Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

Karl Popper suggested that the utilitarian formula "Maximise happiness" should be replaced by the formula "Minimize suffering" - a view which has been called "negative utilitarianism". Can such a view be spelled out in a plausible way? Examining several ways of understanding the alleged ethical priority of pain over pleasure, I come to the conclusion that none of them is satisfactory as a basis for a theory of benevolence. However, once we move from hedonistic to preference utilitarianism two possible views (...) emerge which, although not fundamentally different from classical utilitarianism, diverge from it in interesting ways and seem to warrant further study. (shrink)

Zusammenfassung: Dieser Artikel nimmt die im Kontext einer vielfach diagnostizierten Renaissance der Stadt erhobene Forderung nach mehr städtischer Autonomie zum Ausgangspunkt, um aus demokratietheoretischer Perspektive der Frage nachzugehen, welche rechtfertigenden Gründe für eine größere städtische Autonomie angeführt werden können. Zu diesem Zweck rekonstruiert der Beitrag normative Leitbilder der demokratischen Stadt, die zugleich Lücken einer allein staatlich verstandenen Demokratiekonzeption verdeutlichen. Es handelt sich bei diesen Leitbildern um das Bild der Stadt als Schule der Demokratie, als urbane Kosmopolis sowie als urbane Allmende. (...) Die untersuchungsleitende These lautet, dass die Stadt ein eigenständiger politischer Handlungsraum ist, an den spezifische demokratische Versprechen geknüpft sind und der spezifische Potenziale für die Verwirklichung einer demokratischen Praxis bietet. Das Erkenntnisinteresse ist zweigeteilt: Einerseits sollen in begrifflicher Perspektive die Leitbilder auf einen spezifisch urbanen Demokratiebegriff hin befragt werden und andererseits gilt es in systematischer Perspektive die zugrundeliegenden Vorstellungen von Gemeinschaft, Partizipation und Mitgliedschaft zu beleuchten und auf ihre demokratietheoretische Anschlussfähigkeit hin zu prüfen. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent (...) that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

Johannes Drerup schlägt für normativ-politische Kontroversen ein Kriterium vor, anhand dessen bestimmt werden soll, wann diese Kontroversen legitime Unterrichtsthemen sind und in Folge dem Kontroversitätsgebot unterliegen. Dies ist dann der Fall, wenn für kontroverse Fragen „auf Basis politischer Grundwerte und -prinzipien, die als konstitutiv gelten können für die Ermöglichung eines guten persönlichen und politischen Lebens in liberal-demokratischen Staaten, keine eindeutige Antwort abgeleitet werden kann.“ Zu diesen Grundwerten und -prinzipien zählt Drerup auch „Grund- und Menschenechte“. Mein kurzer Beitrag möchte zeigen, weshalb (...) Drerups an sich fruchtbarer Ansatz die Komplexität des Maßstabes „Grundund Menschenrechte“ tendenziell unterschätzt und insbesondere das Verhältnis von Demokratie und Menschenrechten zu wenig als potenzielles Spannungsverhältnis ernst nimmt. Ich schlage daher weitere Differenzierungen vor, um Drerups Kriterium konzeptionell zu schärfen. Zudem rege ich an, Kontroversen, die Drerups Kriterium nicht genügen, aus didaktischen Gründen dennoch eine gewisse Anfangs-Kontroversität zuzugestehen, um die Bedeutung der betreffenden Grundprinzipien, die als „rote Linien“ fungieren, deutlicher herausarbeiten zu können. (shrink)

In this study, Tyler Frick aims to display and commend the theological ontology that arises from a careful analysis of Karl Barth's understanding of divine action.

Parfit's Mere Addition Paradox seems to show that we must give up one of three very plausible beliefs about the relative goodness of certain outcomes, which would put a strong damper on our hopes of finding an acceptable theory of benevolence dealing with issues of procreation. I shall argue that such a result can be avoided if we challenge some basic assumptions about moral reasoning which underlie Parfit's argument. An alternative account of the nature of moral reasoning will be given, (...) and a non-standard version of Utilitarianism capable of solving the Paradox will be developed and defended. (shrink)

En su artículo “On Knowing One’s Own Mind” (1988), Shoemaker argumenta en favor de tres afirmaciones: (1) se requiere un autoconocimiento directo (self-acquaintance) para la cooperación racional con otras personas (porque ésta depende de que podamos decirles qué es lo que creemos e intentamos hacer); (2) el autoconocimiento directo es necesario para la deliberación sobre qué creer y qué hacer (porque no podemos ajustar racionalmente creencias y deseos sin saber qué creencias y deseos tenemos); y (3) el autoconocimiento directo es (...) una consecuencia inmediata de nuestra capacidad para reconocer el carácter paradójico de oraciones que ejemplifican la paradoja de Moore. En este capítulo trato de mostrar que las afirmaciones (1) y (2) no son correctas; la cooperación se puede llevar acabo comunicándonos exclusivamente sobre (supuestos) hechos y acciones y el ajuste racional de creencias normalmente sucede de una manera automática a un nivel de primer orden. Sin embargo, la afirmación (3) indica una relación interesante entre nuestras capacidades conceptuales y lingüísticas, por un lado, y, por el otro, nuestra capacidad de “contestar la pregunta de si creo que p poniendo en marcha el proceso (cualquiera que éste sea) mediante el cual respondo a la pregunta de si p” (Evans, 1982: 225). (shrink)

