This article presents an empirical study of approaches to ethical decision-making among nurses and doctors. It takes as its starting point the distinction between the perspectives of care and of justice in ethical thinking, and the view that nurses' thinking will be aligned with the former and doctors' with the latter. It goes on to argue that the differences in these approaches are best understood in terms of the distinction between partialist and impartialist modes of moral thinking. The study seeks (...) to determine the distribution of these modes of thinking between nurses and doctors, and finds that there are no signif icant differences between them. A 'two-level' philosophical view of the nature of moral thinking is appealed to in order to explain the study findings. (shrink)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

What is reality for an agent? What is minimal cognition? How does the morphology of a cognitive agent affect cognition? These are still open questions among scientists and philosophers. In this chapter we propose the idea of info-computational nature as a framework for answering those questions. Within the info-computational framework, information is defined as a structure, and computation as the dynamics of information. To an agent, nature therefore appears as an informational structure with computational dynamics. Both information and computation in (...) this context have broader meaning than in everyday use, and both are necessarily grounded in physical implementation. Evolution of increasingly complex living agents is understood as a process of morphological computation driven by agents’ interactions with the environment. It is a process much more complex than random variation; instead the mechanisms of change are morphological computational processes of self-organisation. Reality for an agent emerges as a result of interactions with the environment together with internal information processing. Following Maturana and Varela, we take cognition to be the process of living of an organism, and thus it appears on different levels of complexity, from cellular via organismic to social. The simpler the agent, the simpler its “reality” defined by the network of networks of info-computational processes, which constitute its cognition. The debated topic of consciousness takes its natural place in this framework, as a process of information integration that we suggest naturally evolved in organisms with a nervous system. Computing nature/pancomputationalism is sometimes confused with panpsychism or claimed to necessarily imply panpsychism, which we show is not the case. Even though we focus on natural systems in this chapter, the info-computational approach is general and can be used to model both biological and artifactual cognitive agents. (shrink)

While analysis of what takes people into prostitution has been widely documented, this article explores the way adult ‘30 something’ prostitutes consider their futures and the ideas they have about leaving or staying in prostitution. Drawing on contested notions of prostitution as ‘work’ and the broader context of life-history research with sex workers, it explores the experiences that frame prostitutes’ own narratives about their working lives and futures. An illustrative range of five life-history accounts from British sex workers are analysed (...) as ‘imagined’ curriculum vitae, listing emergent categories of: aliases, education, interests, thoughts on retirement, financial planning, getting older, hopes and ambitions and fantasy futures. These ‘stories’ are analysed looking at ways they inform on-going feminist debates about the realities of (voluntary adult) sex workers’ concerns. They point again to the relevance for sex workers and feminists of understanding sex work as ‘a job’. (shrink)

Graphene is a nanomaterial with many promising and innovative applications, yet early studies indicate that graphene may pose risks to humans and the environment. According to ideas of responsible research and innovation, all relevant actors should strive to reduce risks related to technological innovations. Through semi-structured interviews, we investigated the idea of graphene as a risk held by two types of key actors: graphene researchers and innovation advisors at universities, where the latter are facilitating the movement of graphene from the (...) laboratory to the marketplace. The most common idea found is that graphene is not a risk due to, e.g., low toxicity, low amounts produced/used, and its similarity to harmless materials. However, some researchers and advisors also say that graphene is a risk, e.g., under certain conditions or due to a lack of risk-related information. We explain the co-existence of these seemingly contradictory ideas through the semantic ambiguity of the word risk and a risk/no-risk rhetoric, where risks are mentioned rhetorically only to be disregarded as manageable or negligible. We suggest that some of the ideas held by the researchers and innovation advisors constitute a challenge to responsible research and innovation regarding graphene. At the same time, we acknowledge the dilemma that the discourse of responsible innovation creates for the actors: denying graphene risks makes them irresponsible due to a lack of risk awareness, while affirming graphene risks makes them irresponsible due to their everyday engagement in graphene development. We therefore recommend more research into what researchers and innovation advisors should do in practice in order to qualify as responsible. (shrink)

