The decision-making environment in intensive care units (ICUs) is influenced by the transformation of intensive care medicine, the staffing situation and the increasing importance of patient autonomy. Normative implications of time in intensive care, which affect all three areas, have so far barely been considered. The study explores patterns of decision making concerning the continuation, withdrawal and withholding of therapies in intensive care. A triangulation of qualitative data collection methods was chosen. Data were collected through non-participant observation on a surgical (...) ICU at an academic medical centre followed by semi-structured interviews with nurses and physicians. The transcribed interviews and observation notes were coded and analysed using qualitative content analysis according to Mayring. Three themes related to time emerged regarding the escalation or de-escalation of therapies: influence of time on prognosis, time as a scarce resource and timing in regards to decision making. The study also reveals the ambivalence of time as a norm for decision making. The challenge of dealing with time-related efforts in ICU care results from the tension between the need to wait to optimise patient care, which must be balanced against the significant time pressure which is characteristic of the ICU setting. (shrink)

_In Perception, Empathy, and Judgment_ Arne Johan Vetlesen focuses on the indispensable role of emotion, especially the faculty of empathy, in morality. He contends that moral conduct is severely threatened once empathy is prevented from taking part in an interplay with cognitive faculties in acts of moral perception and judgment. Drawing on developmental psychology, especially British "object relations" theory, to illuminate the nature and functioning of empathy, Vetlesen shows how moral performance is constituted by a sequence involving perception, judgment, (...) and action, with an interplay between the agent's emotional and cognitive faculties occurring at each stage. In the powerful tradition from Kant to present-day theorists such as Kohlberg, Rawls, and Habermas, reason is privileged over feeling and judgment over perception, in such a way that basic philosophical questions remain unasked. Vetlesen focuses our attention on these questions and challenges the long-standing assertion that emotions are damaging to moral response. In the final chapter he relates his argument to recent feminist critiques that have also castigated moral theorists in the Kantian tradition for their refusal to recognize a role for emotion in morality. While the book's argument is philosophical, its method and scope are interdisciplinary. In addition to critiques of such philosophers as Arendt, MacIntyre, and Habermas, it contains discussions of specific historical, ideological, and sociological factors that may cause "numbing"—selective or broad-ranging, pathological insensitivity—in humans. The Nazis' mass killing of Jews is studied to illuminate these and other relevant empirical aspects of large-scale immoral action. (shrink)

This article argues for the notion of the embodied self in reformulating insights in Kierkegaard that point to the existential difference in being embodied. The main arguments are: 1. Kierkegaard uses a Hegelian model: the human mind exteriorizes itself, in history and language, in actions and speech. Human being is being there. 2. This does not make the notions of self and interiority obsolete. On the contrary, in order to understand human exteriority, we need to re-define what a human self (...) is. 3. The crucial point in this re- definition is that self is to be understood as self-relation. Self is to relate oneself to others and to a world in between, and, in these relations, to relate to oneself. 4. Human consciousness is embodied in being embedded in a social, historical and cultural context. A human being relates to itself as being corporeally and temporally determined. 5. Human embodiment, with its intrinsic history, is a matter of concern: how humans take themselves in being embodied. In this there is a critical difference between being present and not being present. Our embodied existence is to be taken over or to be appropriated by ourselves as embodied beings. (shrink)

Ecologically responsible policies are concerned only in part with pollution and resource depletion. There are deeper concerns which touch upon principles of diversity, complexity, autonomy, decentralization, symbiosis, egalitarianism, and classlessness.

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

Contrary to assumptions that changes in brain networks are possible only during crucial periods of development, research in the past decade has supported the idea of a permanently plastic brain. Novel experience, altered afferent input due to environmental changes and learning new skills are now recognized as modulators of brain function and underlying neuroanatomic circuitry. Given findings in experiments with animals and the recent discovery of increases in gray and white matter in the adult human brain as a result of (...) learning, the old concept of cognitive reserve, that is the ability to reinforce brain volume in crucial areas and thus provide a greater threshold for age-dependent deficits, has been reinforced. The challenge we face is to unravel the exact nature of the dynamic structural alterations and, ultimately, to be able to use this knowledge for disease management. Understanding normative changes in brain structure that occur as a result of environmental changes and demands is pivotal to understanding the characteristic ability of the brain to adapt. (shrink)

Background: As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate. Aim and assumptions: This study investigates the individual variations of caring cultures in relation to dignity (...) and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth. Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts. (shrink)

