Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

As John Casti wrote, "Finally, a book that really does explain consciousness." This groundbreaking work by Denmark's leading science writer draws on psychology, evolutionary biology, information theory, and other disciplines to argue its revolutionary point: that consciousness represents only an infinitesimal fraction of our ability to process information. Although we are unaware of it, our brains sift through and discard billions of pieces of data in order to allow us to understand the world around us. In fact, most of what (...) we call thought is actually the unconscious discarding of information. What our consciousness rejects constitutes the most valuable part of ourselves, the "Me" that the "I" draws on for most of our actions--fluent speech, riding a bicycle, anything involving expertise. No wonder that, in this age of information, so many of us feel empty and dissatisfied. As engaging as it is insightful, this important book encourages us to rely more on what our instincts and our senses tell us so that we can better appreciate the richness of human life. (shrink)

Following the lead of Duncan Pritchard’s “Wittgensteinian Pyrrhonism,” this paper takes a further, comparative and contrastive look at the problem of justification in Sextus Empiricus and in Wittgenstein’sOn Certainty. I argue both that Pritchard’s stimulating account is problematic in certain important respects and that his insights contain much interpretive potential still to be pursued. Diverging from Pritchard, I argue that it is a significant and self-conscious aspect of Sextus’ sceptical strategies to call into question large segments of our belief systemen (...) masseby exposing as apparently unjustifiable fundamental propositions which are closely related in their linchpin role to Wittgenstein’s hinge propositions. In the first instance, the result is a more complex account of both a deeper affinity between Wittgenstein’s approach to hinge propositions and Sextus’ approach to what I termarchaipropositions and a divergence between the two. In the second instance, I suggest how the comparison withOn Certaintycan be illuminating for the interpreter of Sextus. In particular, it can help us to see how the Pyrrhonist’s everyday conduct—common assumptions to the contrary notwithstanding—involves rational procedures of justification, in line with a naturalism reminiscent of Wittgenstein. Furthermore, it can help us to reflect on the Pyrrhonist’s attitude to what Wittgenstein would have called her ‘worldview’. Throughout, I suggest that the comparison with Wittgenstein is interesting, although it must be cashed out differently, not only on the interpretation—or, perhaps, strand—of ancient Pyrrhonism which has the sceptic exempt ordinary beliefs from her suspension of judgement, but also on the interpretation (or strand) which has her disavow all beliefs categorically. (shrink)

Semantic justifications of the classical rules of logical inference typically make use of a notion of bivalent truth, understood as a property guaranteed to attach to a sentence or its negation regardless of the prospects for speakers to determine it as so doing. For want of a convincing alternative account of classical logic, some philosophers suspicious of such recognition-transcending bivalence have seen no choice but to declare classical deduction unwarranted and settle for a weaker system; intuitionistic logic in particular, buttressed (...) by assertion-conditional semantics, is often considered to enjoy a degree of meaning-theoretical respectability unattainable by classical logic.The decision to forgo the classical inference rules is not always made lightly. Thus, Dummett: " In the resolution of the conflict between [the view that generally accepted classical modes of inference ought to be theoretically accommodated, and the demand that any such accommodation be achieved without recourse to bivalence] lies, as I see it, one of the most fundamental and intractable problems in the theory of meaning; indeed, in all philosophy. "The present article ventures to suggest that the conflict need not be irresoluble. Helping ourselves only to such conceptual resources as are standardly invoked by proponents of intuitionistic logic, we shall formulate a rudimentary meaning theory for a selection of logical constants, define a relation of valid inferability, and prove that the latter includes all of classical first-order logic. The result is essentially that reported in Sandqvist as Theorem 2.20.2. TheoryWe will be considering a standard-syntax first-order language with ⊃, ⊥ and ∀ as its only primitive logical constants. We assume countable supplies of individual constants, individual functors , and predicates , as well as a denumerably infinite set of individual variables. By a basic 1 formula we will mean one that …[Full Text of this Article]. (shrink)

