Background: Despite the growing potential of mobile-based technologies, innovative interventions targeting the reduction of acute stress in daily life remain under-researched. Music listening is an easy-to-administer activity that is associated with lower levels of biological and self-reported stress. However, the application of music as an intervention in moments of acute stress in daily life remains to be examined. We developed a just-in-time intervention delivering music in moments of stressful experiences in daily life and tested its feasibility using a mixed methods (...) approach.Methods: In this uncontrolled pilot study, the ecological momentary music intervention was tested by 10 chronically stressed women aged 23.5 ± 3.3 years. Over 18 consecutive days, whenever participants reported stressful experiences, they were encouraged to listen to a self-compiled playlist. Subjective stress levels and saliva samples were assessed at three time points per stress report. We analyzed app-based log data, in-the-moment responses, questionnaire data, and semi-structured interview data.Results: On average, participants’ compliance with the study protocol lay at 70%. Overall, 65 stressful experiences were reported, 51 of which were followed by music listening, for an average duration of 12:53 min. Complete data were provided for 46 stressful experiences. Participants reported immediate relaxation and distraction through music listening. The interviews revealed that the intervention was easy to use and that music listening in moments of perceived stress was viewed as a new and pleasant activity. Several aspects of the protocol were identified, which should be improved in future studies.Conclusion: Since repeated stressful experiences in daily life can pose a threat to physical and mental integrity, interventions that are easily applicable and deliver support when needed most are necessary. Following minor adaptations, the EMMI can be considered as a feasible approach to target psychobiological stress responses in daily life, which is worthy of investigation in future larger-scale trials. (shrink)

Many opponents of BIG programs believe that receiving guaranteed subsistence income would act as a strong disincentive to work. In contrast, various areas of empirical research in psychology suggest that a BIG would not lead to meaningful reductions in work. To test these competing predictions, a comprehensive review of BIG outcome studies reporting data on adult labor responses was conducted. The results indicate that 93 % of reported outcomes support the prediction of no meaningful work reductions when the criterion (...) for support is set at less than a 5 % decrease in either average hours worked per week or the rate of labor participation. Overall, these results indicate that adult labor responses would show no substantial impact following a BIG intervention. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge (...) scores did not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

To address the burden of maternal morbidity and mortality in low‐ and middle‐income countries (LMICs), research with pregnant women in these settings is increasingly common. Pregnant women in LMIC‐context may experience vulnerability related to giving consent to participate in a clinical trial. To recognize possible layers of vulnerability this study aims to identify factors that influence the decision process towards clinical trial participation of pregnant women in an urban middle‐income setting. This qualitative research used participant observation, in‐depth interviews, (...) and focus group discussion with medical staff and pregnant women eligible for trial participation, at a regional hospital in Accra, Ghana. Besides lack of familiarity with modern scientific concepts, specific factors influencing the decision‐making process were identified. These include a wide power difference between health provider and patient, and a different perception of risk through externalization of responsibility of risk management within a religious context as well as a context shaped by authority. Also, therapeutic misconception was observed. The combination of these factors ensued women to rely on the opinion of the medical professional, rather than being guided by their own motivation to participation. Although being a (pregnant) woman per se should not render the label of being vulnerable, this study shows there are factors that influence the decision process of pregnant woman towards trial participation in a LMIC context that can result in vulnerability. The identification of context‐specific factors that can create vulnerability facilitates adaptation of the design and conduct of research in a culturally competent manner. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

BackgroundMental stress and imbalance of its two neural stress systems, the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, are associated with chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction. However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms and ED.Materials and methodsParticipants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National Institutes (...) of Health Chronic Prostatitis Symptom Index, the International Index of Erectile Function-5 and the International Prostate Symptom Score were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory, Perceived Stress Scale, Type A Personality Test and Symptom Checklist 90 were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed.ResultsThe BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group. The PSS scores of both groups with ED were significantly higher than the control group. Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients. The IPSS scores were shown to have significantly positive correlations with BAI, PSS and SCL-90 in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI, PSS, SCL-90 and quality of life score in NIH-CPSI. Cortisol awakening response parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency was significantly lower in ED patients when compared with CP/CPPS+ED patients and healthy controls, high frequency power was significantly higher in healthy controls compared to patients with ED, CP/CPPS and CP/CPPS+ED, and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group.ConclusionCP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not. (shrink)