When the social relevance of robotic applications is addressed today, the use of assistive technology in care settings is almost always the first example. So-called care robots are presented as a solution to the nursing crisis, despite doubts about their technological readiness and the lack of concrete usage scenarios in everyday nursing practice. We inquire into this interconnection of social robotics and care. We show how both are made available for each other in three arenas: innovation policy, care organization, and (...) robotic engineering. First, we analyze the discursive “logics” of care robotics within European innovation policy, second, we disclose how care robotics is encountering a historically grown conflict within health care organization, and third we show how care scenarios are being used in robotic engineering. From this diagnosis, we derive a threefold critique of robotics in healthcare, which calls attention to the politics, historicity, and social situatedness of care robotics in elderly care. (shrink)

Recent theoretical and empirical work in cognitive science and neuroscience is brought into contact with the concept of the flow experience. After a brief exposition of brain function, the explicit–implicit distinction is applied to the effortless information processing that is so characteristic of the flow state. The explicit system is associated with the higher cognitive functions of the frontal lobe and medial temporal lobe structures and has evolved to increase cognitive flexibility. In contrast, the implicit system is associated with the (...) skill-based knowledge supported primarily by the basal ganglia and has the advantage of being more efficient. From the analysis of this flexibility/efficiency trade-off emerges a thesis that identifies the flow state as a period during which a highly practiced skill that is represented in the implicit system’s knowledge base is implemented without interference from the explicit system. It is proposed that a necessary prerequisite to the experience of flow is a state of transient hypofrontality that enables the temporary suppression of the analytical and meta-conscious capacities of the explicit system. Examining sensory-motor integration skills that seem to typify flow such as athletic performance, writing, and free-jazz improvisation, the new framework clarifies how this concept relates to creativity and opens new avenues of research. (shrink)

Many consumers implicitly associate sustainability with lower product strength. This so-called ethical = less strong intuition (ELSI) poses a major threat for the success of sustainable products. This article explores this pervasive lay theory and examines whether it is a key barrier for sustainable consumption patterns. Even more importantly, little is known about the underlying mechanisms that might operate differently at the implicit and explicit levels of the consumer’s decision-making. To fill this gap, three studies examine how the implicit judgments (...) that consumers activate automatically shape their consumption behaviors, in concert with their more controlled explicit beliefs about sustainable products. The Main Study investigates the ELSI’s imprint on actual shopping patterns and disentangles the implicit and explicit mechanisms of the lay theory. This paper also asks how this negative influence can be attenuated by examining whether the consumer’s interest in sustainable consumption reduces reliance on the ELSI. Two follow-up studies confirm the robustness from different methodological and practical perspectives. Implications for companies and policy makers are derived. (shrink)

Evil is a poorly understood phenomenon. In this provocative 2005 book, Professor Vetlesen argues that to do evil is to intentionally inflict pain on another human being, against his or her will, and causing serious and foreseeable harm. Vetlesen investigates why and in what sort of circumstances such a desire arises, and how it is channeled, or exploited, into collective evildoing. He argues that such evildoing, pitting whole groups against each other, springs from a combination of character, situation, and social (...) structure. By combining a philosophical approach inspired by Hannah Arendt, a psychological approach inspired by C. Fred Alford and a sociological approach inspired by Zygmunt Bauman, and bringing these to bear on the Holocaust and ethnic cleansing in the former Yugoslavia, Vetlesen shows how closely perpetrators, victims, and bystanders interact, and how aspects of human agency are recognized, denied, and projected by different agents. (shrink)

Besedila je prevedel Arne Kušej. Strokovno redakcijo prevoda je opravil Matjaž Vesel, ki je napisal tudi večino opomb.

Definition of the problem Organizations, being important intermediaries of modern, highly differentiated, and pluralistic societies, are a key place of decision making. This especially applied to health care organizations. Arguments Organizations and their processes are reconceptualized and eminently challenged by digitization and cross-linking in the World Wide Web. Thus, organizational ethics also needs to be reconceptualized. Conclusion The paper provides scenarios of some of the crucial issues of organizational ethics in light of digitization.

