Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. Participants and (...) research context The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. Ethical considerations The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. Findings A main challenge was that staff found it difficult to respect the patient’s autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff’s threshold for considering the use of coercion appeared to be high. Conclusions Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems. (shrink)

A prominent trend in moral philosophy today is the interest in the rich textures of actual human practices and lives. This has prompted engagements with other disciplines, such as anthropology, history, literature, law and empirical science, which have produced various forms of contextual ethics. These engagements motivate reflections on why and how context is important ethically, and such metaethical reflection is what this article undertakes. Inspired by the work of the later Wittgenstein and the Danish theologian K.E. Løgstrup, I first (...) describe one of the ways in which context plays a central role with regard to ethical meaning and normativity. I then examine how ‘context’ is to be defined, and finally I discuss some of the questions which arise when giving context prominence in ethics – namely, how to delimit the scope of relevant context, the relevant traits of a particular context and what ‘the ethical’ is. (shrink)

Since the publication of Annette Baier’s agenda-setting article entitled ‘Trust and Antitrust’, trust has become an increasingly popular topic, not only in moral philosophy and epistemology but als...

Background The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff (...) struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. Methods An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. Results Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home. Conclusion The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care. (shrink)

This article provides a critical realist take on comparative methodology. Heeding the call for greater attention to the ontological presuppositions inherent in all methods, it first outlines comparative methods as they have traditionally been conceived and practised. Discerning two important aspects of these approaches - their notion of causality and their reliance on inductive inferences - the discussion moves on to consider their applicability within a critical realist social science. Arguing that the ontological presuppositions of traditional approaches to comparative methodology (...) are not compatible with the ontology of critical realism, it seeks to specify some initial steps in the direction of designing a new approach securing this compatibility. Important to this new approach is theoretical, or abductive, comparison and the need to be context-sensitive. (shrink)

The COVID-19 pandemic presents unprecedented challenges to public health decision-making. Specifically, the lack of evidence and the urgency with which a response is called for, raise the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response to the various threats we face. Here we discuss the intervention of introducing technology that aims to trace and alert contacts of infected persons—contact tracing (CT) technology. Determining whether such an intervention is proportional (...) is complicated by complex trade-offs and feedback loops. We suggest that the resulting uncertainties necessitate a precautionary approach. On the one hand, precautionary reasons support CT technology as a means to contribute to the prevention of harms caused by alternative interventions, or COVID-19 itself. On the other hand, however, both the extent to which such technology itself present risks of serious harm, as well as its effectiveness, remain unclear. We therefore argue that a precautionary approach should put reversibility of CT technology at the forefront. We outline several practical implications. (shrink)

There is growing interest in contact tracing apps for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. (...) We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness. (shrink)

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

'The church in danger' : latitudinarians, Socinians, and Hobbists -- Animal spirits and living fibres -- Mortalists and materialists -- Journalism, exile, and clandestinity -- Mid-eighteenth-century materialism -- Epilogue : some consequences.

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

Michel Foucault’s _History of Sexuality_ has been one of the most influential books of the last two decades. It has had an enormous impact on cultural studies and work across many disciplines on gender, sexuality, and the body. Bringing a new set of questions to this key work, Ann Laura Stoler examines volume one of _History of Sexuality_ in an unexplored light. She asks why there has been such a muted engagement with this work among students of colonialism for whom (...) issues of sexuality and power are so essential. Why is the colonial context absent from Foucault’s history of a European sexual discourse that for him defined the bourgeois self? In _Race and the Education of Desire, _Stoler challenges Foucault’s tunnel vision of the West and his marginalization of empire. She also argues that this first volume of _History of Sexuality_ contains a suggestive if not studied treatment of race. Drawing on Foucault’s little-known 1976 College de France lectures, Stoler addresses his treatment of the relationship between biopower, bourgeois sexuality, and what he identified as “racisms of the state.” In this critical and historically grounded analysis based on cultural theory and her own extensive research in Dutch and French colonial archives, Stoler suggests how Foucault’s insights have in the past constrained—and in the future may help shape—the ways we trace the genealogies of race. _Race and the Education of Desire_ will revise current notions of the connections between European and colonial historiography and between the European bourgeois order and the colonial treatment of sexuality. Arguing that a history of European nineteenth-century sexuality must also be a history of race, it will change the way we think about Foucault. (shrink)

A FALSE DICHOTOMY BETWEEN INTEGRITY AND IMPARTIALITY HAS become entrenched in contemporary ethical and political theory. Drawing on the work of Bernard Williams and Alasdair MacIntyre, this essay sketches the dichotomy and argues for its ultimate falseness. Eco-theologians' innovative use of the term "integrity" suggests directions for transcending the false dichotomy. Increasingly, the term "integrity of creation" is used to flag religioethical dimensions of ecology. This usage changes the subject of integrity from individuals to systems, implying that personal integrity is (...) a derivative concept that is related to how one responds to the complexity of systems. A structurally parallel change in the subject of integrity would benefit political theory. It would promote an "ecological politics" that integrates alternative definitions of integrity as wholeness, consistency, and balance. It also would suggest new conceptions of civic virtue that avoid dichotomizing between personal integrity and public impartiality. (shrink)