BackgroundWe conducted a survey to identify what types of health/medical research could be exempt from research ethics reviews in Australia.MethodsWe surveyed Australian health/medical researchers and Human Research Ethics Committee members. The survey asked whether respondents had previously changed or abandoned a project anticipating difficulties obtaining ethics approval, and presented eight research scenarios, asking whether these scenarios should or should not be exempt from ethics review, and to provide comments. Qualitative data were analysed thematically; quantitative data in R.ResultsWe received 514 (...) class='Hi'>responses. Forty-three per cent of respondents to whom the question applied, reported changing projects in anticipation of obstacles from the ethics review process; 25% reported abandoning projects for this reason. Research scenarios asking professional staff to provide views in their area of expertise were most commonly exempted from ethics review ; scenarios involving surplus samples and N-of-1 studies were most commonly required to undergo ethics review. HREC members were 26% more likely than researchers to require ethics review. Need for independent oversight, and low risk, were most frequently cited in support of decisions to require or exempt from ethics review, respectively.ConclusionsConsiderable differences exist between researchers and HREC members, about when to exempt from review the research that ultimately serves the interests of patients and the public. It is widely accepted that evaluative research should be used to reduce clinical uncertainties—the same principle should apply to ethics reviews. (shrink)

In order to systematically evaluate perceptual anticipation between experts and non-experts for different kinds of combat sports, we needed to perform a comprehensive assessment. In this systematic review and meta-analysis, we searched four English-language and three Chinese-language databases that used expert/non-expert research paradigms, to explore perceptual anticipation in combat sports. We employed a random effects model for pooled analyses using the inverse variance method. We included 27 eligible studies involving 233 datasets in this meta-analysis. We observed large effect sizes for (...) the differences between experts and non-experts in both response accuracy and reaction time. We also observed substantial differences between experts and non-experts in the mean duration of visual fixations per trial, but not in the visual fixation duration. Taken together, high-level combat athletes have more advantages in perceptual anticipation than lower-level athletes, showing faster and more accurate responses when facing the opponent's attacks, as well as focusing on fewer points of visual fixations than novice athletes. Different types of combat sports and stimulus presentations affect perceptual anticipation abilities to varying extents in relation to outcome measures, with more pronounced expertise in a stimulus that is closer to real-world situations.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226343, PROSPERO CRD42021226343. (shrink)

When we forgive, we do so for reasons. One challenge for forgiveness theorists is to explain which reasons are reasons to forgive and which are not. This paper argues that we forgive in response to a perceived change of heart on the part of the offender. The argument proceeds in four steps. First, I show that we forgive for reasons. Second, I argue that forgiveness requires the right kind of reason. Third, I show that these two points explain a common (...) distinction between forgiving and letting go and, in doing so, solve a problem facing many accounts of forgiveness. Finally, I consider candidate reasons to forgive and argue that all of them are either the wrong kind of reason or are instances of a more general reason of the right kind, namely, a perceived change of heart. (shrink)

This paper investigates the possibility of understanding the rudimentary elements of clinical sensitivity by investigating the works of Edmund Husserl and Emmanuel Levinas on sensibility. Husserl's theory of intentionality offers significant reflections on the role of pre-reflective and affective intuition as a condition for intentionality and reflective consciousness. These early works of Husserl, in particular his works on the constitution of phenomenological time and subjective time-consciousness, prove to be an important basis for Levinas’ works on an ethics of alterity and (...) infinite responsibility for the other person. In fact, it is difficult to understand the core of Levinasian ethics, of vulnerability as proximity, of ethical sensitivity as passivity and a suffering for the suffering of another, without understanding the influence from Husserl's work. Crucially, the paper will, on the basis of Levinasian ethics, establish an understanding of sensibility as vulnerability and receptivity that is fundamental also for understanding significant intuitions in clinical nursing. Clinical sensitivity and carefulness in nursing are shaped by the concrete and also bodily expressions of vulnerabilities in a receptivity that is pre-reflective and pre-ontological. (shrink)