This article has two main divisions, the first consisting in parts 1-3, the second in parts 4-8. The purpose of the first division is to assess Hauerwas's contentions regarding what he takes to be serious debilities in modern theological culture. The objects of Hauerwas's criticism are: (1) natural theology; (2) reason as it is represented in the structure of the modern university and in the "Enlightenment Project"; and (3) liberal Protestantism--the latter particularly as it turns up, by his account, in (...) Reinhold Niebuhr's theology. The article will offer a defense of natural theology and an alternative approach to Niebuhr's theology while showing how Hauerwas's contentions concerning these two matters are mistaken. Parts 4-8 are theological studies. These studies concentrate on selected though main aspects of Hauerwas's outlook. Part 4 concerns a problematic implication of the notion, mainly from Barth, of divinity's humanity; Part 5 a note of difficulty from William James about the idea of the theistic God and its pertinence to the Barthian or Hauerwasian God; Part 6 the relation between belief and witness; Part 7 theology's discourse and analogy; Part 8 the Barthian-Hauerwasian theology as a metaphysics. Part 1, concerning natural theology, stands over both divisions. These observations are not in the main intended as textual studies, though in certain passages the analysis is closely attentive to Hauerwas's text. Also, the paper does not offer the sort of account that would come from a historian, intellectual biographer, or social or cultural analyst or critic. Its focus is philosophical-theological criticism. (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...) Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

This paper tries to evolve a distinctive model of Swedish management from the standpoint of human values. The author attempts to understand the deeper and subtle aspects of the Scandinavian manage ment style and discusses ways to understand different management styles in different cultural contexts and how they can be sustained in an information age where culture-specific values face extinction. His analysis draws on several sources including personal experiences and mythological references. The paper explores the 'deep structure' of the Swedish (...) mind and enumerates 'typical Swedish' values like equality, self-criticism, worship of nature, and their relationship with the Swedish management style. It also articulates the dilemma of the Swedish manager who has to stick to traditional Swedish values at work and at the same time be responsive to universal human values. According to the author, the ideal way to overcome this dilemma is to transcend into pure being by knowing one's real self and then coming out into the world of action to reflect the universal in the relative. (shrink)

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...) possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses. (shrink)

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

RÉSUMÉ: Cet article examine la relation que Ronald Dworkin veut établir entre les idéaux libéraux d’égalité et de liberté dans le cadre de sa théorie dite de l’Égalité des ressources. Dworkin soutient que la spécification d’un système de libertés est essentielle à la définition même de l’égalité et que la théorie de l’Égalité des ressources unifie en profondeur ces deux idéaux par sa notion centrale de «vrais coûts de renonciation». Le présent article accepte avec Dworkin que la liberté et l’égalité (...) doivent être définies en interdépendance, mais nie que la théorie de l’Égalité des ressources y parvienne d’une manière cohérente. Cette théorie reste incomplète en tant que théorie de l’égalité et critiquable comme interprétation du libéralisme. Une autre voie serait de dériver le libéralisme d’un idéal libéral perfectionniste — celui de l’autonomie personnelle. On indique brièvement comment la chose pourrait être accomplie. (shrink)

Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges (...) in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed. No data are available. (shrink)

One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting (...) point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed (...) to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed. (shrink)