Cet article mobilise la notion d’« approche transactionnelle », empruntée à John Dewey et Arthur Bentley, pour nous inviter à concevoir les images circulant sur nos réseaux électroniques au-delà des représentations dont elles sont porteuses à la surface des écrans. Comprendre leur dynamique implique de prendre en compte les multiples couches dont elles se composent, depuis la matérialité des flux électriques, à travers les strates de langages-machine, les protocoles de transfert ou le design des interfaces. L’image que nous identifions et (...) isolons dans ses traits figuraux apparaît comme un leurre cachant les implications multiples des transactions dont elle résulte – et qu’il faut apprendre à repérer pour en déjouer certaines illusions. (shrink)

In September 2021, Rhodes University’s Environmental Learning Research Centre, together with WITS’s Centre for Researching Education and Labour (REAL), hosted The 24th annual International Associat...

Social enterprises are seen as innovative towards solving societal problems, but little research exists on possible negative aspects, the so‐called dark sides. In this study, the emphasis is on dark sides of social entrepreneurship, how they are managed, and how systems thinking can contribute towards managing these effects. Dark sides of social entrepreneurship can take many forms, like unethical or insincere motives and unintended outcomes like the negative impact on the well‐being of founders and employees, but they are also a (...) call for a critical reflection on the role of the government in society and the economic system social enterprises have to operate in. This paper aims to contribute to the dark side theory of social entrepreneurship by linking system archetypes to themes of dark side thereby stressing how management strategies act as balancing feedback loops to mitigate or prevent dark sides. A qualitative research was conducted by interviewing 21 respondents who play an important role in the world of social entrepreneurship in Belgium. The results show that dark sides of social enterprises manifest itself mostly in the form of trade‐offs and financial, business, and management related issues. Taking over the habits of profit‐oriented companies emerged as a new dark side element. Management strategies include anchoring goals, transparency, obtaining external views, changing the system, and above all reflection. The latter is an important first step to become aware of these issues to be able to change the negative dynamism of these dark sides. (shrink)

Background: Studies from Western countries show that doctors working in neonatal intensive care units find withdrawal of treatment to be their most difficult ethical dilemma. There is less knowledge of how this is experienced in other economic, cultural, religious and educational contexts.Objectives: To explore and describe how Indian doctors experience ethical dilemmas concerning the withdrawal of treatment among critically sick and/or premature neonates.Method: Qualitative data from interviews was analysed according to Giorgi's phenomenological approach. The subjects were 14 doctors with various (...) levels of neonatal experience, recruited from two state‐owned NICUs in India. Main outcome measures: description reflecting the nature of ethical dilemmas and how they are experienced.Results: All doctors reported situations where the question of withdrawal of treatment was experienced as the worst part of their job. They felt that they lacked training in how to handle such dilemmas, and some had never talked about ethics before. They were especially concerned about non‐medical considerations that do not feature in current treatment guidelines. In describing their personal experiences, the informants mentioned their sense of responsibility in situations where they were aware that their decisions would influence a family's economy and reputation, availability of food and education for siblings, other children's access to equipment in the unit, and the use of resources in an underprivileged population. Sometimes lack of resources, usually ventilators, forced them to make decisions about which babies should get the chance to live. Other reported dilemmas included difficulties co‐operating with uneducated and poor parents.Conclusion: While Western doctors seem to focus on the rights and problems of the individual child, Indian doctors tend to refer to consequences for other children, for parents and society. There is a need for further research in this field, and for the development of guidelines on how to cope with differences in resources, and how to handle different patient groups’ cultural and religious concerns. (shrink)

A significant portion of newborns cared for in the neonatal intensive care unit or other ICUs, such as the cardiac ICU, have a medical condition with a genetic component, including congenital malformations, the leading cause of death in the NICU. In many cases, however, it is not clear which condition the child has or what can be done to help him or her. Genomic sequencing of sick newborns has the potential to bypass the prolonged journey to a diagnosis, improving the (...) medical care of individual infants. Sequencing also has the potential to benefit others beyond the child whose genome is sequenced and his or her immediate family. Sequence data from sick newborns will expand medicine's understanding of genetic diseases, leading to improvements in clinicians’ ability to counsel family and to provide even more targeted care. Not only will more frequent use of sequencing lead to discovery of new genes; it will also provide unique insights into the full spectrum of known Mendelian genetic diseases, so‐called phenotypic expansion, when a gene previously recognized as associated with a phenotype is found to be associated with an expanded set of clinical features. Genetic and environmental changes that modify the expression of a genetic disease may also be elucidated. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted (...) by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)