Once relegated to the margins of the responsibility debate, moral influence theories have recently been rehabilitated. This paper offers a moral influence theory with two parts: a theory of responsibility as influenceability and an act-consequentialist justification of blame. I defend this account against six concerns commonly raised both by opponents and by advocates of similar views. Some concerns target act consequentialism, claiming that it 1) permits blaming innocents; 2) permits coercion, manipulation, and other objectionable forms of influence; and 3) fails (...) to capture intuitions about desert. Other concerns target responsibility as influenceability, claiming that influenceability accounts are 4) unsophisticated, 5) make ascriptions of responsibility dependent on assessments of permissible blame, and 6) have various counterintuitive implications. (shrink)

The first part of this paper seeks to clarify how interpersonal relationships are generally rooted in considerations about trust, vulnerability and interpersonal dependence. However, for nurse–patient relationships, and from the point of view of justice and fair rationing, it is essential to investigate their distinct moral nature. Hence, the second part of the paper argues that nurse–patient relationships, as a special kind of interpersonal relationship, raise particular normative issues. I will discuss dilemmas facing nurses and professional care‐givers in general who (...) are torn between their obligations to existing patients and more general and impartial considerations regarding the distribution of nursing care. This discussion concerning the normative claims of immediacy and mercy vs. fairness in health care is a pressing issue for nursing care. The claims that arise from particular relationships in nursing care are typically associated with closeness to a person's vulnerabilities. The pressing issue is how considerations of mercy and protection of individual patients can be safeguarded within today's nursing and health‐care practices in which distributivist considerations are crucial. (shrink)

Abolitionism is the view that if no one is responsible, then we ought to abandon the reactive attitudes. Proponents suggest that reactive attitudes can be replaced in our emotional repertoire by non-reactive analogues. In this paper, I dispute and reject a common challenge to abolitionism according to which the reactive attitudes are necessary for protesting unfairness and maintaining social harmony. While other abolitionists dispute the empirical basis of this objection, I focus on its implications. I argue that even if non-reactive (...) analogues cannot perform the interpersonal and social functions of reactive attitudes, it does not follow that the losses of abandoning them outweigh the gains of retaining them. The force of the challenge rests on a mistake, identified by John Stuart Mill among others, that is common when evaluating entrenched social practices. (shrink)

There is much to admire in Michelle Ciurria’s provocative approach to ascribing moral responsibility. Her work is detailed and spells out explicitly her methodological assumptions. In this commentary, my main focus is on the methodological assumptions she makes. Ciurria’s arguments often depend on our reactions to actual cases and thought experiments. She takes it for granted that we need a theory that matches certain of our intuitions. This is not an unreasonable way to proceed. We definitely need a good reason (...) if we are going to adopt a theory that does not fit with well-established moral intuitions. Nevertheless, we need to be cautious in using these cases to guide our theory choice, especially when our .. (shrink)

Standard tools used in societal risk management such as probabilistic risk analysis or cost–benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor’s list to argue that the alternative (...) ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost–benefit analysis. (shrink)

In 2015, observers argued that the fourth agricultural revolution had been initiated. This article focuses on one part of this high-tech revolution: the origin, development, applications, and user value of unmanned aerial systems (UAS). Institutional changes connected to the UAS innovation are analyzed, based on a Swedish case study. The methods included autoethnography. The theoretical frame was composed by four perspectives: innovation, institutions, sustainability, and ethics. UAS can help farmers cut costs and produce higher quantity with better quality, and also (...) has environmental benefits. However, this promising innovation was exposed to institutional forces and suddenly became subordinated the Act of Camera Surveillance. This study illuminates how legislative institutions can inhibit responsible innovation. The study shows that different ethical perspectives can collide with each other. (shrink)

