The nursing profession has a long history of advocating for social justice and health equity, and both values profoundly infuse nursing ethics, theory, and education. Homecare nursing occurs between the patient's daily life at home and the public health care system. Therefore, homecare nurses ideally possess insight into the living conditions and social determinants of health that their patients experience. This interpretive phenomenological study explores the strategies employed by homecare nurses to fight health inequity and advance social justice. Data were (...) collected through participant observations, situational interviews, and small group interviews with 12 homecare nurses from two municipalities. Three analytical approaches were used: paradigm cases, exemplars, and thematic analysis. The data identified two primary strategies homecare nurses use to circumvent, solve, and mitigate the negative consequences of social determinants of health on patients' care and treatment: “Negotiating practice” and “Aligning practice.” “Negotiating practice” ensures that care and treatment are delivered in a way acceptable to all involved. “Aligning practice” ensures cohesion, progression in the treatment and care trajectory, and support for patients and relatives in navigating the system. Both strategies are part of nurses' largely hidden work, reflecting the nursing profession's position as nested between the individual patient and the system. (shrink)

This article presents a study of how co-present individuals work out the nature of embodied engagement and disengagement displays by individuals with dementia in a Danish public care facility. Research has found that moderate to severe dementia may result, for example, in a lack of social engagement, apathy and problems in maintaining conversations. Research has, however, also found that co-present individuals indicate their right to unavailability for social interaction. This is accomplished through details of embodied and multimodal conduct such as (...) gaze behavior, which includes practices of glancing and gazing at co-present individuals or practices of gazing into space. These practices may coincide with indications of ‘lack of social engagement’ and ‘apathy’. This study falls within the framework of ethnomethodology and employs multimodal conversation analytic methods to show how co-present individuals monitor residents’ displays of engagement and disengagement, primarily gaze behavior and how they respond to them. The study is based on 20 hours of video-recordings. (shrink)

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality (...) of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

A number of philosophers and logicians have argued for the conclusion that maps are logically tractable modes of representation by analyzing them in propositional terms. But in doing so, they have often left what they mean by "propositional" undefined or unjustified. I argue that propositions are characterized by a structure that is digital, universal, asymmetrical, and recursive. There is little positive evidence that maps exhibit these features. Instead, we can better explain their functional structure by taking seriously the observation that (...) maps arrange their constituent elements in a non-hierarchical, holistic structure. This is compatible with the more basic claim advanced by defenders of a propositional analysis: that (many) maps do have formal semantics and logic. (shrink)

Watersheds constitute a special case of multiple-use common pool resources (CPRs). In a textual sense, watersheds tend to be mosaics of privately owned and managed patches of land. At the same time, however, watersheds are also ecosystems in which multiple resources and people interact through an infinity of bio-physical processes. Through such interaction, new watershed-level qualities emerge that, together with other factors, condition watershed users' continued resource use and access. In this perspective, watersheds become common-pool resources. Hence, watershed users do (...) not only manage their individual plots, crops, forests, etc., knowingly or not, they manage landscape patterns and bio-physical processes that transcend their private property. In this context, drawing on experiences gained through participatory action research in a micro-watershed in the Andean hillsides of southern Colombia, this paper describes a process aimed at fostering collective watershed management. The paper illustrates the importance of platforms as a mechanism for negotiating and coordinating collective action by multiple users and discusses the issues of representation on such platforms as well as the importance of third party facilitation. (shrink)

Ten years ago, one of us proposed a dynamic hierarchical model of intentions that brought together philosophical work on intentions and empirical work on motor representations and motor control (Pacherie, 2008). The model distinguished among Distal intentions, Proximal intentions, and Motor intentions operating at different levels of action control (hence the name DPM model). This model specified the representational and functional profiles of each type of intention, as well their local and global dynamics, and the ways in which they interact. (...) A core insight of the model was that action control is the result of integrated, coordinated activity across these levels of intention. Since the proposal of the model, empirical and theoretical works in philosophy and cognitive science have emerged that would seem to support and expand on this central insight. In particular, an updated understanding of the nature of sensorimotor processing and motor representations, as well as of how the different levels of intention and control interface and interact, allows for the further specification and precisification of the original DPM model. (shrink)