Intuitionistic sentential logic is shown to be sound and complete with respect to a semantics centered around extensions of atomic bases (i.e. sets of inference rules for atomic sentences). The result is made possible through a non-standard interpretation of disjunction, whereby, roughly speaking, a disjunction is taken to hold just in case every atomic sentence that follows from each of the disjuncts separately holds; it is argued that this interpretation makes good sense provided that rules in atomic bases are conceived (...) of as being accepted hypothetically rather than categorically. (shrink)

Organization in a tangled world -- Process views of organization -- Alfred North Whitehead on process -- Bruno Latour on relativizing the social, and the becoming of networks -- Niklas Luhmann on autopoiesis and recursiveness in social systems -- James March on decision processes and organization : a logic of streams -- Karl Weick on organizing and sensemaking -- A scheme for process based organizational analysis -- Some implications for organizational analysis.

The Russian Cards Problem has been extensively studied as an example of a problem of an unconditionally secure protocol where the sender and receiver are able to transmit secret information safely over a public non-secure channel without the secret being learned by a third party with access to the channel. Epistemic logic in general and public announcement logic in particular have been very useful in this study, as it involves careful analysis of subtle properties of nested knowledge. A long standing (...) open problem is whether or not there exist protocols of length strictly greater than two for the original problem. In this paper we finally settle this problem, answering the question in the affirmative, by presenting a new solution to the original Russian Cards Problem that involves more than two steps. It starts with an initial announcement with so-called crossing hands, after which it is not common knowledge that the protocol can terminate in one more step. (shrink)

This book demonstrates that we need not choose between seeing so-called Presocratic thinkers as rational philosophers or as religious sages. In particular, it rethinks fundamentally the emergence of systematic epistemology and reflection on speculative inquiry in Hesiod, Xenophanes and Parmenides. Shaul Tor argues that different forms of reasoning, and different models of divine disclosure, play equally integral, harmonious and mutually illuminating roles in early Greek epistemology. Throughout, the book relates these thinkers to their religious, literary and historical surroundings. It is (...) thus also, and inseparably, a study of poetic inspiration, divination, mystery initiation, metempsychosis and other early Greek attitudes to the relations and interactions between mortal and divine. The engagements of early philosophers with such religious attitudes present us with complex combinations of criticisms and creative appropriations. Indeed, the early milestones of philosophical epistemology studied here themselves reflect an essentially theological enterprise and, as such, one aspect of Greek religion. (shrink)

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and (...) nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

Researchers have wondered how the brain creates emotions since the early days of psychological science. With a surge of studies in affective neuroscience in recent decades, scientists are poised to answer this question. In this target article, we present a meta-analytic summary of the neuroimaging literature on human emotion. We compare the locationist approach (i.e., the hypothesis that discrete emotion categories consistently and specifically correspond to distinct brain regions) with the psychological constructionist approach (i.e., the hypothesis that discrete emotion categories (...) are constructed of more general brain networks not specific to those categories) to better understand the brain basis of emotion. We review both locationist and psychological constructionist hypotheses of brain–emotion correspondence and report meta-analytic findings bearing on these hypotheses. Overall, we found little evidence that discrete emotion categories can be consistently and specifically localized to distinct brain regions. Instead, we found evidence that is consistent with a psychological constructionist approach to the mind: A set of interacting brain regions commonly involved in basic psychological operations of both an emotional and non-emotional nature are active during emotion experience and perception across a range of discrete emotion categories. (shrink)

Part 1. Some problems of organization theory and the potential of process organization theory -- Why assumptions in organization theory do not work for explaining organizing in a world on the move -- Assumptions for organizing in a world on the move -- Part 2. Toward a process theory of organization -- Temporality and process -- Organization, meaning structures, and time -- Articulatory models and agency -- Part 3. Process theory and selected aspects of organization management -- Process theory, organizational (...) continuity, and change -- Managing and leading in time -- Organizational culture, identity, and institutions -- Some thoughts on studying process -- A plea for mystery. (shrink)