Abolitionism is the view that if no one is responsible, we ought to abandon the reactive attitudes. This paper defends abolitionism against the claim, made by P.F. Strawson and others, that abandoning these attitudes precludes the formation and maintenance of valuable personal relationships. These anti-abolitionists claim that one who abandons the reactive attitudes is unable to take personally others’ attitudes and actions regarding her, and that taking personally is necessary for certain valuable relationships. I dispute both claims and argue that (...) this objection exaggerates the role of the reactive attitudes and underestimates the importance of non-reactive moral emotions. (shrink)

Citizen science (CS) has been presented as a novel form of research relevant for social concerns and global challenges. CS transforms the roles of participants to being actively involved at various stages of research processes, CS projects are dynamic, and pluralism arises when many non-professional researchers take an active involvement in research. Some argue that these elements all make existing research ethical principles and regulations ill-suited for guiding responsible CS conduct. However, while many have sought to highlight such challenges from (...) CS, few have discussed principles per se providing the foundation for regulations. In this article we will investigate the possibilities of midlevel principlism in guiding responsible CS conduct. Principlism has the potential of accommodating many of the concerns taken to reduce the relevance of existing principles. (shrink)

This paper examines the psychology of existential guilt with Martin Heidegger and Rollo May’s conceptualizations as the point of departure. The concept of existential guilt describes preconditions for responsibility and accountability in life choices and the relationship to the potential given in the life of a human. It might also be used as a starting point to examine an individual’s relationship to the potential offered in their life and life context and, in this way, the hitherto unlived life of an (...) individual. The following questions are discussed in contexts of identity development, perfectionism, and current cultural shifts in conceptualizations of selfhood: How can humans relate to the fact that only limited parts of who they might be can ever be actualized? Moreover, how can they relate to the fundamental ambiguity and “groundlessness” in the contexts of life where choices are made? There are striking parallels between the role of exploration in the Eriksonian approaches to healthy identity development and the ontological groundlessness that stands out as a premise for existential guilt. There are also parallels between identity fore-closure and normative identity styles and “falling” into das Man in the existential framework. Perfectionistic ideals easily become an objectivization – and closure – of possible alternatives and choices. In contemporary theories of constructions of selfhood, the dangers of alienation from the community on the one hand and escape into what might become totalitarian collectivism on the other is pointed out. The contextualization of personal responsibility offered through the concept of existential guilt might address both dangers. It provides a perspective on how personal responsibility is embedded in contexts of human relationships, relationships to nature, and the finitude, freedom, uncertainties, and suffering that is given through human existence. Existential guilt can wake sorrow and regret over opportunities overlooked and lost. However, most of all, it can be seen as a drive toward repair in the relationship toward both oneself and the other. It takes the form of receptivity, an openness to a life not yet lived, and creative use of imagination. (shrink)

Gadow's understanding of nursing as a relational narrative anchored in a dialectic between the fundamental subjectivity of the individual client and the objectification of his illness poses some interesting questions for nursing ethics and care. For Gadow, nursing is an encounter with the immediate vulnerability of the client and also lends it responsibilities to the medical objectification of illness aiming at disease treatment and control. Hence, nursing agency is divided between its responsibilities induced by the personal vulnerability of the patient (...) and the more impersonal, but benevolent intention shaped by medical knowledge. Medical knowledge is impersonal in the sense that it is knowledge detached from the subjectivity of the patient. But how is nursing able to reconcile the interests derived from personal and experienced vulnerability with the more impersonal and often conflicting demands of medical knowledge? This question is even more intriguing because there seems to be an objective dimension within a patient's subjectivity itself: an autonomous person can critically evaluate his own subjectivity as a basis for informed self‐interest. The sick person is thus confronted with objectivity on two important levels: the objective facts of his disease and his detachment from his own experiential vulnerability when engaged in the critical evaluation of his self‐interest. This paper will discuss the normative dimensions of these complex and, frequently, conflicting perspectives from the theoretical perspectives of Thomas Nagel's normative responsibility and Sally Gadow's clinical epistemology and relational narratives. The empirical basis for the discussion will be an ongoing study of the ethical dimensions of pain relief and sedation in an intensive care unit. (shrink)

