Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral (...) doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Background:Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.Methods:Qualitative individual and focus group interviews were conducted.Ethical considerations:Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.Participants and research context:Thirty nurses working within acute psychiatric wards in two mental health hospitals.Results:Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make (...) oneself immune. Colleagues and work climate were important for choice of coping strategies.Discussion:Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.Conclusions:It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience. (shrink)

Philosopher Judith Butler has influenced how people talk about vulnerable bodies and sees vulnerability as universal, existential, and relational. Being vulnerable is part of the human condition. The main theoretical areas that run across Butler’s work; power, knowledge and subjectivity, performativity, and ethics—are of particular relevance to nursing practice. This review aims to explore how Butler’s theoretical work is reflected in research literature within a nursing context. We conducted a scoping review guided by Arksey and O’Malley’s methodological framework. A systematic (...) literature search of CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science identified 15 papers. Butler’s theoretical work was applied at an individual and social level in research literature within a nursing context. Nurses need to reflect on their clinical practice and role as health professionals in relation to power and performativity in encounters with patients who are marginalized. Nurses’ working conditions, recognition, and understanding are strongly influenced by society, and calling nurses heroes undermines their capacity to challenge and resist the hero identity. The healthcare system’s impact on patient-nurse encounters challenges patients’ and nurses’ subjectivity, performativity, and power relations. The review allowed us to describe how Butler’s theoretical work can facilitate a reflection on nursing practice which is a prerequisite for caring, ethical relationships, and working conditions within a nursing context. Butler’s concepts can provide useful perspectives on how nurses understand, communicate with, and care for patients, as well as a nuanced understanding of the nursing role and power relations and structures. (shrink)

Recording and manipulating neuronal ensemble activity is a key requirement in advanced neuromodulatory and behavior studies. Devices capable of both recording and manipulating neuronal activity brain-computer interfaces should ideally operate un-tethered and allow chronic longitudinal manipulations in the freely moving animal. In this study, we designed a new intracortical BCI feasible of telemetric recording and stimulating local gray and white matter of visual neural circuit after irradiation exposure. To increase the translational reliance, we put forward a Göttingen minipig model. The (...) animal was stereotactically irradiated at the level of the visual cortex upon defining the target by a fused cerebral MRI and CT scan. A fully implantable neural telemetry system consisting of a 64 channel intracortical multielectrode array, a telemetry capsule, and an inductive rechargeable battery was then implanted into the visual cortex to record and manipulate local field potentials, and multi-unit activity. We achieved a 3-month stability of the functionality of the un-tethered BCI in terms of telemetric radio-communication, inductive battery charging, and device biocompatibility for 3 months. Finally, we could reliably record the local signature of sub- and suprathreshold neuronal activity in the visual cortex with high bandwidth without complications. The ability to wireless induction charging combined with the entirely implantable design, the rather high recording bandwidth, and the ability to record and stimulate simultaneously put forward a wireless BCI capable of long-term un-tethered real-time communication for causal preclinical circuit-based closed-loop interventions. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic (...) optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term ‘therapeutic optimism’—one is ethically benign and the other is potentially worrisome. Distinguishing these two phenomena is crucial for understanding the nature and ethical significance of therapeutic optimism. The failure to draw a distinction between these phenomena also helps to explain why different writers on the topic often speak past one another. (shrink)

A recent qualitative study published in Neuroethics by Schembs and colleagues explores how functional neurodiagnostics of consciousness inform surrogate decision making in cases of disorders of consciousness. In this commentary, we argue that the chosen methodology significantly limits the scope of the potential conclusions and suggest an embedded ethnographic approach of co-presence as an alternative.