This fascinating and timely volume explores current thinking on vital topics in moral psychology, spanning the diverse disciplines that contribute to the field. Academics from cognitive science, evolutionary biology, anthropology, philosophy, and political science address ongoing and emerging questions aimed at understanding the thought processes and behaviors that underlie our moral codes-and our transgressions. Cross-cutting themes speak to individual, interpersonal, and collective morality in such areas as the development of ethical behavior, responses to violations of rules, moral judgments in the (...) larger discourse, and universal versus specific norms. This wide-angle perspective also highlights the implications of moral psychology research for policy and justice, with cogent viewpoints from: Philosophy: empiricism and normative questions, moral relativism. Evolutionary biology: theories of how altruism and moral behavior evolved. Anthropology: common moral values seen in ethnographies from different countries. Cognitive and neural sciences: computational models of moral systems and decision-making. Political science: politics, governance, and moral values in the public sphere. Advice on moral psychology research-and thoughts about its future-from prominent scholars. With the goal of providing a truly multidisciplinary forum for moral psychology, this volume is sure to spark conversations across disciplines and advance the field as a whole. Sampling the breadth and depth of an equally expansive and transformative field, Moral Psychology: A Multidisciplinary Guide will find an engaged audience among psychologists, philosophers, evolutionary biologists, anthropologists, political scientists, neuroscientists, lawyers, and policymakers, as well as a more general audience interested better understanding the complexity of moral psychology research. (shrink)

This article argues that Empedocles’ trust in Strife (DK31 B115.14 = LM22 D10.14) is not, as the prevailing interpretation has it, only a past misjudgement and failure. Rather, trust in Strife still, and to his own lament, infects Empedocles’ mind and informs his life. This detail then offers a fresh perspective on Empedocles’ self-conception and on how, through the daimōn’s cosmic peregrinations, Empedocles raises and pursues questions of agency and responsibility. Furthermore, it sheds light on Empedocles’ understanding of his own (...) ethical standing: common assumptions to the contrary notwithstanding, he does not see himself as an unqualifiedly successful embodiment of his own ideals. (shrink)

Expanding on a discussion by Hansson, this paper treats of Goodman's and Lewis' accounts of counterfactual conditionals, comparing the senses in which these theories may be accused of circularity. While I do maintain that in this respect Lewis has an edge over Goodman, the paper's aim is not so much to reach a firm conclusion as to disentangle some previously conflated aspects of the issue. It is also suggested that the importance of avoiding circularity may vary depending on the philosophical (...) purpose of one's analysis. (shrink)

It seems plausible, even truistic, that when an agent is faced with the choice of giving up one belief or another, the decision should be based on the relative strengths of these beliefs along some dimension of doxastic merit. This said, however, two non-trivial questions arise: (1) Which dimension? (2) How should the contraction outcome be affected by the distribution of beliefs along this dimension?

_ Source: _Volume 60, Issue 1, pp 3 - 39 This paper pursues a new approach to the problem of the relation between Alētheia and Doxa. It investigates as interrelated matters Parmenides’ impetus for developing and including Doxa, his conception of the mortal epistemic agent in relation both to Doxa’s investigations and to those in Alētheia, and the relation between mortal and divine in his poem. Parmenides, it is argued, maintained that Doxastic cognition is an ineluctable and even appropriate aspect (...) of mortal life. The mortal agent, however, is nonetheless capable of sustaining the cognition of Alētheia by momentarily coming to think with—or as—his divine soul. (shrink)

A constructive proof is provided for the claim that classical first-order logic admits of a natural deduction formulation featuring the subformula property.

Well-being can be promoted in two ways. Firstly, by affecting the quantity, quality and allocation of bundles of consumption (the Resource Approach), and secondly, by influencing how people benefit from their goods (the Taste Approach). Whereas the former is considered an ingredient of economic analysis, the latter has conventionally not been included in that field. By identifying the gain the Taste Approach might yield, the article questions whether this asymmetry is justified. If successfully exercised, the Taste Approach might not only (...) enable people to raise their wellbeing, but also provide solutions to a number of issues such as sustainable development and global justice. The author argues that recently developed accounts such as Happiness Economics (HE) and Libertarian Paternalism (LP) both can be considered specifications of the Taste Approach. Furthermore a third specification is identified: Inexpensive Preference Formation (IPF). Whereas LP suggests that choice architecture should be exercised when rationality fails, IPF holds that governance in certain instances should improve choices also in absence of no such failure. (shrink)