The aim of this paper is to provide a conceptual framework that will help in understanding and evaluating, along social and ethical lines, the issue of killing day-old male chicks and two alternative directions of responsible innovations to solve this issue. The following research questions are addressed: Why is the killing of day-old chicks morally problematic? Are the proposed alternatives morally sound? To what extent do the alternatives lead to responsible innovation? The conceptual framework demonstrates clearly that there is a (...) moral “lock-in”, and why the killing of day-old chicks is indeed an issue. Furthermore, it is shown that both alternative directions address some important objections with regard to the killing of day-old chicks, but that they also raise new dilemmas. It also becomes clear that the framework enables and secures anticipation, reflection, deliberation with and responsiveness to stakeholders, the four dimensions of responsible innovation, in a structured way. (shrink)

Rules of thumb are simple instructions, used to guide actions toward a specific result, without need of advanced knowledge. Knowing adequate rules of thumb is a common form of technological knowledge. It differs both from science-based and intuitive (or tacit) technological knowledge, although it may have its origin in experience, scientific knowledge, trial and error, or a combination thereof. One of the major advantages of rules of thumb is the ease with which they can be learned. One of their (...) major disadvantages is that they cannot easily be adjusted to new situations or conditions. (shrink)

Wrongdoing is inescapable. We all do wrong and are wronged; and in response we often blame one another. But if blame is a defining feature of our social lives, so is ceasing to blame. We might excuse, justify, or forgive an offender; or simply let the offence go. Each mode of ceasing to blame is a social practice and each has characteristic norms that influence when and how we do it, as well as how it’s received. We argue that how (...) we relinquish blame, and how effective we are, depends on many circumstances only partially within our control. Like any norm-governed practice, one can do it well or poorly, appropriately or inappropriately, successfully or unsuccessfully. To successfully participate in a practice, one’s action must be done for the right reasons and secure uptake. We argue that social and material circumstances can compromise one’s ability to effectively cease to blame in the manner one prefers. But if one can fail, then one can lack access to particular ceasing to blame practices if one is regularly prevented from effectively relinquishing blame. However, uncooperative social and material circumstances do not only arise by chance. Our central argument is that circumstances of oppression can systematically compromise one’s ability and opportunities to effectively perform a variety of ceasing to blame practices. This deprivation is an insidious facet of oppression that is neglected both in theories of oppression and of forgiveness but which has significant implications for how we understand the power and purpose of forgiveness. (shrink)

Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography, brain imaging, genetics, and biochemistry are reviewed: Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. Studies of the absolute level of regional cerebral blood flow (...) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index. High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory. (shrink)

This article considers the foundation of nursing as a moral practice. Its basic claim is that all nursing knowledge and action reside on a moral foundation. The clinical gaze meets vulnerability in the patient’s human condition. To see a patient’s wound is to see his or her hurt and discomfort; it is a concerned observation. To see the factual and pathophysiological is at the same time to see the ethical: the moral realities of suffering, pain and discomfort. A nurse’s emotional (...) sensitivities are central to understanding a patient’s experiences of illness. Emotions reveal value and ascribe moral importance to certain situations; they are addressed centrally by vulnerability and the moral realities of illness. Hence, the essence of nursing knowledge and nursing performance cannot be understood merely as ontology (i.e. as being-with-the-other). Nursing is basically being-for-the-other; it is responsibility; it is ethics. (shrink)

This article contends that an ethics of care has a particular moral ontology that makes it suitable to argue for the normative significance of relational responsibilities within professional health care. This ontology is relational. It means that moral choices always have to account for the web of relationships, the relational networks and responsibilities that are an essential part of particular moral circumstances. Given this ontology, the article investigates the conditions for health care professionals to be partial and to act on (...) the basis of particular responsibilities to their patients. We will argue that priorities could be partial in three ways: first, because there may be exceptional circumstances that allow for giving priority to one patient over another; second, because the integrity of the patient and a health care worker may be connected in special ways; and, finally, even if impartiality is essential, the institutional basis of health care must always give ample space for an ethically qualified individual and personal care for patients. Even if difficult priorities may be necessary, the conditions of institutional health care should always seek to create the prerequisites for nurses and doctors to administer proper care. (shrink)

We are very grateful for the responses given to our article and for the editor of this journal for inviting us to have this kind of interaction. We simply need to have this kind of open discussion...

