Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental (...) healthcare opens up the door to admitting hopelessness, there is a danger of a self-fulfilling prophecy. Finally, proponents of assisted dying in mental healthcare overlook the dangers posed to mental-health services by the institutionalization of assisted dying. (shrink)

Background:To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.Methods:A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociologicals and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included.Ethical considerations:The review is conducted according to the Vancouver Protocol.Results:There are few studies that study ethical (...) challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good and inflicting harm. In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion.Conclusion:There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (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)

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...

There is a relationship between reading and math skills, as well as comorbidity between reading and math disorders. A mutual foundation for this comorbidity could be that the quality of phonological representations is important for both early reading and arithmetic. In this study, we examine this hypothesis in a sample traced longitudinally from preschool to first grade. The results show that phonological awareness does not explain development in arithmetic, but that there is an indirect effect between phoneme awareness in preschool (...) and arithmetic in first grade via phoneme awareness in first grade. This effect is, however, weak and restricted to verbal arithmetic and not arithmetic fluency. This finding is only partly in line with other studies, and a reason could be that this study more strongly controls for confounders and previous skills than other studies. (shrink)

Impairments in pragmatic abilities, that is, difficulties with appropriate use and interpretation of language – in particular, non-literal uses of language – are considered a hallmark of Autism Spectrum Conditions (ASC). Despite considerable research attention, these pragmatic difficulties are poorly understood. In this paper, we discuss and evaluate existing hypotheses regarding the literalism of ASC individuals, that is, their tendency for literal interpretations of non-literal communicative intentions, and link them to accounts of pragmatic development in neurotypical children. We present evidence (...) that reveals a developmental stage at which neurotypical children also have a tendency for literal interpretations and provide a possible explanation for such behaviour, one that links it to other behavioural, rule-following, patterns typical of that age. We then discuss extant evidence that shows that strict adherence to rules is also a widespread feature in ASC, and suggest that literalism might be linked to such rule-following behaviour. (shrink)

Mental health problems start early in life. However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients. In this study, we interviewed 12 young people who entered mental health care reluctantly at the initiative of others before the age of 18. Their journeys through mental health care (...) varied significantly despite sharing the same starting point. Our analyses resulted in a model of three trajectories. We describe relational and structural facilitators and obstacles within each trajectory and have formulated narratives highlighting core experiences differentiating them. Trajectory 1 was characterized by a rapid loss of hope, leading the adolescents to conclude that mental health care was not worth the investment. Trajectory 2 was characterized by a lingering hope that never materialized into a constructive therapeutic process despite prevailing efforts by both therapists and adolescents. Trajectory 3 was characterized by genuine meetings, allowing the therapist to transform from an unsafe stranger into a safe, competent, and benevolent adult. We discuss how our results have implications for understanding agency displayed by adolescent clients in therapy, therapist flexibility and authenticity, service organization, and attributional processes influencing clinical judgment and therapeutic processes when adolescent psychotherapy has a difficult starting point. (shrink)

Psychopathology in children cannot be understood without considering developmental processes and transactional relationships, particularly the relationship with caregivers. Time-limited intersubjective child psychotherapy is a developmental and transactional approach aimed at helping children and caregivers get back on healthier developmental trajectories. Core developmental processes, such as self-other-regulation and affect integration, are considered particularly important for healthy function and transactions with caregivers and contexts. Therefore, TIC seeks to strengthen core developmental processes in the child and the caregivers’ ability to scaffold the child’s (...) development. This is achieved through parallel child therapy and parent sessions. The current study is a qualitative study of parents’ experiences of change after TIC. The study explores parents’ perception of change in their child, themselves, and their transactions, and what they experienced as helpful in therapy.Materials and MethodsNine semi-structured qualitative interviews were conducted with parents of nine children aged 9–12 years with internalizing difficulties after completing TIC. The data were analyzed with thematic analysis.ResultsThe parents described positive changes in the children’s ability to understand, regulate and express themselves. The parents also described positive changes in their parenting, and for all nine children the parents reported positive changes in the transactions between themselves and the child. Most parents saw the parallel child and parental sessions as particularly important, while several parents mentioned play and the therapeutic focus.DiscussionParents’ description of changes after TIC indicate that the parents perceived their children as strengthened in core developmental processes important for intersubjective exchanges such as self-regulation and affect integration. In addition, parents saw their children and their own contributions more clearly, and their transactions were described as more supportive and positive.ConclusionThe results from this study give support to TIC as a developmentally supportive approach to therapy, with potential effects on children’s core developmental processes, their parents’ ability to both see and scaffold the child’s development and positive effects on the transactions between children and parents. The positive effects likely result from the integration of the different parts of TIC and the synergies taking place between them, rather than any one component by itself. (shrink)

Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

The welfare of farmed fish is often regarded with less concern than the welfare of other husbandry animals, as fish are not universally classified as sentient beings. In Norway, farmed fish and other husbandry animals are legally protected under the same laws. Additionally, the legislature has defined a number of aquaculture-specific amendments, including mandatory welfare courses for fish farmers who have a key role in securing animal welfare, also with regards to noting welfare challenges in the production process. This article (...) uses fish welfare courses as a site from which to inquire about the common-sense understanding of fish welfare in Norwegian fish farming. The focus is specifically on fish farm employees, their experiences of welfare-related issues and contradictions in their daily work, and the struggle to act responsibly in aquaculture settings. Through participant observation at welfare courses, as well as interviews and conversations with fish farm workers, the article details how challenges are experienced ‘on the ground’, and suggests how fish farm workers’ own experiential knowledge might be mobilized to improve the general welfare of farmed fish. (shrink)

A literature search indicates an absence of research into boy’s experiences of physical education in classes in which there is a significant majority of girls. The aim of the study was to examine how boys in such classes experience their PE lessons. The methodological approach was qualitative, and data were collected with interviews of 13 boys in classes with more than 90% girls at a Norwegian high school. The data were analyzed with QSR NVivo 10, focused on creating categories of (...) meaning, in which students’ experiences were taken as subjectively true. The data are based on subjective constructions, which students constructed as part of their own interpretations and reflections on what had occurred in PE at the school. Results of the study came out in the form of three main findings. Two of those relate to a negative experience and the third to a positive experience of PE. The boys mostly felt that they are physically superior and have to consider the girls. Furthermore, the boys reported little challenge and feelings of mastery while being together with passive girls who are allowed to choose the activities. However, the boys found it easier to show off in front of the teachers and classmates when there were just a few boys in the class. The results are discussed in relation to gender-related theory on how the respondents are producing a traditional male gender in PE through their mastery, strength, and ambition to compete. We suggest a new approach of teaching that is more student-centered. A strategy could be to include other activities than sport-based activities into PE – activities that do not require strength and other athletic skills leading to feelings of hegemonic masculinity. A larger focus on social interactions during PE classes – activities in which students’ sex is not as important as in traditional teacher- and sport-centered PE classes, may be a good strategy. (shrink)

This work attempts to show that the Scottish common sense philosophers Thomas Reid, James Oswald and James Beattie, had a substantial influence upon the development of German thought during the period of the late enlightenment. Their works were thoroughly reviewed in German philosophical journals and translated into German soon after they had appeared in English. Whether it was Mendelssohn, a rationalist, Lossius, a materialist, Feder, a sensationalist, Tetens, a critical empiricist, or Hamann and Jacobi, irrationalist philosophers of faith, important (...) philosophers read the Scots and found them relevant for the solution of their problems. The Scots were seen as not just opposing Hume's skepticism, but also as complementing his more positive tenets. The most important chapter of this work shows that even Kant, who in this regard is known only for his devastating criticism of the Scots, learned much from them. It is argued that the Scottish influence opens a new perspective for the understanding of the German enlightenment, revealing how central were the twin problems of idealism versus realism, on the one hand, and of philosophical justification versus mere descriptive metaphysics, on the other. (shrink)