The capacity of next-generation closed-loop or adaptive deep brain stimulation devices to read and write shows great potential to effectively manage movement, seizure, and psychiatric disorders, and also raises the possibility of using aDBS to electively modulate mood, cognition, and prosociality. What separates aDBS from most neurotechnologies currently used for enhancement is that aDBS remains an invasive, surgically-implanted technology with a risk-benefit ratio significantly different when applied to diseased versus non-diseased individuals. Despite a large discourse about the ethics of enhancement, (...) no empirical studies yet examine perspectives on enhancement from within the aDBS research community. We interviewed 23 aDBS researchers about their attitudes toward expanding aDBS use for enhancement. A thematic content analysis revealed that researchers share ethical concerns related to safety and security; enhancement as unnecessary, unnatural or aberrant; and fairness, equality, and distributive justice. Most researchers felt that enhancement applications for DBS will eventually be technically feasible and that attempts to develop such applications for DBS are already happening. However, researchers unanimously felt that DBS ideally should not be considered for enhancement until researchers better understand brain target localization and functioning. While many researchers acknowledged controversies highlighted by scholars and ethicists, such as potential impacts on personhood, authenticity, autonomy and privacy, their ethical concerns reflect considerations of both gravity and perceived near-term likelihood. (shrink)

The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A (...) smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term ‘personality,’ while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. (shrink)

The expansion of research on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises important neuroethics and policy questions related to data sharing. However, there has been little empirical research on the perspectives of experts developing these technologies. We conducted semi-structured, open-ended interviews with aDBS researchers regarding their data sharing practices and their perspectives on ethical and policy issues related to sharing. Researchers expressed support for and a commitment to sharing, with most saying that they were either sharing their data (...) or would share in the future and that doing so was important for advancing the field. However, those who are sharing reported a variety of sharing partners, suggesting heterogeneity in sharing practices and lack of the broad sharing that would reflect principles of open science. Researchers described several concerns and barriers related to sharing, including privacy and confidentiality, the usability of shared data by others, ownership and control of data (including potential commercialization), and limited resources for sharing. They also suggested potential solutions to these challenges, including additional safeguards to address privacy issues, standardization and transparency in analysis to address issues of data usability, professional norms and heightened cooperation to address issues of ownership and control, and streamlining of data transmission to address resource limitations. Researchers also offered a range of views on the sensitivity of neural activity data (NAD) and data related to mental health in the context of sharing. These findings are an important input to deliberations by researchers, policymakers, neuroethicists, and other stakeholders as they navigate ethics and policy questions related to aDBS research. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Cognitive Phenomenology Phenomenal states are mental states in which there is something that it is like for their subjects to be in; they are states with a phenomenology. What it is like to be in a mental state is that state´s phenomenal character. There is general agreement among philosophers of mind that the category of mental states includes at least some sensory states. For example, there is something that it is like to taste chocolate, to smell coffee, to feel the (...) wind in one´s hair, to see the blue sky and to feel a pain in one´s toe. Is there also something that it is like to consciously think, to consciously judge and to consciously believe something? Are such cognitive states, when conscious, phenomenal states? Is there a clear distinction between sensory states and cognitive states? Or, can our knowledge, thoughts and beliefs influence our sensory experiences? Is there a cognitive phenomenology? It is challenging to give a clear characterization of the cognitive phenomenology debate, since different contributors conceive of the debate in different ways. Central for the debate is the question of whether conscious thoughts possess a non-sensory phenomenology. Intuitively, there is something that it is like to consciously think, consciously judge and consciously believe something. However, the debate about cognitive phenomenology is not, strictly speaking, about whether there is something that it is like to consciously think. Rather, the debate concerns the nature of cognitive phenomenology. Is the phenomenology of cognitive states reducible to purely sensory phenomenology? Or, is there an irreducible cognitive phenomenology? A sceptic about cognitive phenomenology claims that conscious cognitive states are non-phenomenal. But, conscious cognitive states may seem to be phenomenal because they are accompanied by sensory states. For instance, when one thinks that ´Paris is a beautiful city`, one´s thought may be expressed in inner-speech and an image of Paris may accompany it. These accompanying sensory states are phenomenal states, and not the thought itself. Contrary to this, the proponent of cognitive phenomenology claims that a conscious cognitive state can have a phenomenology that is irreducible to purely sensory phenomenology. Other debates have also been placed under the ´cognitive phenomenology’ label. There is an ongoing debate within the philosophy of perception about how cognition influences our sensory experiences. Philosophers tend to agree that, for example, an expert ornithologist´s perceptual experience of a type of bird can differ from that of a novice, even if the viewing conditions for both expert and novice are the same. The expert´s knowledge of birds can influence her experience. However, what philosophers disagree about is how the expert´s knowledge influences her experience, and how her knowledge contributes to what her experience is like. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