I denne artikkelen drøfter vi hvordan norske forbrukeres holdninger til genmodifisert mat har endret seg gjennom årene. Allerede da genteknologi ble etablert som et eget forskningsfelt og utviklingsområde på 1980-tallet, viste den norske opinionen stor skepsis. Den norske lovgivningen tidlig på 1990-tallet utmerket seg også som den mest restriktive i Europa. Dette bildet endret seg ikke mye i løpet av 1990-tallet, mens opinionen i mange europeiske land i disse årene kom mer på linje med den norske. I hele denne perioden (...) var både forbrukeropinionen og lovgivningen i USA langt mer aksepterende enn i Europa, noe som ga seg utslag i en handelskonflikt som toppet seg med EU sitt moratorium for utsetting av genmodifiserte planter i 1999. I denne artikkelen stiller vi spørsmålet om norske forbrukeres holdninger til genmodifisert mat har endret seg de siste årene. Artikkelen viser at mellom 2002 og 2007 er det en voksende gruppe av forbrukere som ser ut til å akseptere genmodifiserte matvarer hvis det fører til en helse- eller miljøgevinst. Men til tross for dette så er nordmenn fremdeles skeptiske til genmodifisert mat. Det kan tolkes slik at genmodifisert mat ikke har ført til den nytten som ansees nødvendig for å ta den risikoen det innebærer å gjøre et betydelig skifte i matseddel. Matpatriotisme og en kulturell konservatisme når det gjelder skifte i matvaner bidrar også til å forklare den dominerende vente-og-se-holdningen. (shrink)

The explosive emergence of net-based learning in higher education brings with it new possibilities and constraints in teaching and learning environments. This edited collection considers how the concept of Academic Bildung - a term suggesting a personal educational process beyond actual educational learning - can be applied to net-based higher education, drawing on Scandinavian research to address the topic from both a theoretical and practical standpoint. Chapters explore the facilitation of online courses and argue how and why universities should involve (...) dimensions of Academic Bildung on both a strategic and technological pedagogical content level.The book is structured in three parts: Part I frames the current state of net-based learning and introduces Bildung as a concept; Part II contains a set of 4 case studies in Norway, Sweden and Denmark, also including a fifth study that looks at Scandinavian approaches to teaching and learning in comparison with data from USA, UK, Australia and Canada; Part III provides a synthesis of theories and cases to examine whether a Scandinavian orientation can be discerned. Contributions suggest that in order to address one of the fundamental functions of higher education, the ability to produce new knowledge, the Academic Bildung of the students has to be in focus. Grounded in theoretical and empirical discussion, this book will appeal to researchers and academics in the field of higher education as well as personnel who work with teaching and learning with technology, and academics interested in the question of Academic Bildung. (shrink)

This article takes the failure to grasp fully the paradigmatic case of European security after the Cold War as an example of how International Relations (IR) would benefit from reformulating not only its empirical research questions but also several of its central conceptual building blocks with the aid of Bourdieusian sociology. The separation between theory and practice and the overemphasis on military power and state actors blind IR from seeing the power struggles that reshaped European security. Instead, a Bourdieusian reformulation (...) adds new types of agency, focuses on the social production of forms of power, and stresses the processual rather than the substantive character of social reality. (shrink)

Was ist das Sein des Sozialen? Was konstituiert die Existenz von Gruppen und Institutionen, ihre Identität und Dauer in der Zeit? Dieses Buch resümiert den aktuellen Diskussionsstand der Sozialontologie und argumentiert für eine Ontologie des Sozialen, die sowohl formellen als auch informellen Institutionen gerecht wird. Es schlägt dafür eine Synthese aus Positionen vor, die in der gegenwärtigen Diskussion mit den Namen von John Searle und Margaret Gilbert verbunden sind.

Long-term potentiation is one of the most extensively studied forms of neuroplasticity and is considered the strongest candidate mechanism for memory and learning. The use of event-related potentials and sensory stimulation paradigms has allowed for the translation from animal studies to non-invasive studies of LTP-like synaptic plasticity in humans. Accumulating evidence suggests that synaptic plasticity as measured by stimulus-specific response modulation is reduced in neuropsychiatric disorders such as major depressive disorder, bipolar disorders and schizophrenia, suggesting that impaired synaptic plasticity plays (...) a part in the underlying pathophysiology of these disorders. This is in line with the neuroplasticity hypothesis of depression, which postulate that deficits in neuroplasticity might be a common pathway underlying depressive disorders. The current study aims to replicate and confirm earlier reports that visual stimulus-specific response modulation is a viable probe into LTP-like synaptic plasticity in a large sample of healthy adults. Further, this study explores whether impairments in LTP-like synaptic plasticity is associated with self-reported subclinical depressive symptoms and stress in a healthy population. Consistent with prior research, the current study replicated and confirmed reports demonstrating significant modulation of visual evoked potentials following visual high-frequency stimulation. Current results further indicate that reduced LTP-like synaptic plasticity is associated with higher levels of self-reported symptoms of depression and perceived stress. This indicate that LTP-like plasticity is sensitive to sub-clinical levels of psychological distress, and might represent a vulnerability marker for the development of depressive symptoms. (shrink)