Ann Whittle offers a fresh approach to questions about whether our actions are free and whether we are morally responsible for them. She argues that the answers to these questions depend on the contexts in which we make claims about our abilities and our control over our actions.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 456-458 [Access article in PDF] Quarrel & Quandary, by Cynthia Ozick; xiii & 247 pp. New York: Alfred A. Knopf, 2000, $25.00. Ask Cynthia Ozick to define a Jewish book and she launches into an extended defense of the integrity of the body of traditional Jewish writing: Torah, Talmud, liturgy, ethics, and philosophy. Ozick takes her Judaism seriously; its literature, in the broad sense, (...) for her, is didactic and dedicated to the promotion of virtue attained through study. She takes literature seriously too and strenuously defends fiction as an act of the "free imagination," with an equal emphasis on both elements of that phrase although, Ozick rightly argues, the imagination by definition is free. Thus, a Jewish book and Jewish fiction are contradictory. To different degrees, emphasis, and purpose, both are freighted by moral purpose.So are the various Ozicks! A traditional Jew, a Jewish American writer, a novelist, an essayist, a classical feminist—all describe Ozick who obviously belies all simple categories save one: writer. Yet even as a writer, Ozick is complex and conflicted, lamenting that she hasn't written enough fiction but claiming that it simply could not have been different.While Ozick may not be as prolific as she would like, she is a commanding presence in American fiction and belles lettres. Her latest collection of non-fiction work, Quarrel & Quandary, demonstrates her clear thinking, breadth of expertise, seriousness, and intelligence. Ranging from the autobiographical to the political, each essay is informed by history and none is light nor nostalgic. "Dostoyevsky's Unabomber" is perceptive and regrettably prescient in its depiction of the philosopher-murderer. In "The Posthumous Sublime," Ozick walks us through the "grieving that has been made beautiful" in the four stories of Sebald's The Emigrants. "A Drug Store Eden" is a warm and familiar but never sentimental portrait of her hard-working parents and her Uncle Ruby. The humor of "Lovesickness" and "How I Got Fired from My Summer Job" resonate for middle-class, studious, awkward young girls. In another essay, awe-inspired respect for Kafka is balanced by reverent awe of God, which is tempered by an uncomfortable acceptance of Job's acquiescence. Where is Job's "impious impatience" in the face of his renewed prosperity and health?, she asks. Where is "the father's bitter grief over the loss" of his first family? In quintessential [End Page 456] Ozick, she acknowledges the staying power of the ancient sages who argued God's majesty at the same time reserving her right to "philosophic doubt," especially in light of the Shoah.Two essays in this volume are exceptional in their insight and influence. "Who Owns Anne Frank?" should put to rest the sentimentalization of Anne Frank and her diary. It should stop the shameless marketing of the Holocaust—the catastrophe that marked a century—as yet another genocide. Ozick's relentless focus on the reality of Nazi evil and its consequent waste of human lives and potential should abort further distortions about Anne's short life, but it probably won't. The diary has been "bowdlerized, distorted, transmuted, traduced, reduced... infantilized, Americanized, homogenized, sentimentalized, falsified, kitschified, and, in fact, blatantly and arrogantly denied." It has "nonsensically" been described as cheerful and optimistic, even in the face of the fact that Anne, along with other members of the attic community, were targeted for murder and that, one month before liberation, Anne and her sister Margot died as prisoners in the unimaginable horror of Bergen Belsen, a camp so lice-ridden and disease-infested that it was burned to ashes by the British rather than cleansed, disinfected, or rehabilitated.Ozick tracks the controversy centered on the transformation of Anne's diary into the Americanized, christianized, perky Junior Miss that American audiences would accept, including the fabrication of lines that rendered the targeting of the Jews as one victim among many: "We're not the only people that've had to suffer" instead of Anne's more thoughtful and complex—and potentially problematic—"In the eyes of the world, we're doomed.... Who knows, maybe our religion will teach... (shrink)

Genome editing is revolutionising the field of genetics, which includes novel applications to food animals. Responsible research and innovation has been advocated as a way of ensuring that a wider-range of stakeholders and publics are able to engage with new and emerging technologies to inform decision making from their perspectives and values. We posit that genome editing is now proceeding at such a fast rate, and in so many different directions, such as to overwhelm attempts to achieving a more reflective (...) pace. An alternative location for reflection is during the much slower process of taking products from the lab to market. We suggest emphasising Responsible Innovation, putting the ‘I’ back into RRI, and encouraging companies to embrace an RRI approach. We review some previous attempts at developing industry-relevant frameworks for RRI. We then describe two examples of genome editing in livestock; hornless cattle and disease resistant pigs, and reflect on the sorts of questions that could be considered in these two genome editing examples. This paper seeks to take forward the discussion on RRI by extending it to bringing products to market in the context of genome edited livestock. (shrink)