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

The association of women with caring dispositions and thinking has become a persistent theme in recent feminist writing. There are a number of reasons for this. One reason is the impetus that has been provided by the empirical work of Carol Gilligan on women’s moral development. The fact that this association is not merely an ideologically or philosophically postulated one, but is argued for on empirical grounds, tends to add to its credibility. Another reason for the resilience of the association (...) is the existence of an increasingly prominent theme in feminist thought and action that focuses on the importance of women’s difference from men, both as a fact and as a goal. Within this theme, there are various views on what the relevant differences are between women and men, and why the differences ought to be emphasized and properly respected. Women’s caring, as will be seen, turns out to have a firm presence in all of these views, and as a result, many women argue that caring should form the basis of a distinctive feminist ethic. On these views, women’s approaches to understanding moral situations, defining selfconceptions, choosing goals and roles, and guiding behaviour, should all be informed by and based upon dispositions of caring. However, if this idea of a feminist ethic of care is to be plausible, it will need to be reconciled with another strong theme in feminism, according to which in fundamental moral respects women ought not be considered or treated differently from men. We will examine the standing of a feminist ethic of care in the context of this tension between the difference theme and the sameness theme in feminism. The discussion begins by re-characterizing the justice and care debate in terms of impartialist and partialist ethical perspectives, and it then goes on to indicate the various ways in which women’s presumed disposition to caring and partialism finds prominence within the difference theme. The central focus of the discussion, however, will be the question of how to reconcile the conflict that exists between impartialist, justice-based moral thinking, and a partialist, caring approach to morality.. (shrink)

Scientific writings and policy documents define the terms nanomaterial and nanoparticle in various ways. This variation is considered problematic because the absence of a shared definition is understood as potentially hindering nanomaterial knowledge production and regulation. Another view is that the existence of a shared definition may itself cause problems, as rigid definitions arguably exclude important aspects of the studied phenomena. The aim of this paper is to inform this state of disagreement by providing analytical concepts for a systematic understanding (...) of how, and even whether, nanomaterial and nanoparticle could and should be defined. To do this, we review definitions of nanomaterial and nanoparticle presented in research articles and policy documents. Definitions were identified by first conducting a Scopus search and then tracing cited definitions back to their sources. In total, 36 definitions were identified. Theories of definition from philosophy and linguistics provide analytical guidance for structuring and categorizing the identified definitions, and the main analytical dimensions of the definitions are then identified and discussed. Finally, we propose a framework for understanding the process of defining nanomaterial and nanoparticle. This framework considers both the generality needed for a shared understanding and the level of precision required for different purposes. (shrink)

There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition‐specific severity). In this paper I argue that giving priority to the worse off in terms of condition‐specific severity does not reflect the morally relevant sense of being (...) worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity). (shrink)

RÉSUMÉ: Cet article examine la relation que Ronald Dworkin veut établir entre les idéaux libéraux d’égalité et de liberté dans le cadre de sa théorie dite de l’Égalité des ressources. Dworkin soutient que la spécification d’un système de libertés est essentielle à la définition même de l’égalité et que la théorie de l’Égalité des ressources unifie en profondeur ces deux idéaux par sa notion centrale de «vrais coûts de renonciation». Le présent article accepte avec Dworkin que la liberté et l’égalité (...) doivent être définies en interdépendance, mais nie que la théorie de l’Égalité des ressources y parvienne d’une manière cohérente. Cette théorie reste incomplète en tant que théorie de l’égalité et critiquable comme interprétation du libéralisme. Une autre voie serait de dériver le libéralisme d’un idéal libéral perfectionniste — celui de l’autonomie personnelle. On indique brièvement comment la chose pourrait être accomplie. (shrink)

Academic integrity has become a significant point of concern in the post-secondary landscape, and many institutions are now exploring ways on how to implement academic integrity training for students. This paper delineates the development of an Academic Integrity E-Learning (AIE-L) tutorial at MacEwan University, Canada. In its first incarnation, the AIE-L tutorial was intended as an education tool for students who had been found to violate the University’s Academic Integrity Policy. However, in a discourse of the academic integrity process, the (...) University reimagined it from only emphasising the increased understanding and strengthened commitment of students found to have committed academic misconduct to a proactive focus with education for all students. The purpose of the present paper is three-fold: first, describe the development of the AIE-L tutorial as an experiential case study; second, improve the content of the AIE-L tutorial through students’ quantitative and qualitative feedback; third, calibrate the pre and post-test questions for content validity for a forthcoming large-scale measurement of the AIE-L tutorial effectiveness. (shrink)

In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and (...) Drug Administration, we use that as a …. (shrink)