Drawing from moral foundations theory, we show that differences in sensitivity to distinct moral norms help explain differences in the perceived fairness of punishing employees for off-duty deviance. We used an initial study to validate realistic examples of non-criminal behavior that were perceived as violating a specific moral foundation. Participants in the main study evaluated scenarios in which co-workers were fired for those behaviors, which took place outside of work but were revealed via social media. The extent to which participants (...) valued the norm violated by the co-worker positively predicted perceived fairness of the firing, and negatively predicted expressed intent to take retributive action against the responsible manager. This effect was moderated by the presence of a pre-existing organizational policy regarding off-duty conduct, which uniformly decreased negative reactions to the firing. Because social media now makes the revelation of an employee’s off-duty behavior to a broad audience increasingly likely, our results suggest the importance of developing an approach for responding to employee off-duty deviance while highlighting the relevance of moral pluralism to the study of third-party reactions. (shrink)

This study investigates the relationship between self-efficacy and resilience among 150 first-year college students. This study used a correlational research design. Thus, General Self-Efficacy Scale and Resilience Scale were utilized to measure the variables. Furthermore, the statistical analysis reveals that the r coefficient of 0.48 indicates a low positive correlation between the variables. The p-value of 0.00, which is less than 0.05, leads to the decision to reject the null hypothesis. Hence, a significant relationship exists between self-efficacy and resilience among (...) first-year college students. Implications were discussed in the study. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Academic integrity establishes a code of ethics that transfers over into the job force and is a critical characteristic in scientists in the twenty-first century. A student’s perception of cheating is influenced by both internal and external factors that develop and change through time. For students, the COVID-19 pandemic shrank their academic and social environments onto a computer screen. We surveyed science students in the United States at the end of their first COVID-interrupted semester to understand how and why they (...) believed their peers were cheating more online during a pandemic. Almost 81% of students indicated that they believed cheating occurred more frequently online than in-person. When explaining why they believed this, students touched on proctoring, cheating influences, and extenuating circumstances due to COVID-19. When describing how they believed cheating occurred more frequently online, students touched on methods for cheating and surreptitious behavior. The student reasonings were associated with four theories that have been used to examine academic dishonesty. Our results can aid institutions in efforts to quell student concerns about their peers cheating during emergencies. Interestingly, most student beliefs were mapped to planned behavior theory while only a few students were mapped to neutralization theory, suggesting it was a novel modality of assessment rather than a pandemic that shaped student perceptions. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

A revised translation of Heidegger's most important work.

Emerging evidence suggests that the long-established distinction between habit-based and goal-directed decision-making mechanisms can also be sustained in humans. Although the habit-based system has been extensively studied in humans, the goal-directed system is less well characterized. This review brings to that task the distinction between conceptual and nonconceptual representational mechanisms. Conceptual representations are structured out of semantic consituents - the use of which requires an ability to perform some language-like syntactic processing. Decision making - as investigated by neuroscience and psychology (...) - is normally studied in isolation from questions about concepts as studied in philosophy and cognitive psychology. We ask what role concepts play in the "goal-directed" decision-making systems. We argue that one fruitful way of studying this system in humans is to investigate the extent to which it deploys conceptual representations. (shrink)