Among the thousands who arrive in Europe to seek asylum each year, a significant number are children traveling on their own. Like adults, they are fleeing from war and armed conflict situations, persecution, severe poverty, and deprivation. Some arrive because they have been trafficked and some are fleeing for reasons specifically related to their status as children. They need special attention, not only in terms of specialized care and assistance, but also in terms of the refugee status determination procedure. When (...) they arrive in a country of asylum they risk further violations of their rights. This paper intends to outline the rignts of these children under international law; to highlight key protection concerns facing them, particularly in the European context; to summarize ways of how a UN/ngo program has attempted to address these problems; and to make some specific recommendations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryTor Phern Chern, Associate ConsultantThe case scenario describes a difficult clinical and ethical challenge of a psychiatric patient refusing treatment in the context of a treatment-resistant condition that may be affecting her capacity to refuse treatment.The patient described in the case scenario displayed partial treatment refusal as evidenced by her refusal of ECT and adherence with medication and her voluntary hospital admission. Partial treatment refusal is generally more (...) common than absolute treatment refusal1 and can be sporadic, time-limited, periodic or continuous. It is important for the medical team to clarify which category of treatment refusal this patient’s refusal falls under. These broad categories include the doctor-patient relationship, religion, secondary gain, treatment- or illness-based refusals.2 The proper identification of category of treatment refusal will guide subsequent management.Refusal of treatments may be in response to reality-based transference issues like fear, distrust or pressure from the patient’s family. In this particular case, there is little data about her relationship with her treating psychiatrist, but the lack of a trusting doctor-patient relationship could be a factor for treatment refusal. The treating psychiatrist at the inpatient setting could be different from the patient’s routine outpatient psychiatrist and this could result in the lack of a trusting doctor-patient relationship. The remedy for this would be to develop a trusting relationship between her treating psychiatrist and the patient via understanding the patient’s needs and concerns. A useful adjunct would be to identify someone with whom the patient has a trusting relationship and recruit that person to help develop trust in the doctor-patient relationship. On this point, it is interesting to note that the patient’s family was noted to be highly supportive and influential in previous treatment decisions, agreed [End Page 235] with the treating psychiatrist’s treatment recommendation and yet both the treating psychiatrist and the patient’s family were unable to convince her to accept ECT. One possibility is that the patient may see her family’s support of the treating psychiatrist’s recommendation as one reason to refuse treatment. This possibility warrants deeper explorations of her premorbid underlying cultural and religious beliefs and attitudes towards her family and her perceived role in her community.Religion-based refusals of treatment (e.g. blood transfusions for Jehovah’s Witnesses) are less prominent in psychiatry than in general medicine but may manifest in treatment refusal due to advice from religious leaders on the need for spiritual solutions to the patient’s challenges. Religion-based refusals need to be distinguished from an illness-based refusal but if truly present will require the support of appropriate religious leaders to allow the patient more management options other than spiritual support for her psychiatric disorder. There is no specific information about the patient’s religion and religion-based refusals of ECT are not particularly common so this is unlikely to be a major reason for treatment refusal in this case.Treatment-based refusals of care are related to the specific treatment modality being offered and are often motivated by concerns about the side effects of treatment or past traumas that the treatment elicits. In this particular case, the patient has demonstrated some degree of treatment resistance as evidenced by the relapse of her bipolar disorder despite adherence to medication, and a change in management is certainly warranted. However, a change in medication management may be possible before proceeding to ECT in view of the patient’s acceptance of medication and no clear evidence of violent or disturbed behaviour in the ward. The occasional refusal of food and water is worrying, but if the patient can be coaxed to continue oral nutrition, there is no absolute indication to have ECT for rapid treatment response. Other options that may be acceptable to the patient are to optimise the dosage of current medications, switch medications or add augmenting pharmacological agents before proceeding to ECT. A change in pharmacotherapy must take into account her past treatment response and side effects to individual medications. Psychotherapy may also be considered to augment treatment response before ECT is considered.3Illness-based refusals are the most challenging category and... (shrink)