This article examines one practice for challenging a co-participant, the use of polar interrogatives that are unanswerable. These are questions that are designed to receive a confirming answer of the same polarity as the question, so-called `Same Polarity Questions'. Speakers accomplish this bias by formatting the question in accordance with their state of knowledge. Based on the recipient's prior turns at talk, a speaker can infer what the recipient's stance towards some matter is and use a `Same Polarity Question' to (...) assert this inference and invite the recipient to confirm the stance. However, the sequential context in which these questions are produced means that with a confirming answer the recipient is heard to be in disagreement with the speaker and can subsequently be held accountable for this disagreement. Neither is a disconfirming response a real alternative, because this would contrast with the information provided by the recipient in prior talk. As this information is what leads the speaker to convey a certain belief about the recipient, the recipient is accountable for having misled the speaker. Because both confirming and disconfirming answers are accountable and hence problematic, recipients treat this type of question as unanswerable and instead orient to it as a challenge. (shrink)

The aim of this article is to continue the discussion about factors of importance for an including ethics of care. A further polarization between partiality and impartiality does not seem a relevant approach. What is important is to direct attention both to the other and to the third person, which requires an acknowledgement of responsibility that extends beyond established relationships. Thus, we need to draw attention not only to the vulnerability existing within every seriously ill or injured person, but to (...) factors of importance for marginalization of groups like refugees, people suffering from serious mental illness, and substance misusers, to mention some in the Western world. Marginalized groups are groups experiencing a discrepancy between need of health care and care given. They are not given proper priority in the distribution of resources, and they may experience ignorance when they first meet the healthcare system as patients.Efforts to understand what circumstances can lead to inadequate inclusion indicate that the elements of differentness and extensive losses of life contexts which may be causing feelings of hopelessness and helplessness in the health professionals, are key factors posing challenges to empathy both within and beyond established relationships, besides geographical distance. Groups of people who have suffered extensive loss in their life contexts may be threatening for us, as they reflect our own fears, and remind us of our own vulnerability.I raise the question: How can we contribute to meeting the need for an ethics of care that extends beyond the familiar to the unfamiliar both in established and non‐established relationships? (shrink)

In this article, we discuss the practice of conducting research in one's own field, in this case, from a position as a researcher with a nursing background doing fieldwork in a hospital and in one's own organization, an orthopedic surgical department. We show how an “insider” researcher position paves the way for analytical insights about sleep as an institutional phenomenon in the orthopedic surgical infrastructure and how acute and elective patient trajectories differ but build on the same logic, creating the (...) same dynamics of inclusion and exclusion. Through a situated and sociomaterial perspective, we analyze different clinical interactions in which we follow the hospital bed as an example of a central relational element that co‐creates sleep as an institutional phenomenon. Inspired by Karen Barad, we demonstrate how to move diffractively when doing and analyzing fieldwork and argue how moving diffractively as a researcher doing fieldwork “at home” is productive and challenges the concept and demand of “distance” as the phenomenological exercise in fieldwork. (shrink)

""Catching Ourselves in the Act" is no less than an attempt to explain intelligence. Delightful how the author dismantles traditional views in.

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of (...) help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)