We are living in a time of acute vulnerability. From climate change to drone warfare, terrorist attacks to mass shootings, safe spaces to trigger warnings, not to mention the COVID-19 pandemic, homo vulnerabilis is once again coming to terms with the fact that it can be wounded, or even killed. Against such finitude, sovereignty is now reasserting itself as a political power that might save us from our ontological state. The irony is, of course, that such sovereignty – for example (...) through camps, walls, police violence, or drones – is also the underlying, historical cause of many of our most intense contemporary experiences of vulnerabilization. Interrupting the dialectic by which sovereignty manages to be both the cause of our vulnerabilization and the phantasmatic tool of its prevention, in Being Vulnerable Arne De Boever explores how today’s experiences of vulnerabilization can be translated into a collective human power that dismantles the form of sovereignty that is producing this state of affairs. Focused on theories, paradigms, and alternative formations of sovereignty, Being Vulnerable reconsiders the tradition of thinking through a political concept in order to approach it anew. (shrink)

There is an international deep ecology social movement with key terms, slogans, and rhetorical use of language comparable to what we find in other activist “alternative” movements today. Some supporters of the movement partake in academic philosophy and have developed or at least suggested philosophies, “ecosophies,” inspired by the movement. R. A. Watson does not distinguish sufficiently between the movement and the philosophical expressions with academic pretensions. As a result, he falsely concludes that deep ecology implies setting man apart from (...) nature-a kind of “anthropocentrism” in his terminology: humans and only humans have no right to interfere with natural processes. What the deep ecology movement insists on is rather that life on Earth has intrinsic value and that human behavior should and must change drastically-and soon. (shrink)

ZusammenfassungDie Gesundheitsreformen der vergangenen Jahrzehnte haben die Organisation Krankenhaus einem grundlegenden Wandel unterzogen. Neben offenkundig notwendigen und sinnvollen Veränderungen hat es aber auch solche gegeben, die die Frage aufwerfen, welchen gesellschaftlichen Aufgaben das Krankenhaus in Zukunft dienen soll. Pointiert gefragt: Welcher Effektivität soll die seit Jahren betriebene Effizienzsteigerung in der Organisation Krankenhaus dienen außer der Begrenzung eines allgemeinen Kostenanstiegs? Es ergibt sich ein paradoxer Befund: Der Wandel der Organisation Krankenhaus scheint sich maßgeblich der Ökonomisierung zu verdanken, die zugleich das Mittel (...) darstellt, mit dem der Wandel bewältigt werden soll. In diesem Beitrag werden organisations- und institutionstheoretische Entwicklungen auf den Prozess der Ökonomisierung abgebildet und aus einer ethischen Perspektive reflektiert. (shrink)

“Living involves being exposed to pain every second—not necessarily as an insistent reality, but always as a possibility,” writes Arne Vetlesen in A Philosophy of Pain, a thought-provoking look at an inevitable and essential aspect of the human condition. Here, Vetlesen addresses pain in many forms, including the pain inflicted during torture; the pain suffered in disease; the pain accompanying anxiety, grief, and depression; and the pain brought by violence. He examines the dual nature of pain: how we attempt (...) to avoid it as much as possible in our daily lives, and yet conversely, we obtain a thrill from seeking it. Vetlesen’s analysis of pain is revealing, plumbing the very center of many of our most intense and complicated emotions. He looks at pain within different arenas of modern life such as family and work, and he specifically probes at a very common modern phenomenon, the idea of pushing oneself to the limit. Engaging throughout with the ideas of thinkers such as Søren Kierkegaard, Sigmund Freud, Martin Heidegger, Jean-Paul Sartre, Maurice Merleau-Ponty, Max Horkheimer, Theodor Adorno, Alice Miller, Susan Sontag, and Melanie Klein, A Philosophy of Pain asks which came first, thinking or feeling, and explores the concept and possibility of empathy. Vetlesen offers an original and insightful perspective on something that all of us suffer and endure—from a sprained ankle to a broken heart. Although pain is in itself unpleasant, our ability to feel it reminds us that we are alive. (shrink)

Though there exists a vast literature dealing with Hannah Arendt's thoughts on evil in general and Adolf Eichmann in particular, few attempts have been made to assess Arendt's position on evil by tracing its connection with her reflections on conscience. This essay examines the nature and significance of such a connection. Beginning with her doctoral dissertation on St Augustine and ending with her posthumously published studies in The Life of the Mind, Arendt's oeuvre exhibits strong thematic continuity: the triad thinking-conscience-evil (...) forms its most enduring core. A puzzling core, to be sure, considering the controversies triggered, especially regarding her notion of the 'banality of evil'. By placing the role of conscience at the very center of Arendt's lifelong reflections, this essay explores the - in many ways related - influence exerted by St Augustine and Heidegger. Heidegger's conception of conscience in Sein und Zeit is identified as a crucial source for understanding - so the claim holds - why Arendt found Heidegger's philosophy particularly wanting as regards the question of evil. Key Words: Arendt • Augustine • conscience • evil • Heidegger • Socrates • thinking. (shrink)