This paper offers an interpretation of multiple-conclusion sequents as a kind of meta-inference rule: just as single-conclusion sequents represent inferences from sentences to sentences, so multiple-conclusion sequents represent a certain kind of inference from single-conclusion sequents to single-conclusion sequents. The semantics renders sound and complete the standard structural rules of reflexivity, monotonicity (or thinning), and transitivity (or cut). The paper is not the first one to attempt to account for multiple-conclusion sequents without invoking notions of truth or falsity—but unlike earlier (...) such efforts, which have typically helped themselves to primitive notions of both acceptance and rejection, the present one makes do with the former alone. For technical reasons, the treatment is limited to sequents with non-empty succedents. (shrink)

The article approaches cut elimination from a new angle. On the basis of an arbitrary inference relation among logically atomic formulae, an inference relation on a language possessing logical operators is defined by means of inductive clauses similar to the operator-introducing rules of a cut-free intuitionistic sequent calculus. The logical terminology of the richer language is not uniquely specified, but assumed to satisfy certain conditions of a general nature, allowing for, but not requiring, the existence of infinite conjunctions and disjunctions. (...) We investigate to what extent structural properties of the given atomic relation are preserved through the extension to the full language. While closure under the Cut rule narrowly construed is not in general thus preserved, two properties jointly amounting to closure under the ordinary structural rules, including Cut, are. -/- Attention is then narrowed down to the special case of a standard first-order language, where a similar result is obtained also for closure under substitution of terms for individual parameters. Taken together, the three preservation results imply the familiar cut-elimination theorem for pure first-order intuitionistic sequent calculus. -/- In the interest of conceptual economy, all deducibility relations are specified purely inductively, rather than in terms of the existence of formal proofs of any kind. (shrink)

This article examines adult online education by investigating the complex relationship between technology and community. The aim was to explore online teaching in relation to the handbook dilemma teachers meet in their teacher profession by focusing on participation and sharing opportunities. This study analysed several handbooks that aim to help teachers design and implement online education. The advice in the handbooks was contrasted against two empirical cases. Specifically, the study examined how two cases – online adult education courses and special (...) needs teacher training courses – implemented online education with respect to participation and sharing. The analysis suggests that pedagogy is the crucial point and a planned pedagogy is absolutely necessary for designing and implementing effective online education, education that encourages participation and sharing. The findings showed that some handbooks offer meaningful guidance regarding the development of online education, but other publications were not helpful which creates a dilemma for teachers. (shrink)

This book explores what science fiction can tell us about the human condition in a technological world, with the ethical dilemmas and consequences that this entails. This book is the result of the joint efforts of scholars and scientists from various disciplines. This interdisciplinary approach sets an example for those who, like us, have been busy assessing the ways in which fictional attempts to fathom the possibilities of science and technology speak to central concerns about what it means to be (...) human in a contemporary world of technology and which ethical dilemmas it brings along. One of the aims of this book is to demonstrate what can be achieved in approaching science fiction as a kind of imaginary laboratory for experimentation, where visions of human (or even post-human) life under various scientific, technological or natural conditions that differ from our own situation can be thought through and commented upon. Although a scholarly work, this book is also designed to be accessible to a general audience that has an interest in science fiction, as well as to a broader academic audience interested in ethical questions. (shrink)

This mixed-methods study explores how high school students ( n=35) enrolled in a school with a high Latino/a population evaluate the trustworthiness of documents in two historical reasoning tasks: one about the Dust Bowl in the 1930s and the other about the experiences of Mexicans and Mexican Americans in the 1920s. Students indicated whether they trusted each document, provided a rationale for their trust (or distrust) of each document, and ranked the trustworthiness of the documents. We also interviewed 10 focal (...) students to explore students’ reasoning in more in-depth ways than the written responses allowed. We found that students tended to trust the secondary source documents more than the primary source documents because, as they argued, the secondary source documents contained more facts. In contrast, students were less likely to trust the primary source documents, particularly the songs, arguing that they were more opinion-based than factual. We also found that some students had an emotional response to the content of some of the documents, and in some cases, these emotional responses shaped how they viewed the documents’ trustworthiness. Additionally, students’ heritage may have played a role in some students’ trust justifications for some documents in the experiences of Mexicans and Mexican Americans task. We conclude with implications for curriculum and instruction. (shrink)

Name der Zeitschrift: Der Islam Jahrgang: 93 Heft: 2 Seiten: 374-402.