The authority of surrogates—often close family members—to make treatment decisions for previously capacitated patients is said to come from their knowledge of the patient, which they are to draw on as they exercise substituted judgment on the patient’s behalf. However, proxy accuracy studies call this authority into question, hence the Patient Preference Predictor (PPP). We identify two problems with contemporary understandings of the surrogate’s role. The first is with the assumption that knowledge of the patient entails knowledge of what the (...) patient’s choice of treatment would be. The second is with the assumption that a good decision reproduces the content of that choice. If we are right, then the PPP, helpful though it might be in guiding surrogates’ decisions, nevertheless would hold them to the wrong standards and in that way could add to, rather than relieve, the stress they experience as they try to do their job. (shrink)

Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled (...) conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

Philosophy & Social Criticism, Volume 48, Issue 2, Page 155-163, February 2022. This article comments on Asger Sørensen’s stimulating book “Capitalism, Alienation and Critique”. The article argues that Sørensen overlooks an important methodological contiunuity between Max Horkheimer’s and Axel Honneth’s work: namely, the model of immanent critique, to which both remain committed. Moreover, through a critical discussion of Honneth’s method of normative reconstruction, the article argues that globalized capitalism represents a serious methodological challenge not only to Honneth’s work, but to (...) the Frankfurt School model of immanent crituque as such. (shrink)

ABSTRACTDo physicians have a duty to sustain the pregnancies of women who die during the first or second trimester? Physicians cannot simply assume that the woman would have wished the pregnancy to continue, nor is it clear that the state has any interest in fetal life before viability. The conditions for beneficence‐based duties of fetal rescue will often be unmet, both because sustaining the pregnancy is not always a clear gain to the born child and because it may impose a (...) substantial burden on the benefactor. And duties of special relationship cannot readily be applied in these cases, as it is difficult to see how the relationship between someone who no longer exists and someone who does not yet exist can breed special duties. Further, to draw on Marx's distinction between the architect, who builds purposefully, and the bee, who cannot help what she is doing, I argue that human pregnancy is in a number of respects purposeful, creative, and deliberate, and that postmortem pregnancy, which follows the model of the bee, is a destructive icon that undercuts women's agency. (shrink)

This introduction summarizes the main contributions of this special issue titled “Quiet Politics and the Power of Business: New Perspectives in an Era of Noisy Politics.” The four articles in the issue use and extend Culpepper’s influential concept of “quiet politics” according to which business is able to shape policies and regulations when issues are of low salience to the public and politicians. The issue takes Culpepper’s analysis further in ways that respond to the rise of noisy politics over the (...) last few years, often associated with new strident forms of left- and right-wing populism. Three contributions are made. First, the articles show that salience is not an inherent property of a policy area but is socially constructed. Second, a variety of strategies are described that business uses when trying to keep politics quiet. Third, strategies are affected by the structure of business, which varies across types of capitalism. Future research can use these insights to extend our understanding of the limits, strategies, and dynamics of quiet politics across political economies. (shrink)

This essay takes a close look at a species of care that is particularly needed by people with progressive dementias but that has not been much discussed in the bioethics literature: the activity of holding the person in her or his identity. It presses the claim that close family members have a special responsibility to hold on to the demented person's identity for her or him, and offers some criteria for doing this morally well or badly. Finally, it considers how (...) even those with dementia can hold others in their identities, and suggests that this kind of holding too can have great moral worth. (shrink)

This book explores the social practice of holding each other in our identities, beginning with pregnancy and on through the life span. Lindemann argues that our identities give us our sense of how to act and how to treat others, and that the ways in which we we hold each other in them is of crucial moral importance.