This paper investigates how participants in cross-functional project groups use a formal work method in their sense making when dealing with the complexity of innovative work, especially in its inventive phase. The empirical basis of the paper is a prospective case study in which three project groups in three different companies are followed as they try to frame and solve their innovation tasks consisting in problems of a relatively general and vague character. The data are analyzed by means of a (...) modified version of the principles of grounded theory. This means that the lessons drawn from the empirical data are guided by a relational sense making perspective in which the formal method used by the participants is seen as a technological artifact. Among the lessons learned by using this frame of reference are that a formal method may be seen as an entity with a meaning depending on the relations it is embedded in; as an enacted cue for interpretation and action; and as a non-human actor. Compared to the tradition of organizational development, these lessons represent an alternative conception of the implementation of a work method and illuminate prevailing notions about the importance of improvisation in innovation. (shrink)

Ours is a literal world. We spend so many words arguing the fundamental truth of a few ancient metaphors that we finally close them to personal meaning. Or we commit our energies to washing every literary form and figure of speech cleanly away to protect our definitions of correctness and to make everyday thinking even safer. But the arguing gives us doctrines. And the purging denies us poetry. And when all the metaphors are gone, we find we've lost the richest (...) ways of knowing. We find we've even narrowed the possibility. Divina is a line of speculative, dimensional, and metaphorical books that will Challenge conventional wisdom, Offer alternative theories, Recreate noumenal experiences, Reach for poetry, and Promise other ways of knowing. The most rewarding reading addresses us personally and challenges what we believe. Divina will bring you books that do just that, chosen and published with the same dedication and editorial sensibility that have established our commitment t literary quality.An ambitious, open-minded inquiry revealing that science itself may be the language of the creator. (shrink)

Excessive fear generalisation is a feature characteristic of clinical anxiety and has been linked to its aetiology. Previous animal studies have shown that the mere passage of time increases fear generalisation and that brief exposure to training cues prior to long-term testing reverses this effect. The current study examined these phenomena in humans. Healthy participants learned the relationship between the presentation of a picture of a neutral male face and the delivery of a mild shock. One group was immediately tested (...) with a novel picture of a somewhat different male face (generalisation test). Another group was tested one week later. A third group was also tested one week later and was additionally exposed to the training picture prior to testing. During picture presentations, shock-expectancy ratings were obtained as a measure of fear. Fear generalisation increased from the immediate test to the 1-week follow-up test. This result could not be attributed to level of neuroticism or a general increase in fear (incubation). Furthermore, the time-dependent increase in fear generalisation vanished following brief exposure to the training picture. Results indicate that human fear generalisation is a temporally dynamic process and that memory for stimulus details can be re-established following a reminder treatment. (shrink)

Big Data and biopolitics are two major issues currently attracting attention in public health discourse, but also in sociology of knowledge, STS Studies as well as in philosophy of science and bioethics. The paper considers big data to be a new form and instrument of biopolitics which addresses both the categories of body and space. It is expected to fundamentally transform health care systems, domestic environments and practices of self-observation and reflection. Accordingly the paper points out some problems and pitfalls (...) as well as open questions that have emerged in the field of AAL, which merit more attention in future public and academic debate. (shrink)

This anthology deals with the changing state of the arts and the incorporation and relevance of the aesthetic dimension in daily life in general. The articles are not restricted to the arts, but emphasis is given to aesthetics at work including art interaction, new aesthetical forms, new aesthetical activities, media and expressions including aesthetical dimensions in current economical and technological development â?? all the aesthetical tendencies that contribute to our world today. The book represents a decisive development in existing theories (...) of art, taking a serious look at the expanding field of aesthetics. The contributors represent aesthetic studies, musicology, art history, literature, and media. Together they have published widely within the aesthetics field and they all take part in the development of an aesthetics program at the University of Oslo. (shrink)

Name der Zeitschrift: Millennium Jahrgang: 14 Heft: 1 Seiten: 191-226.