This book argues that human rights cannot go global without going local. This important lesson from the winding debates on universalism and particularism raises intricate questions: what are human rights after all, given the dissent surrounding their foundations, content, and scope? What are legitimate deviances from classical human rights and where should we draw “red lines”? Making a case for balancing conceptual openness and distinctness, this book addresses the key human rights issues of our time and opens up novel spaces (...) for deliberation. It engages philosophical reasoning with law, politics, and religion and demonstrates that a meaningful relativist account of human rights is not only possible, but a sorely needed antidote to dogmatism and polarization. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

This paper provides a defence of a lifetime limit on how much a person can receive in the form of gifts and inheritances, that is, a person's accessions. I argue that any accessions above that limit should be taxed at a rate of 100%. The analysis shows how this proposal can bring into equilibrium the core values and other goals at stake in the design of taxation on inheritances and gifts. To counter the low level of support for inheritance taxation (...) in general, the analysis must include a proposal concerning what will be done with the tax revenues. I propose turning the accession tax revenues into an unconditional citizen's stake that is granted to young adults. Such an institutional design would create additional value by reducing unfair inequalities between age groups. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

The aim of this literature study was to suggest a value ground for nursing anchored in two ethical principles: the principle of human value and the right to experience a meaningful life. Previous nursing research between the years 2000 and 2009 was analysed. Presented values suggested in this value ground are thus in line with the nursing context and science of today. Statements within ethical literature have been used in order to formulate arguments aimed at supporting the values that were (...) found in the study. In the literature study six values were found: trust, nearness, sympathy, support, knowledge and responsibility. These values hold equal status and are not presented in hierarchical order. They vary due to the persons involved, nursing situations and cultural surroundings, but have the common requirement of being non-excluding. In order to implement the values within the value ground, two prerequisites are discussed and claimed as essential: ethical dialogue and a caring encounter between care provider and patients. (shrink)

Many older gay men experience diminished psychological well‐being (PWB) due to unique circumstances including discrimination, living with HIV, and aging through the HIV/AIDS crisis. However, there remains ambiguity as to how older gay men define and understand PWB. Our team interviewed and analyzed the accounts of 26 older (50+) self‐identifying English‐speaking men living in southwestern British Columbia, Canada. We drew on tenets of constructivist grounded theory and intersectionality to account for unique contextual considerations and power relations. Semi‐structured Zoom interviews were (...) conducted from August‐October 2022. Interview transcripts were compared to generate high‐order conceptual findings underpinned by processes understood as central to PWB. Three PWB temporal processes highlighted interlocking social and contextual circumstances intersecting with power and maturation: (1) being emotionally balanced, (2) living gratitude (3) and fully embracing self‐acceptance. Being emotionally balanced supported the affective and sustainable state of contentment, living gratitude drew from the wisdom of accrued experiences to cultivate a positive affective state inclusive to recognising social location privileges, whilst fully embracing self‐acceptance redressed the harms of anti‐gay discourses that men endured throughout their lives. The knowledge is relevant to service and resource development to deliver tailored PWB supports to older gay men. (shrink)

The foundational conviction of contemporary liberal thought is that all persons possess equal moral worth and are entitled to equal concern and respect by others. At the same time, nation states, as the primary organs of our collective self-governance, frequently pursue policies that are strikingly partial towards the interests of compatriots over those of foreigners. A common strategy for justifying this national partiality is to view it as grounded in associative obligations that we incur by standing in special relationships with (...) our fellow citizens. For instance, according to familiar arguments from ‘fair play’, voluntarily partaking in and benefiting from cooperative relationships with our fellow citizens gives us reciprocal obligations to maintain these social institutions and care for needy compatriots. By contrast, we do not have corresponding associative obligations towards foreigners. I maintain that such arguments from associative obligations face an important stumbling block. I argue for the following “Boundary Principle”, according to which we cannot appeal to special relationships amongst members of a group to justify an attitude of partiality towards them unless the boundaries of this group, and the fact that they exclude other persons from membership, can also be justified. If this is right, arguments from associative obligations, by themselves, are necessarily incomplete. Most modern states severely limit the scope of economic migration, and thereby prevent many would-be contributors to the collective enterprises of affluent societies from entering into those special relationships with us that would give rise to associative obligations on our part. Not only are would-be immigrants excluded from the benefits that participation in the cooperative schemes of affluent nation-states would itself confer; in addition, the fact that they do not stand in such cooperative relationships with us is then appealed to in order to justify the fact that we assign significantly less weight to their interests in the formulation of state policy. The upshot of my discussion is not that a defense of national partiality in terms of associative obligations cannot succeed. It is rather that a successful defense of national partiality in these terms is more closely tied to the question whether principled restrictions can be placed on immigration than most political philosophers have hitherto assumed. (shrink)