I argue that in order to solve the main difficulties confronted by the classical versions of the causal theory of action, it is necessary no just to make room for intentions, considered as irreducible to complexes of beliefs and desires, but also to distinguish among several types of intentions. I present a three-tiered theory of intentions that distinguishes among future-directed intentions, present-directed intentions and motor intentions. I characterize each kind of intention in terms of its functions, its type of content, (...) its dynamics and the rationality and time constraints that bear on it. I then try to show how the difficulties encountered by the causal theory can be solved within this new framework. 1. (shrink)

On a familiar and prima facie plausible view of metaphor, speakers who speak metaphorically say one thing in order to mean another. A variety of theorists have recently challenged this view; they offer criteria for distinguishing what is said from what is merely meant, and argue that these support classifying metaphor within 'what is said'. I consider four such criteria, and argue that when properly understood, they support the traditional classification instead. I conclude by sketching how we might extract a (...) workable notion of 'what is said' from ordinary intuitions about saying. (shrink)

This paper on the phenomenology of joint agency proposes a foray into a little explored territory at the intersection of two very active domains of research: joint action and sense of agency. I explore two ways in which our experience of joint agency may differ from our experience of individual agency. First, the mechanisms of action specification and control involved in joint action are typically more complex than those present in individual actions, since it is crucial for joint action that (...) people coordinate their plans and actions. I discuss the implications that these coordination requirements might have for the strength of the sense of agency an agent may experience for a joint action. Second, engagement in joint action may involve a transformation of agentive identity and a partial or complete shift from a sense of self-agency to a sense of we-agency. I discuss several factors that may contribute to shaping our sense of agentive identity in joint action. (shrink)

We address the controversy in the literature concerning the definition of holobionts and the apparent constraints on their evolution using concepts from community population genetics. The genetics of holobionts, consisting of a host and diverse microbial symbionts, has been neglected in many discussions of the topic, and, where it has been discussed, a gene-centric, species-centric view, based in genomic conflict, has been predominant. Because coevolution takes place between traits or genes in two or more species and not, strictly speaking, between (...) species, it may affect some traits but not others in either host or symbiont. Moreover, when interacting species pairs are embedded in a larger community, indirect ecological effects can alter the expected pairwise dynamics. Mode of symbiont transmission and the degree of host inbreeding both affect the extent of microbial mixing across host lineages and thereby the degree to which selection on one trait of either partner affects other aspects of a holobiont phenotype. We discuss several potential defining criteria for holobionts using community genetics and population genetics models, suggesting their application and limitations. Using community genetics models, we show how conflict between genomes can be self-limiting, while cooperation and mutualism tend to be self-accelerating. It is likely that this bias in the evolutionary dynamics of interaction between hosts and symbionts is an important feature of holobionts. This bias in the evolutionary dynamic could contribute to explaining the absence of cheaters from natural mutualisms, although cheaters are predicted by gene-centered conflict theory to cause the evolutionary instability of mutualisms. Additionally, it may help explain the more frequent origin of mutualisms from parasitic than from free-living systems, an evolutionary trajectory opposite to that predicted by genome conflict theory. (shrink)

In Stoic physics, blending (κρᾶσις) is the relation between active pneuma and passive matter; natural bodies from rocks and logs to plants, animals and the cosmos itself are blends of pneuma and matter. Blending structures the Stoic cosmos. I develop a new interpretation of the Stoic theory of blending, based on passages from Hierocles. The theory of blending, I argue, has been misunderstood. Hierocles allows us to see in detail how the theory is supposed to work and how it fits (...) into Stoic physics. (shrink)

In recent literature, it has been suggested that Lange’s social and political philosophy is separate from his neo-Kantian program. Prima facie, this interpretation makes sense given that Lange argues for an account of social norms that builds on Darwin and Smith rather than on Kant. Still, this paper argues that elements of psychophysiological transcendentalism can be found in Lange’s social and political philosophy. A detailed examination of the second edition of the History of Materialism, Schiller’s Poems, and the second edition (...) of The Worker’s Question reveals that Lange sought to develop a systematic foundation of psychophysiological transcendentalism that is presupposed in his social and political philosophy. This allows for a more detailed understanding of Lange’s practical philosophy and assures him a position in the tradition of neo-Kantian socialism. (shrink)