På et fotballag i overgangen mellom barne- og ungdomsfotballen er spilletid på fotballbanen under kamp både en knapp ressurs og en kilde til diskusjoner om fordeling. Spørsmålet som er utgangspunkt for denne artikkelen, er hvilke hensyn som bør tas når trener og lagleder skal fordele samlet spilletid på enkeltspillere. Er det viktigst å vinne fotballkampen, eller har det størst betydning å fordele spilletiden mest mulig likt mellom spillerne? Skal det tas hensyn til guttenes evner, motivasjon og preferanser? Er deres familiebakgrunn (...) og personlighet av betydning? Diskusjonen baserer seg på en gjennomgang av ulike politiske rettferdighetsteorier for fordeling av knappe goder.Nøkkelord: rettferdighet, practice, fordelingsrettferdighet, diskursetikk, idrettsetikkEnglish summary: Minutes of justice: Distribution of time during football matches in a boys' teamDuring a football match, time for playing can be considered as a limited good. In this article the point of departure is the redistribution of time in a boys' football team in the transition phase between children and youth football. The questions are how and under which conditions time for playing should be distributed among the players. Is winning the game more important than trying to let every player play for an equal amount of time? Should the boys' talents, motivation, and preferences be considered while distributing time, or are family background and personality of importance? Different theories of political justice for the distribution of limited goods underpin the discussion of how to distribute the minutes of playing time during a football match. (shrink)

Since the beginning of the last century, the Swiss school opened special classes to educate the most vulnerable students. Measures were put in place to develop specific practices related to the role assigned to the special education teacher. An investigation of interactional type has covered the process for reporting student at a preschool and elementary school levels. Qualitative analysis of teacher reports was conducted following the model of Goffman. The results highlight the role of the specialist teacher at the school. (...) This works as a barometer of the integration in school life, the practices of marginalization in regular classrooms and school exclusion of some students. (shrink)

It is timely and important that new developments in conversation analysis become the subject of principled debate. John Heritage’s recent papers on the role of epistemics constitute one such development, and by re-analysing excerpts from this work, the articles in this Special Issue reveal some significant problems with a programmatic approach to epistemics. This commentary agrees with the critics that there are dangers in an overemphasis on epistemics and in using isolated utterances and proposing abstract scales and terms. But the (...) commentary also warns against totally rejecting epistemics as a domain of inquiry in CA and points to places where the critics exaggerate their criticisms in a way that makes them unnecessarily hostile. (shrink)

ABSTRACT When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end‐of‐life contexts, when patients are receiving ‘artificial’ life‐support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten (...) his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self. (shrink)

The concept of imagination is notoriously ambiguous. Thus one must be cautious not to use ‘imagination’ as a placeholder for diverse phenomena and processes that perhaps have not much more in common than that they are difficult to assign to some other, better defined domain, such as perception, conceptual thought, or artistic production. However, this challenge also comes with great opportunities: the fecundity and openness of ‘imagination’ appeal to researchers from different disciplines with different approaches and questions, and it draws (...) together fields of enquiry that are initially considered far apart. Hence, arguably, the field of imagination is particularly poised for interdisciplinary enquiry. In the section on Imagination in Interdisciplinary Research, I will talk about some of the issues that have already entered that field of interdisciplinary inquiry. (shrink)

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A (...) hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence. (shrink)

Résister à teinter l’information dans un monde polarisé, ainsi pourrait se résumer le principal défi des salles de presse contemporaines, soumises à la transmission rapide et à une circulation de l’information qui n’a pas toujours le luxe du temps et donc, du nécessaire recul pour bien témoigner des faits. Lise Millette, journaliste à la Presse Canadienne et rédactrice en chef de la revue Trente, croit que l’heure n’est plus à la hantise des médias sociaux, mais qu’en revanche, les journalistes (...) doivent s’imposer eux-mêmes des normes d’utilisation et assumer leurs responsabilités professionnelles. Les débats polarisés de la der­nière année ont plus que jamais divisé le Québec. Ces scissions ont pris d’assaut les réseaux sociaux, qui sont devenus le carrefour et le nerf d’une guerre de mots. Les journalistes ont été sur les lignes de front que sont le terrain et la couverture quotidienne, mais ils ont aussi été confrontés à leurs propres réflexions. La profession journalistique exige de la rigueur. Les responsabilités de la presse sont grandes, comme le sont les attentes du public. (shrink)

Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction on the mental health of student teachers when offered at their educational institution in a real-life context.Methods: A parallel randomized controlled trial was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of clinical depression or a diagnosis of psychosis or schizophrenia, abuse of alcohol, drugs, (...) and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling.Results: The study group included 67 student teachers with 34 allocated to the intervention group ; and 33 students allocated to a waiting list control group. At baseline, mean Perceived Stress Scale scores were 18.88 in the intervention group and 17.91 in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up. Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found.Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099]. (shrink)

The essays are grouped in three sections. In Part I Vogel considers the relationship between feminism and socialism.