PurposeTo explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.IntroductionResponsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the (...) partner’s use of responsive strategies.Materials and methodsA therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when the participants used the gaze-controlled device and the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.ResultsInter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.ConclusionThe communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not. (shrink)

In order to responsibly protect certain cherished values, for instance, human or environmental health, privacy, or ‘human dignity’, societies see a need for oversight, guidance and regulation of de...

In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about (...) the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well‐founded. (shrink)

This paper explores the role of existential vulnerability in the experience of personal identity and how identity is found and created. Existential vulnerabilities mark a boundary between what humans can bring about willfully or manipulate to their advantage and what is resistant to such actions. These vulnerabilities have their origin, on an ontological level, in fundamental conditions of human existence. At the same time, they have implications on a psychological level when it comes to self-experience and identity formation. Narrative and (...) value-based identity depend on how a person relates to finitude and the ambiguous side of lived experience. Relational identity depends on how a person relates to existential aloneness and the fact that the meaning and value of our actions are partly out of our control; they are always also dependent on other people’s responses to us. Bodily identity makes us feel continuous and real, but at the same time vulnerable to death and the gaze and actions of others. Being ‘thrown’ into an arbitrary life context is also a form of existential vulnerability. Authentic psychological identities can develop by giving meaning to these circumstances and balancing acceptance of existential vulnerability with the courage to make choices and act. (shrink)

The problem we face today is that there is a huge gap between our ethical judgments about the ecological crisis on the one hand and our ethical behavior according to these judgments on the other. In this article, we ask to what extent a phenomenology of the ecological crisis enables us to bridge this gap and display more ethical or pro-environmental behavior. To answer this question, our point of departure is the affordance theory of the American psychologist and founding father (...) of ecological psychology, James Gibson. There are two reasons for taking this approach. First of all, an ontological reading of Gibson’s affordance theory provides a concept of nature which is non-dualistic, non-anthropocentric and eco-centric, but is not seen as an ‘intrinsic value’ or product of ‘human valuation’. Secondly, the affordance ontology provides us with a concept of nature which in itself calls for certain action and behavior. If we indeed face a gap between ethical judgment and ethical behavior with regard to the current ecological crisis, an affordance of nature could bridge this gap. Based on our ontological reading of Gibson’s affordance theory, we open a radically new perspective on the current ecological crisis and the responsibility of mankind with regard to this crisis. (shrink)

Philosophers and psychologists have long tried to understand people's irrational behaviour through concepts such as weakness of will, compulsion and addiction. The scientific basis of the project has been greatly enhanced by advances in cognitive psychology and neuroscience. However, some philosophers have also been critical of the more general conclusions drawn by the scientists. This is especially true when scientific researchers start making claims that go to philosophical issues, such as free will and responsibility. Conversely, some scientists have been critical (...) of philosophical approaches for not understanding the results of recent research. I examined some of the recent history of scientific claims about addiction, and the rise of the claims from scientists to have shown that addiction is a brain disease and that addictive behaviour is compulsive. Given the well-confirmed evidence that addicts can modulate their behaviour in response to rewards, punishments and context, it is clear that according to normal definitions of compulsivity the behaviour of addicts is not typically compulsive, suggesting that neuroscientists are making an error in their interpretation of data. Since philosophers have expertise in making distinctions between different kinds of action and categorising them as free, weak-willed and compulsive, we will achieve a better interpretation of the neuroscience of addiction when taking this philosophical work into account. Conversely, given the status of science in the modern world, philosophers have to grapple with the latest neuroscientific discoveries and show the compatibility of their philosophical theories with the data for their approaches to maintain credibility. (shrink)