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

It is traditionally believed that cerebral activation (the presence of low voltage fast electrical activity in the neocortex and rhythmical slow activity in the hippocampus) is correlated with arousal, while deactivation (the presence of large amplitude irregular slow waves or spindles in both the neocortex and the hippocampus) is correlated with sleep or coma. However, since there are many exceptions, these generalizations have only limited validity. Activated patterns occur in normal sleep (active or paradoxical sleep) and during states of anesthesia (...) and coma. Deactivated patterns occur, at times, during normal waking, or during behavior in awake animals treated with atropinic drugs. Also, the fact that patterns characteristic of sleep, arousal, and waking behavior continue in decorticate animals indicates that reticulo-cortical mechanisms are not essential for these aspects of behavior. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

There is an enduring and widespread perception amongst policy makers and practitioners that certain groups of children, in particular those who find learning difficult, have a detrimental effect on the achievement of other children. Challenging this basic assumption, this award-winning book argues that high levels of inclusion can be entirely compatible with high levels of achievement and that combining the two is not only possible but essential if all children are to have the opportunity to participate fully in education. This (...) fully revised second edition is packed with vivid case studies that explore the benefits and tensions for children and schools, and sets out to answer the following questions: What is the nature of the relationship between the inclusion of some children and the achievement of all? Are there strategies which can raise the achievement of all children, whilst safeguarding the inclusion of others who are more vulnerable? What changes can a school make to ensure high levels of inclusion as well as high levels of achievement for all its children? Achievement and Inclusion in Schools offers a fully up-to-date analysis of current issues in light of recent changes to education policy in England, Scotland, Wales and Northern Ireland. It provides practical guidance for practitioners and policy-makers, and will be of interest to anyone passionate about inclusive education. (shrink)

Moral Internalism proposes a necessary link between judging that an action is right/wrong and being motivated to perform/avoid that action. Internalism is central to many arguments within ethics, including the claim that moral judgments are not beliefs, and the claim that certain types of moral skepticism are incoherent. However, most of the basis for accepting Internalism rests on intuitions that have recently been called into question by empirical work. This paper further investigates the intuitions behind Internalism. Three experiments show not (...) only that these intuitions are not widespread, but that they are significantly influenced by normative evaluations of the situation in question. These results are taken to undermine Internalist intuitions, and contribute to the growing body of evidence showing that normative evaluations influence supposedly non-normative judgments. (shrink)

The starting point for this article is the question of the relationship between Darwinism and Christian theology. I suggest that evolutionary theory presents three broad issues of relevance to theology: the phenomena ofcontinuity, naturalism, andcontingency. In order to formulate a theological response to these issues I draw on the semiotics (theory of signs) and cosmology of the American philosopher Charles Sanders Peirce. Peirce developed a triadic theory of signs, underpinned by a threefold system of metaphysical categories. I propose a semiotic (...) model of the Trinity based on Peirce's semiotics and categories. According to this model the sign‐processes (such as the genetic “code”) that are fundamental to life may be understood as vestiges of the Trinity in creation. I use the semiotic model to develop a theology of nature that addresses the issues raised by evolutionary theory. The semiotic model amounts to a proposal for a new metaphysical framework within which to understand the relationship between God and creation and between theology and science. (shrink)

In teacher education, students have to link theoretical knowledge from educational studies or other academic fields with classroom experiences in formal settings such as triadic mentoring conversations. Students make this link through verbal activities, which are the heart of our analysis. Students produce complex discourses in which they position themselves, refer to multiple types of knowledge, describe and analyse their practicum. Considering that discourse analysis enlightens professional development processes, we study what prospective teachers (PTs) learn in a specific moment of (...) formal mentoring conversations that is a presentation of problematic issues. We compare the evolution of these presentations for two PTs. Through an utterer centred approach, we focus on three key elements: positioning adopted by PTs regarding the content of their sayings and their discussion partners; the way they integrate the theoretical concepts in their discourse; and the way they put in words working experiences and specific internship events. These elements enlighten the process of self-building and building of professional knowledge. Our results point out that in these « in between » settings, preservice teachers produce two kinds of discourse: academic and professional. (shrink)