In the literature the term “natural balance” occurs frequently and is used for highly divergent collections of facts and for results arrived at by different methods. In this paper it is attempted to give a review of the many possible meanings of “balance in nature”, and to evaluate the application of the term in the scientific literature.To achieve this twofold objective it seemed useful to start by giving as objective as possible a description of the “balance situation” in natural communities, (...) in analogy with the original physical concept and according to strict scientific criteria. On the basis of this working standard, part of the ecological literature is discussed with respect to statements and presumptions concerning “balance”. The extensive literature is classified according to several groups, on the one hand on the basis of the nature of the views , on the other hand according to the importance that certain authors attach to the theory of a given author. For each of these groups, an evaluation of the content of the term “balance” is given. It was found that the reasoning is not always sound and that the nature of the data on which the concept is based varies widely, which also holds for the method of reasoning applied in the conclusions drawn. In none of the publications arguments were found supporting the existence of a natural “balance situation” as formulated in the standard description. Consequently, it seemed justified to conclude that it is not correct to apply a concept “natural balance”, defined purely scientifically, to natural situations, either because “balance” in the indicated sense is simply not present or because the situation under consideration is not a natural one . The concept “natural balance” has had only heuristic value for scientific research. In other contexts it has a different value, because there criteria other than scientific or methodological ones hold for the content of a concept. It is therefore not objectionable to use the term “natural balance” in common parlance, especially since this usage makes it possible to convey to the layman a great deal in few words. (shrink)

New techniques for modifying the genomes of agricultural organisms create difficult ethical challenges. We provide a novel framework to replace worn-out ethical lenses relying on ‘naturalness’ and ‘crossing species lines.’ Thinking of agricultural intervention as a ‘negotiation’ of ‘integrity’ and ‘agency’ provides a flexible framework for considering techniques such as genome editing with CRISPR/Cas systems. We lay out the framework by highlighting some existing uses of integrity in environmental ethics. We also provide an example of our lens at work by (...) looking at the creation of ‘cisgenic’ potatoes to resist late potato blight. We conclude by highlighting three distinct advantages offered by the integrity framework. These include a more fitting way to look at the practice of scientific researchers, a more inclusive way to consider ethics around agriculture, and a more flexible way to provide the ethical grounds for regulation in different cultural contexts. (shrink)

Introducing formal causation / Ludger Jansen and Petter Sandstad -- Form, intention, information : from scholastic logic to artificial intelligence / Gyula Klima -- Formal causation : accidental and substantial / David S. Oderberg -- A non-hylomorphic account of formal causation / Petter Sandstad and Ludger Jansen -- Formal causes for powers theorists / Giacomo Giannini and Stephen Mumford -- Away with dispositional essences in trope theory / Jani Hakkarainen and Markku Keinänen -- Functional powers / Michele Paolini (...) Paoletti -- An Aristotelian approach to existential dependence / Benjamin Schnieder and Jonas Werner -- Finean feature dependence and the Aristotelian alternative / Wolfgang Sattler -- A problem for natural-kind essentialism and formal causes / José Tomás Alvarado and Matthew Tugby -- Form as cause and the formal cause : Aristotle's answer / James G. Lennox -- Form, cause, and explanation in biology : a neo-Aristotelian perspective / Christopher J. Austin -- Formal explanation and mechanisms of conceptual representation / Sandeep Prasada. (shrink)

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and experiences of (...) physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain—at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of “intention,” and that, as a result, they are led to exaggerate the extent to which (...) clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation. (shrink)

Ethical research on human subjects requires that subjects, if they have the capacity to do so, give free and informed consent to participate in the trials in which they are enrolled. This requirement, which is commonly referred to as the principle of informed consent, was prominently endorsed by the authors of the Belmont Report in 1978, and it remains widely accepted today. Yet while the principle of informed consent is by now almost universally accepted, the responsibilities that it imposes on (...) those who conduct research on human subjects is a more contentious matter. New challenges to securing informed consent have emerged since the publication of the Belmont Report, and responding to these challenges requires... (shrink)