According to the Stoics, ordinary unified bodies—animals, plants, and inanimate natural bodies—each have a single cause of unity and being: pneuma. Pneuma itself has no distinct cause of unity; on the contrary, it acts as a cause of unity and being for itself. In this paper, I show how pneuma is supposed to be able to unify itself and other bodies in virtue of its characteristic tensile motion (τονικὴ κίνησις). Thus, we will see how the Stoics could have hoped to (...) account for corporeal unity by positing another body (pneuma) apparently itself in need of unification. (shrink)

Zusammenfassung Das German Diagnosis Related Groups (G-DRG)-System hat zu einem weitgehend erlösorientierten Krankenhausfinanzierungssystem geführt. Im vorliegenden Beitrag werden die ethischen Implikationen und Folgen dieses Systems am Beispiel rekonstruktiver Maßnahmen (Defektversorgung) bei Patient*innen mit Mundhöhlenkarzinomen herausgearbeitet. Dabei gilt es zugleich, das Wechselspiel von G‑DRG-System und Leitlinienentwicklung zu beleuchten. Vorangestellt werden einführende Angaben zum Mundhöhlenkarzinom und den bestehenden Behandlungsoptionen: konventionelle Rekonstruktionstechnik versus kostenintensive High-End-Chirurgie. Methodische Grundlage und argumentativer Bezugspunkt der Arbeit ist das theoretische Fallszenario „Versorgung mittelgroßer Defekte nach Tumorresektion“. Das G‑DRG-System und (...) die dadurch geschaffenen ökonomischen Anreize haben weitreichende ethische Implikationen in der bedarfsorientierten Behandlung von Patient*innen und führen zu mehrdimensionalen Wechselwirkungen. Die bestehende Tendenz zur High-End-Chirurgie birgt das Risiko der Über- und Fehlversorgung und läuft demnach den Prinzipien Benefizienz und Nonmalefizienz zuwider. Die einseitige Indikationsstellung zugunsten der High-End-Chirurgie lässt zudem auf eine direktive Patientenaufklärung schließen (Verstoß gegen das Prinzip des Respekts der Patientenautonomie). Kostspielige High-End-Verfahren konterkarieren überdies das Wirtschaftlichkeitsgebot und berühren somit zugleich Fragen der Verteilungsgerechtigkeit. Schließlich wirkt die klinische Bevorzugung von High-End-Verfahren auch auf die innermedizinische Logik, namentlich auf die Publikationslandschaft (publication bias), die Ausgestaltung der betreffenden Leitlinien sowie auf die chirurgische Expertise. Zu fordern ist eine Sensibilisierung aller in der Chirurgie tätigen Akteur*innen (Chirurg*innen; Leitlinienexpert*innen, Gutachter*innen). (shrink)

In this article, I offer a literary-critical reading of Modernity and the Holocaust, arguing that Bauman’s non-Hobbesian ethics is linked to a form of Orphic authorship. I contextualize this reading with a study of three literary authors: W.G. Sebald, Peter Weiss and Janina Bauman, and their respective versions of this post-Holocaust authorship. At stake is the drama of the forbidden gaze, the moment when Orpheus turns to look at Eurydice, killing her a second time. Using Levinas’ ethics and his scenario (...) of recognition, Bauman re-writes this fateful gaze as a loving gaze, implicitly proposing a counter-model to the Schmittian gaze — always ready to recognize the enemy, always ready to kill. (shrink)

This volume contains the English translation of Felix Kaufmann's (1895-1945) main work Methodenlehre der Sozialwissenschaften (1936). In this book, Kaufmann develops a general theory of knowledge of the social sciences in his role as a cross-border commuter between Husserl's phenomenology, Kelsen's pure theory of law and the logical positivism of the Vienna Circle. This multilayered inquiry connects the value-oriented reflections of a general philosophy of science with the specificity of the methods and theories of the social sciences, as opposed to (...) abstract natural science and psychology. The core focus of the study is the attempt to elucidate how and under what conditions scientific knowledge about social facts, empirically justified and theoretically embedded, can be obtained. The empirical basis of knowledge within the social sciences forms a phenomenological concept of experience. According to Kaufmann, this concept of experience exhibits a complex structure. Within the meaning-interpretation of human action as the core of knowledge in the social sciences, this structure reaches out across the isolated act of verification toward the synthesis of external and internal experiences. The book opens with a detailed and useful introduction by Ingeborg K. Helling, which introduces the historical and theoretical background of Kaufmann's study and specifically illuminates his relation to Alfred Schütz and John Dewey. Finally, it contains interviews with and letters to members of his family, colleagues and students. (shrink)

