevitable part of the human condition. ...

This paper critically examines the implications of state efforts to expand prescriptive authority of pharmacists, which will allow them to prescribe various types of hormonal contraceptives. With this expansion, women no longer need to see a physician before being prescribed such contraceptives, but instead, they must answer self-assessment questionnaires at the pharmacy to ensure that their chosen method is safe and appropriate. This paper argues that while these measures to expand pharmacists’ prescriptive authority will surely meet the stated goal to (...) increase access to hormonal contraceptives, the measures may have detrimental consequences that have largely been downplayed. Studies consistently show that the OB-GYN is a significant primary care provider identified by young female patients, and some of the main reasons provided by these young women for going to the OB-GYN is to discuss, or obtain a prescription for, contraceptives. Through the expansion of pharmacists’ prescriptive authority, a likely consequence is that some women will relinquish going to the OB-GYN. However, the OB-GYN provides important services beyond contraceptives, such as preventive screenings for hypertension, cardiovascular diseases, alcohol abuse, mental health, etc., and there is evidence supporting both the effectiveness and cost–benefits of these interventions. By increasing access to contraceptives, the likely result is that many women will have less interaction with a physician and will receive fewer preventive screenings. I do not wish to suggest that these bills should not pass, nor that OB-GYNs should hold contraceptives hostage, only that there are consequences to expanded prescriptive authority that must be anticipated. Further, expanding prescriptive authority obscures the real problem: some individuals have trouble accessing the health care system, not merely trouble accessing hormonal contraceptives. The expansion of prescriptive authority to include contraceptives applies a Band-Aid to treat one aspect of this problem. What is needed is not merely expanded access to hormonal contraceptives, but better access to health care in general. (shrink)

Self psychology is the study of the psychodynamics that come into existence with self reflection-that is, the intentions that emerge with introspection. In this respect, self psychology is different from Freudian psychoanalysis and intimately related to the phenomenological-existential perspective. In this paper, I examine how a general psychological model of intentional reflection can be developed on the basis of Kohut's self psychology, a model that illustrates one of the central organizational principles of human psychology. I conclude with a discussion of (...) the general psychological concepts of self, life-project, and activity in the light of self psychology. (shrink)

The paper presents a general critique of the use of conceptual frameworks in design, illustrated by the well known synchronous/asynchronous, co-located/non-co-located framework. It argues that while frameworks are a necessary and inevitable starting point for design, the business of tailoring and adapting them to specific situations need not be ad hoc.Triggering artefacts are a way of systematically challenging both designers' preunderstandings and the conservatism of work practice. Experiences from the Great Belt tunnel and bridge project are used to illustrate howtriggering (...) artefacts change themodality of designing for change. (shrink)

Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing their practice? This essay describes how a group of researchers have, over a number of years, developed improvised participatory theatre as a means of engaging healthcare practitioners, patients and other lay people in situations where (...) it is legitimate to reappraise their practice and reunderstand the nature of an illness such as chronic pain. One conclusion was to consider that it is a relational rather than an individual phenomenon that in turn demands alternative practice. Through iterative workshop processes of improvised theatre, participants are encouraged to experience the vulnerable, the unknown, and the need to be alternatively present when dealing with patients whose situation is imbued with suffering. (shrink)

In public debate GMPs are oftenreferred to as being unnatural or a violationof nature. Some people have serious moralconcerns about departures from what is natural.Others are concerned about potential risks tothe environment arising from the combination ofhereditary material moving across naturalboundaries and the limits of scientificforesight of long-term consequences. To addresssome of these concerns we propose that anadditional element in risk assessment based onthe concept of familiarity should beintroduced. The objective is to facilitatetransparency about uncertainties inherent inthe risk assessment of (...) the GMP. Familiarityconventionally involves data and experiencerelating to the plant species and the ecosystemin question. We would like to extend thisconcept to the molecular level of plantbreeding and suggest that GMP characteristicsshould be compared to a reference baselinedetermined by conventional breeding techniques.Three GMPs are ranked according to familiarityat the plant and ecosystem level and themolecular level. The approach may help tointegrate discussion of the scientificarguments and moral questions raised in thedebate about GMOs by providing an operationalscheme within which moral concerns are broughtwithin the framework of science-based riskassessment. (shrink)

In recent years, it has become commonplace among the Global Burden of Disease study authors to regard the disability-adjusted life year primarily as a descriptive health metric. During the first phase of the GBD, it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the (...) DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning to the most recent releases. We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative. (shrink)

In a metaphorical sense, a thing is complex if it comprehends a magnitude of homogeneous or different things. However, it depends on the kind of comprehension, if we conceive something that consists of many things as complex or not. It is perhaps most distinctive for complex phenomena that their properties and behavior aren't reducible to the properties and behavior of their elements. This poses some challenging metaphysical problems. The articles in this anthology don't follow a leitmotif - aside from all (...) essays having a look at complexity problems in different areas of scientific research and showing in which ways the challenges of complexity can be answered. (Series: Applied Philosophy / Anvendt Filosofi - Vol. 4). (shrink)