Value-freedom or value-neutrality is a well-known topic in the philosophy of science. But what about the value-neutrality of technology, medical or other? Is it too far-fetched to imagine technology as in some sense value-neutral — in view of its intimate connection with purposeful human action? No; unexpected perhaps, but less far-fetched than expected. If we try to conceive of technology as a cognitive possibility abstracted from each and every specific social context, we shall find three senses in which it may (...) be regarded as value-neutral: neutral vis-à-vis different possible uses and ends; neutral before action; neutral qua cognitive object, analogous to the cognitive core of science. The further meanings and implications of these three senses of value-neutrality are discussed.What is this exercise good for? The nature of technology is indeed worth pondering in its own right, not least from this rather unusual angle. But beyond that: as the possible meanings of value-neutrality are tried out, the radical nature of human responsibility for the social implementation of technology will be highlighted. (shrink)

This thesis in an invistigation into the concept of "harm" and its moral relevance. A common view is that an analysis of harm should include a counterfactual condition: an act harms a person iff it makes that person worse off. A common objection to the moral relevance of harm, thus understood, is the non-identity problem. -/- This thesis criticises the counterfactual condition, argues for an alternative analysis and that harm plays two important normative roles. -/- The main ground for rejecting (...) the counterfactual condition is that it has unacceptable consequences in cases of overdetermination and pre-emption. Several modifications to the condition are considered but all fail to solve this problem. -/- According to the alternative analysis to do harm is to perform an act which is responsible for the obtaining of a state of affairs which makes a person’s life go worse. It is argued that should be understood in terms of counterfactual dependence. This claim is defended against counterexamples based on redundant causation. An analysis of is also provided using the notion of a well-being function. It is argued that by introducing this notion it is possible to analyse contributive value without making use of counterfactual comparisons and to solve the non-identity problem. -/- Regarding the normative importance of harm, a popular intuition is that there is an asymmetry in our obligations to future people: that a person would have a life worth living were she to exist is not a reason in favour of creating that person while that a person would have a life not worth living is a reason against creating that person. It is argued that the asymmetry can be classified as a moral option grounded in autonomy. Central to this defence is the suggestion that harm is relevant to understanding autonomy. Autonomy involves partly the freedom to pursue one’s own aims as long as one does no harm. (shrink)

This paper argues that there is a dimension of human consciousness which allows for a pre-intentional and non-cognitive intuition of sensibility. A sensibility which allows for the vulnerability of the human other is by nature characterized by passivity and receptivity. Moreover, sensibility invokes the significance of relating to the human other in an affective way of being touched by his or her pain and suffering. This capacity of being distressed by the distress of another person opens up for ethical responsibility (...) and even in a fundamental sense is a presupposition for full-fledged clinical knowledge in medical care and health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.1 (2003) 39-47 [Access article in PDF] Restraint and Emotion in Cicero's De Oratore Per Fjelstad In De Oratore Cicero has the revered orator Crassus ask, "Who then is the man who gives people a thrill? whom do they stare at in amazement when he speaks? who is interrupted by applause? who is thought to be so to say a god among men?" (1942a, III.53). Crassus, (...) who is asking his companions to think about emotional energy in speech, goes on, "It is those whose speeches are clear, explicit, and full, perspicuous in matter and language, and who in actual delivery achieve a sort of rhythm and cadence—that is, whose style I call 'ornate'."Several things are striking about the passage. First, it resolves its inquiry by invoking the concept of ornatus, a word widely used to translate the Greek idea of kosmos (DiLorenzo 1978). Cicero thus refers to a quality that joins the ideas of cosmic order, physical beauty, and earthly power. Second, the passage is delivered in the midst of Crassus's discussion of the fourth rhetorical canon, that referring to the elaboration of ideas in language, of selecting levels of style and modes of verbal embellishment. Third, the passage ranges across the entire field of rhetorical art, at least as indexed by the scope of the canons. The performative quality directly under discussion, that which gives people a thrill—initially associated with the Theophrastian virtues of style that Crassus has been enumerating, that is, clarity and explicitness—quickly is expanded to include copiousness of invention, perspicuity of language, and energetic beauty in delivery. Cicero's Crassus thus discusses a performative dynamic that appears to govern rhetoric as a whole.As the other characters in the dialogue discuss this quality of speech, which engages listeners emotionally and transforms their experience of the present, they bound beyond the preliminary categories of their analysis and describe a power of speech that is aesthetic and philosophical. As the [End Page 39] narrator of this dialogue, Cicero eventually associates the possibility of emotional transformation with a quality of performance we might identify as graceful or urbane. Cicero suggests that performative style can rise above particular details, conventions, and rules of standard rhetorical instruction. Ornate speech is, in sum, emotionally transformative. In detail, however, how does Cicero theorize this grand ability? What goals, resources, or models does he invoke?This essay argues that Cicero's theory of ornatus insists an orator display emotions relevant to the performance while responding to the need of listeners to hear emotional expression against a backdrop of relative calm. In developing this analysis, I claim that the dialogic format of De Oratore allows insight to emerge from juxtaposed perspectives, that Cicero's ideal of ornatus contains a limiting threshold for performative exuberance, and that his examples of emotional engagement illustrate the importance of context and aesthetic restraint. Theoretical tensions as sources for synthetic insight Theoretical tensions in Cicero's De Oratore are instructive. While Cicero's effort to reconcile Isocratean practice with Aristotelian teleology ultimately makes for a rough fit, the juxtaposition of those understandings within the dialogue also generates new insight, even about limits for rhetorical theory itself. Referring to this mode of theorizing as "ironic eloquence," Michael Leff holds that "through this merger of theory and practice, the rival conceptions of oratory as systematic art and oratory as synthetic practice coalesce within the text, the two perspectives interacting to produce a development that incorporates both" (1986, 323).A similar theoretical tension can be observed in De Oratore regarding the prospects and significance of emotional engagement in oratorical performance. In discussing the practices of emotional oratory Cicero draws on three distinct intellectual sources: a quasi-enthymematic model of emotional engagement, in which an orator need not share or display the sought-after emotional response; a mimetic theory of theatrical performance (that is, a typology of tonal and gestural "moods"); and a latent theory of "authenticity," according to which that which is being theatrically displayed is not "fakely" fictional, but somehow genuine.The conflicting theories suggest... (shrink)