This paper considers what function—if any—colocation of bodies may have in the Stoic theory of blending (κρᾶσις), by examining (1) whether colocation is part of the definition of what blending is; and (2) whether colocation is posited by the Stoics as a requirement necessary for the definition to be satisfied. I reconstruct the standard, Chrysippean definition of blending, and I show that the answer to (1) is ‘no’; further, I argue that the evidence gives no reason to affirm (2). Thus, (...) it appears that colocation does not have a central function in the Stoic theory of blending. (shrink)

Cassirer’s view on ethical objectivity is puzzling. In his scarce comments on Kantian ethics, he defines the “pure will” as a “function of consciousness,” which he considers a prerequisite for the possibility of objective ethical normativity embedded in empirical reality. In the existing body of literature, we find two different interpretations of Cassirer’s account of ethical objectivity. The “meta-philosophical” interpretation takes objectivity as a telos that humanity gradually approaches, thereby emphasizing the historically relative truth standards to which the teleologically-evolving symbolic (...) forms respond. The “Kantian” interpretation takes objectivity as a concept inherent to the conduct of the moral law, highlighting the evaluative and prescriptive aspects of his philosophical method. In this paper, I defend the thesis that, by interpreting Cassirer’s ethics through the lens of Hermann Cohen’s mature ethical theory, we can see that ethical deliberation in Cassirer involves a notion of universality that is a priori and depends on a substantiated concept susceptible to change. The proposed “contingent conception of universality” thesis accounts for both: the evaluative and teleological features of Cassirer’s ethical theory, grounding an a priori account of ethical objectivity conceptualized relative to contingent truth standards that gradually improve. (shrink)

This paper challenges the hitherto common distinction between Hermann Cohen’s early phase of Völkerpsychologie and his later phase as a critical idealist. Recently, it has been claimed that Cohen’s turn was not a rapid conversion but a development that was already inherent to his early view. This paper argues that even in Cohen’s mature critical idealism, a thin basis of Völkerpsychologie continues to exist. Cohen’s critical programme is presented as having a twofold aim: On the one hand, it strives to (...) give an account of pure, formal, and logical laws that regulate critical thinking; on the other hand, it offers a reading of Kant’s dualism between matter and form that allows critical thinking to be seen as inevitably embedded in causal laws of psychology, history, and physiology. Concerning the latter, the paper argues that Cohen remained in the tradition of Völkerpsychologie in his mature ethical thought. (shrink)

Two main approaches can be discerned in the literature on agentive self-awareness: a top-down approach, according to which agentive self-awareness is fundamentally holistic in nature and involves the operations of a central-systems narrator, and a bottom-up approach that sees agentive self-awareness as produced by lowlevel processes grounded in the very machinery responsible for motor production and control. Neither approach is entirely satisfactory if taken in isolation; however, the question of whether their combination would yield a full account of agentive self-awareness (...) remains very much open. In this paper, I contrast two disorders affecting the control of voluntary action: the anarchic hand syndrome and utilization behavior. Although in both conditions patients fail to inhibit actions that are elicited by objects in the environment but inappropriate with respect to the wider context, these actions are experienced in radically different ways by the two groups of patients. I discuss how top-down and bottom-up processes involved in the generation of agentive self-awareness would have to be related in order to account for these differences. (shrink)

Texts about theory in nursing often refer to theory construction by using inductive methods in a rigid way. In this paper, it is instead argued that theories are created, which is in line with most philosophers of science. Theory creation is regarded as a creative process that does not follow a specific method or logic. As in any creative endeavour, the inspiration for theory creation can come from many sources, including previous research and existing theory. The main idea put forward (...) is that deductive qualitative research approaches should play a key role in theory creation. Furthermore, there is a need to differentiate between theory creation and theory justification. A model that emphasizes the creative aspects of theory creation and theory justification using qualitative approaches is presented. The model suggests that knowledge development is a deductive trial‐and‐error process where theory creation is followed by testing. Scientific theory creation and justification are presented as an iterative process that is deductive in that a testable hypothesis is derived from the theory. If the hypothesis is falsified, then the theory needs modification or might be altogether wrong. Several factors can block the creative process, both in theory development and in finding ways to test a theory in the justification phase. Some of these blockers are the idea of ‘building blocks’ and the inductive view of science often brought forward in nursing. Other blockers include striving for consensus and adherence to existing nursing philosophies and existing theories. Research and knowledge development are creative processes, and following predefined methods is not enough to ensure scientific rigour in qualitative nursing research. (shrink)