Introducing the main theories of distributional justice the book covers utilitarianism and welfare economics, moving on to Rawls's social contract and the Sen/Nussbaum capability approach with a refreshingly readable style. There is a chapter covering the position of mothers and children in theories of justice. The book then studies empirical methods used in analysing the distribution of economic goods, covering Lorenz curves and inequality measures. The concepts of income, wealth and economic goods are comprehensively discussed, with a particular view to (...) their role in theories of justice. This book is an important read for economists and other social scientists, as well as philosophers who want to quantify social and economic justice. (shrink)

Enthusiasm over technology is found among men. Or, at least, that is the impression we get from the main body of earlier research, which leaves us with an understanding of men as computer enthusiasts, while women are more reluctant and ‘rational’ in their relation to the computer. In this paper I will argue that women do in fact enjoy working with computers. The empirical material is from a study of a group of students taking a computer course. We will meet (...) women who enjoy working with computers, and explore how they express their pleasure in relation to the computer. Contrary to earlier claims that ‘computing is incompatible with being a girl’, we will find that many of the 21 women in this study are not afraid to articulate their pleasure in computing. (shrink)

Natur og menneske.--Hvorfor politiken bliver tilbage.--Om menneskeanlæg og om menneskekunst.--Om store mænd. Et vurderingsforsøg.

Magt og ideal.--Retfærdighet og kultur.--Kapitalisme og kollektivisme.--Nytteværdier og stemningsværdier.--Krig og fred.--Nationalisme og folkebrorskap.

This article identifies and critically examines three differentaspects of investor responsibility. First, investors haveresponsibilities toward their clients. Second, investors are responsible for taking steps toreduce the risk that an investment directly or indirectlycontributes to harm. Finally, investorsshould take into consideration the symbolic and signallingeffects of an investment decision. This article discusses howthese responsibilities should be interpreted and also howthey play out in practice. Norway’s Government PensionFund is used as a case in point.

The present research investigates the role of voluntary, conscious processing in strategy change. In 2 experiments, we address whether the switch to a new strategy is the result of data - driven, automatic processes or of voluntary processes. Experiment 1 demonstrates that participants performing an alphabet verification task are able to transfer a newly adopted strategy to dissimilar information never encountered before, verbally describe the task regularity that allows for the generation and application of the new strategy immediately after the (...) strategy was adopted. Using the same experimental task, Experiment 2 shows that participants, and decide against adopting a new strategy when the available evidence suggests that the new strategy cannot be used for the entire range of problems encountered. Overall, the obtained results support the view that strategy change is mediated by voluntary controlled processing. They do not support the view that strategy change is an inevitable, automatic consequence of task practice. The present research thus highlights a potential function of conscious human processing. (shrink)

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and research context: (...) We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance. (shrink)

Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others (...) view them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

The essays in this volume critically analyze and revitalize agrarian philosophy by tracing its evolution in the classical American philosophy of key figures such as Franklin, Jefferson, Emerson, Thoreau, Dewey, and Royce.

Background In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. Objectives This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. Research design A cross-sectional survey was conducted among care providers who worked (...) in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). Ethical considerations Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. Results Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. Discussion Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. Conclusions The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes. (shrink)

This publication presents a selection of photographic work by Hilde Honerud, made in collaboration with Yoga and Sports with Refugees (YSR) in Lesbos, Greece. It is introduced by a text coauthored with Jon Honerud. In order to engage with the experiences and the vulnerable position of the refugees involved, this project used increasingly apparent formal manipulations to convey an experience beyond the documentary image and to push observers to question the objectivity of images; to move from representation to immediate (...) experience. This entailed a kind of violence to the images that could only be done after spending a long time getting to know the organization and its context. The process raised a number of ethical questions, which we attempt to address in the text accompanying these images. The selection of images published here were part of the exhibition Reality Slipped into a Symbol, at the Vestfold Art Centre, Tonsberg, Norway (9 June–10 July 2022). (shrink)

All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals' responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation (...) of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals' attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance' and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer. (shrink)

In human lives, technology holds sway in mundane and extraordinary ways, such as in the ways we work, entertain, transport, and feed ourselves, and importantly in the ways we encounter and manage health, disease, illness, and death. A significant area of Heidegger's later work is questioning technology. Unlike many current inquiries that centre on contemporary technology's function, utility, and positive transformations, Heidegger offers a radical way of thinking about technology through developing an inquiry that uncovers technology's essence of revealing. In (...) this article, Heidegger's thinking about technological modes of revealing in regard to bodies, health, and illness is explored. In Heidegger's view, the ordered revealing of modern technology has overshadowed other modes of revealing. This article highlights how remembering concealment and unconcealment in its many modes can be relevant to nurses and others involved in health care. Through tracing Heidegger's thinking about technology, a more critical approach to the effects and outcomes of modern technologies within health care systems can be generated. (shrink)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)

If personhood involves the construction of a narrative identity, then what are we to say of someone who is seriously ill or disabled? How can her life have any narrative when she is unable to write one?