Results of studies that cast doubt on the safety of genetically modified crops have been published since the first GM crop approval for commercial release. These ‘alarming studies’ challenge the dominant view about the adequacy of current risk assessment practice for genetically modified organisms. Subsequent debates follow a similar and recurring pattern, in which those involved cannot agree on the significance of the results and the attached consequences. The standard response from the government—a reassessment by scientific advisory bodies—seems insufficient to (...) bring the debate to a satisfactory closure. The recurrence of the same debate every time an alarming study is published shows that science alone cannot solve the problem. We believe that further analysis is needed to investigate if and how we can prevent this repetitive cycle that creates frustration amongst all stakeholders. In this paper, we analyse the dynamics behind discussions which occur following alarming studies. We will use a selection of representative alarming GMO case studies to underpin our claim that it is likely that there will be a permanent difference in view of opinion that cannot be solved with more data or new facts. The current strategy of more research is a pitfall that is unlikely to solve this issue. Instead, the focus of the GM crop discussion should shift towards managing permanent different viewpoints and providing a platform for a broader conversation on agriculture and food production. (shrink)

Rebecca Brown and Julian Savulescu argue in ‘Responsibility in Healthcare Across Time and Agents’ that if responsibility should play a crucial role in healthcare, then we need a concept of responsibility that reflects that an individual’s behaviour is sometimes, if not routinely, influenced by external factors in various ways. As Brown and Savulescu convincingly show, health-related behaviour in particular is often affected by other agents and typically involves multiple decisions on different occasions. Smoking and a poor diet are but two (...) examples where these factors are salient. Since health-related behaviour is often influenced by others, and often spread out over time, a notion of responsibility that does not take these two factors into account will be inadequate. In this comment to their paper I wish to raise an issue concerning Brown and Savulescu’s characterisation of individual responsibility for health-related behaviour that involves multiple choices by the same agent over a period of time. For simple acts—smoking a cigarette or eating some junk food for example—Brown and Savulescu assume two necessary conditions for responsibility: a ‘control condition’ and a ‘epistemic condition’. These conditions are intended to capture the plausible idea that …. (shrink)