The possible future use of lethal autonomous weapons systems (LAWS) and the challenges associated with assigning moral responsibility leads to several debates. Some authors argue that the highly autonomous capability of such systems may lead to a so-called responsibility gap in situations where LAWS cause serious violations of international humanitarian law. One proposed solution is the doctrine of command responsibility. Despite the doctrine’s original development to govern human interactions on the battlefield, it is worth considering whether the doctrine of command (...) responsibility could provide a solution by applying the notion analogously to LAWS. A fundamental condition underpinning the doctrine’s application is the control requirement, stipulating that a superior must exert some degree of control over subordinates. The aim of this article is to provide an in-depth analysis of this control condition and assess whether it leads to the impossibility of applying the doctrine of command responsibility to LAWS. To this end, the first section briefly introduces the topic of LAWS and responsibility gaps. The subsequent section provides a concise overview of the doctrine itself and the conditions typically necessitated for its application. In the third section, a comprehensive scrutiny of the control requirement is undertaken through examination of key case law, examining how the concept has been interpreted. Finally, the fourth section delves into the evaluation of commanders’ potential to exert effective control over their (non-human) subordinates. Based on this, the feasibility of considering command responsibility as a viable solution is assessed, aiming to determine whether its application should be prima facie excluded or warrants further exploration. (shrink)

These essays from a variety of authors address issues of sexuality in modern lives, including the roles of men and women, friendship, the single life, temporary relationships, and marriage.

Inspired by the work of prominent University of Notre Dame political philosophers Catherine Zuckert and Michael Zuckert, this volume of essays explores the concept of natural right in the history of political philosophy. The central organizing principle of the collection is the examination of the idea of natural justice, identified in the classical period with natural right and in modernity with the concept of individual natural rights. Contributors examine the concept of natural right and rights in all the manifold and (...) interdisciplinary dimensions associated with the Zuckerts’ oeuvre. Part I explores the theme of natural right in the ancient and medieval political philosophy of Plato, Xenophon, Aristotle, and St. Augustine. Part II examines the early modern break from the classical tradition in the work of Montaigne, Spinoza, Montesquieu, Locke, and Hegel as well as the legacy of the modern natural rights tradition as explored by Leo Strauss and Pope John Paul II. Part III treats the theme of natural rights from the Puritans through the Founding period in such figures as Thomas Jefferson and Gouverneur Morris and up to the Progressive era with Booker T. Washington and Theodore Roosevelt. Part IV addresses questions of natural justice in literature, including works of Euripides, Cervantes, Shakespeare, Edith Wharton, and Tom Stoppard. "In this collection compiled in honor of Catherine and Michael Zuckert, the contributors address a wonderful variety of serious issues in important literary and philosophic texts. Their topics range from Plato on piety to Stoppard on socialist utopianism, and from Aristotle and Augustine to Euripides, Locke, Hegel, Shakespeare, and Booker T. Washington. The volume stands as an impressive introduction to the liberal arts and a lively introduction to many great issues of liberalism, Christianity, justice, and liberty; it is also a tribute to the Zuckerts' breadth of study, teaching, and influence." —_Robert K. Faulkner, Boston College_. (shrink)

I consider a grand, yet neglected proposal put forward by Shoemaker—a functionalist theory of all properties. I argue that two possible ways of developing this proposal meet with substantial objections. However, if we are prepared to endorse an ontology of tropes, one of these functionalist analyses can be developed into an original and informative theory of properties.

Despite establishing the gendered construction of infertility, most research on the subject has not examined how individuals with such reproductive difficulty negotiate their own sense of gender. I explore this gap through 58 interviews with women who are medically infertile and involuntarily childless. In studying how women achieve their gender, I reveal the importance of the body to such construction. For the participants, there is not just a motherhood mandate in the United States, but a fertility mandate—women are not just (...) supposed to mother, they are supposed to procreate. Given this understanding, participants maintain their gender by denying their infertile status. They do so through reliance on essentialist notions, using their bodies as a means of constructing a gendered sense of self. Using the tenets of transgender theory, this study not only informs our understanding of infertility, but also our broader understanding of the relationship between gender, identity, and the body, exposing how individuals negotiate their gender through physical as well as institutional and social constraints. (shrink)

Enduring disparities in choice of college major constitute one of the most significant forms of gender inequality among undergraduate students. The existing literature generally equates major choice with career choice and overlooks possible variation across student populations. This is a significant limitation because gender differences in major choice among liberal arts students, who attend college less for specific career training and more for broader learning objectives, are just as great as among those choosing pre-professional majors. This study addresses this gap (...) by examining how privileged men and women at an elite, liberal arts university select their fields of study. Drawing on in-depth interviews, findings contradict the prevailing assumption of a unitary model of major choice as career choice by revealing a plurality of gendered meanings around choosing a field of study. Majors may play an important part in the construction of an intellectual identity as much as a means of career preparation. How students approach the choice relates to both gender and social background. For privileged students, traditional gendered associations with bodies of knowledge hold salience in their decision making as well as expectations of reproducing future elite family roles. This research also illuminates how gendered processes of choosing fields of study take place in relationship to particular institutional contexts. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)