The Vlaams Blok is one of the most successful of the extreme right-wing parties in Europe. The growth of the party was partly due to its populist rhetoric on race and security, and its anti-establishment rhetoric.Indeed, over the years, the party has prioritized the immigration issue, which has yielded electoral rewards, and sidelined the Flemish question.Further, the Vlaams Blok has filtered, softened and rewritten strongly-worded ideological texts in order to broaden its electoral appeal, and consolidate its gains.The recent transformation of (...) the Vlaams Blok into Vlaams Belang may be seen as a further step in the party’s attempt to become a right-conservative people’s party.It is another indication of an attempt to get away from the party’s image as being on the extreme of the right wing and the historical legacy of collaboration, and radical Flemish nationalism. (shrink)

We characterize seniority rules, also known as lexical dictatorships, under weak consistency constraints on the group’s choice function. These constraints are base triple-acyclicity in the case of binary choices and rationalizability (although not rationality) in the case of choices between an arbitrary number of alternatives. Existing results on these weakened constraints remain silent on the treatment of the group’s most junior individuals and therefore do not yield a complete characterization of seniority rules. We also impose a universal domain, binary strict (...) Pareto optimality, binary Pareto indifference, binary independence of irrelevant alternatives, and the newly introduced condition of conflict resolution. The latter condition requires a social choice rules not to remain indecisive between alternatives for which individuals have conflicting preferences. (shrink)

We show that Bayesian ex post aggregation is unstable with respect to refinements. Suppose a group of Bayesians use ex post aggregation. Since it is a joint problem, each agent’s problem is captured by the same model, but probabilities and utilities may vary. If they analyze the same situation in more detail, their refined analysis should preserve their preferences among acts. However, ex post aggregation could bring about a preference reversal on the group level. Ex post aggregation thus depends on (...) how much information is used and may keep oscillating (‘‘flipping’’) as one keeps adding more information. (shrink)

This paper works within a model of ungraded belief that characterizes epistemic states as logically closed and consistent sets of sentences. The aim of this paper is to discuss three diachronic coherence conditions for such beliefs. These coherence conditions are formulated in terms of the reasoner's present beliefs about how his present beliefs will evolve in the future, for instance, in response to different pieces of future evidence.

Our research concerns political knowledge among eighteen-year-old pupils in Belgium and the variables that may cause a differential level of political knowledge.The results point out that the average level of political knowledge is really low, though some elementary items score up to 98 %. The studyreveals as the most significant independent variables : the sex, political participation of the parents, mass media, and school. Mass media are most frequently mentioned as the most important sources of political information. Moreover, respondents with (...) a high level of newsmedia exposure do indeed score best. Political education at school shows to have low impact, on the contrary, respondents that mention school as their most important source of political information tend to score worst. (shrink)

Violence is often considered gendered on the basis that it is violence against women. This assumption is evident both in “gender-based violence” interventions in Africa and in the argument that gender is irrelevant if violence is also perpetrated against men. This article examines the relation of partner violence not to biological sex, but to gender as conceptualized in feminist theory. It theorizes the role of gender as an analytical category in dominant social meanings of “wifebeating” in Tanzania by analyzing arguments (...) for and against wife-beating expressed in 27 focus group discussions in the Arumeru and Kigoma-Vijijini districts. The normative ideal of a “good beating” emerges from these data as one that is supported by dominant social norms and cyclically intertwined with “doing gender.” The author shows how the good beating supports, and is in turn supported by, norms that hold people accountable to their sex category. These hegemonic gender norms prescribe the performance of masculinity and femininity, power relations of inequality, and concrete material exploitation of women’s agricultural and domestic labor. The study has implications for policy and practice in interventions against violence, and suggests untapped potential in theoretically informed feminist research for understanding local power relations in the Global South. (shrink)

This chapter contains section titled: Where We've Been Where We're Going Feminist Epistemology Counterstories Acknowledgments Notes References.