Ernie Lepore and Herman Cappelen (2005) argue that contextual influences on semantic content are much more restricted than most theorists assume, by presenting three tests for semantic context-sensitivity and concluding that only a very restricted class of expressions pass them. They combine this extreme semantic minimalism with an even more extreme speech-act pluralism, according to which a speaker has said anything that she can be reported as having said. I argue that because Lepore and Cappelen refuse to distinguish what is (...) said from what is claimed, their tests wrongly classify metaphor as semantically context-sensitive. I then argue that our ordinary linguistic practices support a distinction between what is said and what is claimed, and that underwrites a much more moderate form of speech act pluralism. (shrink)

This paper is concerned with the possibility of an objectivism for aesthetic judgements capable of incorporating certain ‘subjectivist’ elements of aesthetic experience. The discussion focuses primarily on a desired cognitivism for aesthetic judgements, rather than on any putative realism of aesthetic properties. Two cognitivist theories of aesthetic judgements are discussed, one subjectivist, the other objectivist. It is argued that whilst the subjectivist theory relies too heavily upon analogies with secondary qualities, the objectivist account, which allows for some such analogies at (...) the epistemological level, is too quick to ground aesthetic judgements in perceptual experiences alone. Further, it is held that aesthetic justification can, contra the objectivist theory under scrutiny, be based on an appeal to generally available justifying reasons without overthrowing the non-inferential character of aesthetic judgements. This possibility relies on a clearly established delineation between (i) aesthetic perception and aesthetic judgement, (ii) justifying reasons and explaining reasons, and (iii) judgement-making and judgement-justification. (shrink)

The Standard Progressive Matrices test was standardized in Estonia on a representative sample of 4874 schoolchildren aged from 7 to 19 years. When the IQ of Estonian children was expressed in relation to British and Icelandic norms, both demonstrated a similar sigmoid relationship. The youngest Estonian group scored higher than the British and Icelandic norms: after first grade, the score fell below 100 and remained lower until age 12, and after that age it increased above the mean level of these (...) two comparison countries. The difference between the junior school children and the secondary school children may be due to schooling, sampling error or different trajectories of intellectual maturation in different populations. Systematic differences in the growth pattern suggest that the development of intellectual capacities proceeds at different rates and the maturation process can take longer in some populations than in others. (shrink)

The aim of the present study was, by means of discussion highlighting ethical questions and moral reasonings, to increase understanding of the situations of caregivers and relatives of older persons living in a public nursing home in Sweden. The findings show that these circumstances can be better understood by considering two different perspectives: an individual perspective, which focuses on the direct contact that occurs among older people, caregivers and relatives; and a societal perspective, which focuses on the norms, values, rules (...) and laws that govern a society. Relatives and caregivers thought that the politicians were sending out mixed messages: they were praising caregivers and relatives for their efforts, but at the same time the public health care sector was subjected to significant cutbacks in resources. Both caregivers and relatives were dissatisfied and frustrated with the present situation regarding the care of older persons in public nursing homes. (shrink)

In “Games and the Art of Agency,” Thi Nguyen argues that games both highlight and foster a profound complexity in human motivation, in the form of “purposeful and managed agential disunity.” I agree that human agency is “fluid and fleeting” rather than stable and unified; but I argue that Nguyen’s analysis itself relies on a traditional conception of selves as enduring goal-driven agents which his discussion calls into question. Without this conception, games look more like life, and both look riskier, (...) than we might otherwise hope. (shrink)

This paper offers a critical discussion of Searle's account of collective intentionality. It argues Bratman's alternative account avoids some of the shortcomings of Searle's account, over-intellectualizes collective intentionality and imposes an excessive cognitive burden on participating agents.Tthe capacities needed to sustain collective intentionality are examined in an attempt to show that we can preserve the gist of Bratman's account in a cognitively more parsimonious way.

Topics in Cognitive Science, Volume 14, Issue 1, Page 78-92, January 2022.

The paper discusses the role affective factors may play in explaining why, in Capgras'delusion, the delusional belief once formed is maintained and argues that there is an important link between the modularity of the relevant emotional system and the persistence of the delusional belief.