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)

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)

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)

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.

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 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.

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)

A ground-breaking volume of all new essays covering the conjunction of two topics--feminism and families--that, for all their centrality in our culture, have not been adequately examined in light of one another. While the family has suffered feminist neglect, most women _are_ in fact members of families, living their lives within the social context of families, even at a time when the concept of "family" has become bewilderingly unstable. The intersection of families and feminism is thus one in need of (...) philosophical reflection, as a basis both for good public policy and for the ethical relationships of intimate life. (shrink)

: The feminist ethic of care has often been criticized for its inability to address four problems--the problem of exploitation as it threatens care givers, the problem of sustaining care-giver integrity, the dangers of conceiving the mother-child dyad normatively as a paradigm for human relationships, and the problem of securing social justice on a broad scale among relative strangers. We argue that there are resources within the ethic of care for addressing each of these problems, and we sketch strategies for (...) developing the ethic more fully. (shrink)

I re-examine Coherence Arguments (Dutch Book Arguments, No Arbitrage Arguments) for diachronic constraints on Bayesian reasoning. I suggest to replace the usual game–theoretic coherence condition with a new decision–theoretic condition ('Diachronic Sure Thing Principle'). The new condition meets a large part of the standard objections against the Coherence Argument and frees it, in particular, from a commitment to additive utilities. It also facilitates the proof of the Converse Dutch Book Theorem. I first apply the improved Coherence Argument to van Fraassen's (...) (1984) Reflection principle. I then point out the failure of a Coherence Argument that is intended to support Conditionalization as a naive, universal, update rule. I also point out that Reflection is incompatible with the universal use of Conditionalization thus interpreted. The Coherence Argument therefore defeats the naive view on Bayesian learning that it was originally designed to justify. (shrink)

Daniel Brudney's clear-headed analysis, in this issue of the Hastings Center Report, of the difference between a patient's and a surrogate's right to make medical treatment decisions contributes to a longstanding conversation in bioethics. Brudney offers an epistemological and a moral argument for the patient's and the surrogate's right to decide. The epistemological argument is the same for both parties: the patient has a right to decide because she is presumed to know her own interests better than anyone else, and (...) the surrogate is entitled to make decisions because she knows the patient better than anyone else. However, argues Brudney, the moral arguments are not parallel. The patient's moral right to decide for herself is an exercise of autonomy, but the only ground for the responsibility held by the surrogate, says Brudney, is that she knows the patient better than the health care professionals do. If in fact that's not the case, then she forfeits her right to be the patient's surrogate. For all the clarity and force of his argument, I think Brudney may be barking up the wrong tree. In cases of proxy decision-making, it's intimacy, not knowledge, that does the heavy moral lifting. (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)

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?

Consider a group of people whose preferences satisfy the axioms of one of the current versions of utility theory, such as von Neumann-Morgenstern (1944), Savage (1954), or Bolker-Jeffrey (1965). There are political and economic contexts in which it is of interest to find ways of aggregating these individual preferences into a group preference ranking. The question then arises of whether methods of aggregation exist in which the group’s preferences also satisfy the axioms of the chosen utility theory, and in which (...) at the same time the aggregation process satisfies certain plausible conditions (e.g., the Pareto conditions below). (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.

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)

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)

Este texto se centra en la génesis de las ciencias sociales a través de una reflexión analítico- descriptiva sobre la sistematización de la ciencia. La ciencia es una creación del ser humano y constituye la mejor herramienta para adquirir conocimientos acerca de su entorno, de sí mismo, del universo... Debe ser interdisciplinaria y para dar soporte a este empeño, hemos tenido que elegir, y hemos optado por comparar la sociología con la filosofía buscando aportaciones (implícitas o explícitas) de prestigiosos pensadores.

Professor Margolis indicates that the problem of the identity of a work of art is a difficult one to resolve. Shall we locate the "work of art" associated with a musical composition in the score or in a performance; and, if the latter, in which particular one? Similarly in poetry, shall we identify the work of art with the printed characters upon the page or with an oral rendition of them? If we call an etching a "work of art," are (...) we referring to the copper plate or to one or more of the prints drawn from it? Some philosophers claim that the "work of art" is none of these; that, in fact, it is not a material object at all, but an experience existing in the mind of the artist and, possibly, in the minds of those whom he has induced to share his experience. (shrink)