This paper investigates the acquisition of residual verb second (V2) in three corpora consisting of data from Norwegian-English bilinguals (Emma, Emily, and Sunniva) in order to determine to what extent these structures are affected by cross-linguistic influence (CLI) from Norwegian V2. The three girls exhibit three different patterns with regard to the relevant constructions. They are very target-like in their use of auxiliaries in the relevant structures. However, when it comes to do-support, Emily and Sunniva are equally target-like, while Emma (...) mainly produces non-target-like structures. These either involve the omission of do, or non-target-like movement of a lexical verb. Furthermore, Emma also allows verb movement across the subject with both lexical verbs and auxiliaries in topicalized structures, suggesting that she has overgeneralized residual V2 across verb types and clause types. Emily, on the other hand, is very target-like in structures involving residual V2 in English, but also allows auxiliaries and dummy-do to move across the subject in topicalized structures, overgeneralizing residual V2 to apply to non-subject-initial declaratives. Finally, Sunniva, is very precocious and very target-like in all the relevant structures, which may be an indication of acceleration due to CLI from Norwegian V2. We discuss these results with reference to language balance, finding that the measures available to us suggest that the differences between the children cannot straightforwardly be explained by language dominance. Instead, we suggest that these results can be accounted for by ambiguity in the English system, leaving the data open to several possible interpretations when acquired in contact with the consistent V2 system in Norwegian. This has several consequences: (i) the three girls’ parsers interpret the input differently, (ii) differences between the three children are qualitative rather than quantitative, and (iii) there has to be some mechanism that ensures that the children can ‘recover’ from these non-target-like grammars. In this paper, we will focus on the first two issues. (shrink)

ABSTRACT In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision‐making competence and 2) the practice of surrogate decision‐making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural (...) arbitrariness’ in the whole process of how we assess decision‐making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision‐ making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision‐making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non‐competent others. (shrink)

Socially assistive robotics is a growing area of research. Evaluating SAR systems presents novel challenges. Using a robot for a socially assistive task can have various benefits and ethical implications. Many questions are important to understanding whether a robot is effective for a given application domain. This paper describes several benchmarks for evaluating SAR systems. There exist numerous methods for evaluating the many factors involved in a robot’s design. Benchmarks from psychology, anthropology, medicine, and human–robot interaction are proposed as measures (...) of success in evaluating a given SAR system and its impact on the user and broader population. (shrink)

Jenefer Robinson takes the insights of modern scientific research on the emotions and uses them to illuminate questions about our emotional involvement with the arts. Laying out a theory of emotion supported by the best evidence from current empirical work, she examines some of the ways in which the emotions function in the arts. Written in a clear and engaging style, her book will make fascinating reading for anyone interested in the emotions and how they work, as well as (...) anyone engaged with the arts and aesthetics. (shrink)

A complement to _Researching Schools_ by the same authors, this book provides readers with a strong theoretical framework for school-based research as well as valuable advice on the ways in which networks of specialist groups can work together to create a broad-ranging approach to educational research. Through a critical examination of existing research and current thinking, the authors draw out implications for the effective policy and practice of school-based research. Illustrated throughout with case studies and including a full and detailed (...) literature review, this book will be a vital resource for all academics pursuing research into education. (shrink)

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (N = 15) were interviewed twice, using semi-structured in-depth interviews, analyzed by and the responses subject to interpretative-phenomenological analysis. Persons with firsthand experience of avoidant personality disorder were included in the research process. Results: The superordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering (...) the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, Ttheese findings highlight the importance, importance of being met intersubjectively as a person with intentionality and agency, even when one does not feel like one.as an agentive intentional being, even when one does not feel like one, of being met intersubjectively by a therapist. The importance of establishing an emotional bond and emergent trust for open therapeutic communication, collaboration, learning, and becoming able to build courage to begin to approach that which one fears, is emphasized. (shrink)

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural arbitrariness’ (...) in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)