Ethical notions such as good and bad, are often treated as though they were ?symmetric? in the sense of having the same moral ?weight?, one in a positive the other in a negative sense. I argue that they are in fact ?asymmetric? and that the negative members of such pairs of notions are more fundamental and definite, logically speaking, and operationally more important than the positive members. Detailed arguments are given to show this for some non?moral notions, such as life (...) and death, health and illness; some semi?moral notions such as pleasure and pain; and finally for the moral notions of happiness, benevolence, right, and good and their negative counterparts. One of the intentions of the article is to show that a systematic view of such asymmetries may have consequences for one's view of the proper or desirable structure of a general theory of ethics: norms stating prohibitions and norms stating permissions will be seen to be, in a sense defined in the text, more fundamental and important than norms stating ('positive') obligations. (shrink)

_Etter revisjonen av bioteknologiloven i mai 2020, ble eggdonasjon på norsk et faktum. I kjølvannet av «bioteknologiforliket» – en koalisjon mellom Ap, Frp og SV som sikret stortingsflertall for endringene i loven – skulle kompensasjonsstørrelsen fastsettes for kvinner som ønsker å donere bort egg. Det ble av den grunn holdt en høring om retningslinjene for donasjon av egg, herunder alternativer for hvor mye donor bør kompenseres økonomisk. I denne artikkelen har jeg analysert høringsutkastet, høringssvarene og de endelige retningslinjene for kompensasjon (...) av eggdonasjon. Hensikten med studien var å undersøke de ulike argumentene i den norske debatten om økonomisk kompensasjon for donasjon av egg. Tre gjennomgående temaer ble identifisert i høringsdokumentene: motivasjonens form og innhold, rettferdighet og donorbutikk. Et sentralt funn i høringen var en gjennomgående bekymring for økonomisk motivert donasjon. Samtidig var det bred enighet om at eggdonasjoner skulle være altruistiske. Altruisme ble forstått som et fravær av økonomisk motivasjon hos donoren, men uten at andre ikke-altruistiske motiver ble problematisert eller at forutsetningene for altruisme ble videre diskutert. Analysen viste også hvordan lignende argumenter ble vinklet ulikt for å kunne understøtte både en høyere og lavere kompensasjon. For eksempel endte en vektlegging av kvinners rettigheter i noen høringssvar opp som et forsvar for det høyeste forslaget til kompensasjon, mens i andre høringssvar ble den brukt som argument for et forbud mot enhver kompensasjon. Samlet sett gir denne studien innblikk i mangfoldet av argumenter som er blitt brukt i den norske debatten om økonomisk kompensasjon for eggdonasjon, og den viser viktigheten av å definere begrepene som brukes – som altruisme, frivillighet og økonomisk motivasjon – for å få bedre frem både enighetene og uenighetene mellom partene i debatten._ _Nøkkelord:_ altruisme, bioteknologi, eggcelledonasjon, godtgjørelse, motivasjon _English abstract_ After the revision of the Biotechnology Act in May 2020, egg donation in Norwegian became a fact. In the wake of the "biotechnology agreement" – a coalition between Ap, Frp and SV that secured a parliamentary majority for the changes in the law – the amount of compensation was to be determined for women who wish to donate eggs. A hearing was therefore held on the guidelines for egg donation, including options for how much the donor should be financially compensated. In this article, I have analyzed the consultation draft, the consultation responses and the final guidelines for compensation for egg donation. The purpose of the study was to examine the various arguments in the Norwegian debate about financial compensation for egg donation. Three consistent themes were identified in the consultation documents: the form and content of the motivation, justice and donor shop. A key finding in the consultation was a consistent concern about financially motivated donation. At the same time, there was broad agreement that egg donations should be altruistic. Altruism was understood as an absence of financial motivation on the part of the donor, but without other non-altruistic motives being problematized or the prerequisites for altruism being further discussed. The analysis also showed how similar arguments were angled differently in order to support both higher and lower compensation. For example, an emphasis on women's rights in some consultation responses ended up as a defense for the highest proposal for compensation, while in other consultation responses it was used as an argument for a ban on any compensation. Overall, this study provides an insight into the diversity of arguments that have been used in the Norwegian debate on financial compensation for egg donation, and it shows the importance of defining the terms used _–_ such as altruism, volunteering and financial motivation _–_ in order to better bring out both the agreements and the disagreements between the parties in the debate. _Keywords:_ altruism, biotechnology, egg cell donation, remuneration, motivation. (shrink)

The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin’s distinction between an “ethics of strangers” and an “ethics of intimacy”, can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an “ethics of intimacy”) and situations where HCP do not know their patients (corresponding to “an ethics of strangers”). Does it (...) make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by “knowing the patient”, we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics. (shrink)

The issue of "forbidden knowledge" is as old as the second chapter of Genesis. Now, after an interlude of "value-free science," the issue has resurfaced in connection with late twentieth-century research and development. In this revival, attention has for the most part been focussed on specific and often controversial cases such as military R&D, medical research on living humans and animals and, more recently, on genetic technology and new reproductive techniques. Undoubtedly, part of the reason for this resurgence is the (...) real or imagined hopes and fears, threats and promises which many now perceive as unavoidably connected with modern science. In general, the effects of the scientific enterprise on human life are now perceived as great, although not very predictable in the short, and, even less in the long run. (shrink)

To investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments.

Luck egalitarianism, a theory of distributive justice, holds that inequalities which arise due to individuals’ imprudent choices must not, as a matter of justice, be neutralized. This article deals with the possible application of luck egalitarianism to the area of health care. It seeks to investigate whether the ethos of luck egalitarianism can be operationalized to the point of informing health care policy without straying from its own ideals. In the transition from theory to practise, luck egalitarianism encounters several difficulties. (...) We argue that the charge of moral arbitrariness can, at least in part, be countered by our provided definition of “imprudent actions” in the health area. We discuss the choice for luck egalitarianism in health care between ex ante and ex post policy approaches, and show how both approaches are flawed by luck egalitarianism’s own standards. We also examine the problem of threshold setting when luck egalitarianism is set to practise in health care. We argue that wherever policy thresholds are set, luck egalitarianism in health care risks pampering the imprudent, abandoning the prudent or, at worst, both. Furthermore, we claim that moves to mitigate these risks in turn diminish the normative importance of the ethos of luck egalitarianism to policy. All in all, our conclusion is that luck egalitarianism cannot be consistently applied as a convincing and relevant normative principle in health care policy. (shrink)

Background The aim of this study was to investigate whether physicians who felt strongly for or against a treatment, in this case a moderately life prolonging non-curative cancer treatment, differed in their estimation of medical indication for this treatment as compared to physicians who had no such sentiment. A further aim was to investigate how the notion of medical indication was conceptualised. Methods A random sample of GPs, oncologists and pulmonologists comprised the study group. Respondents were randomised to receive either (...) version of a case presentation; in one version, the patient had smoked and in the other version she had never smoked. The physicians were labelled value-neutral and value-influenced on the basis of their attitude towards the treatment. Results In the ‘value-influenced’ group, there was a significant difference in the estimation of medical indication for treatment depending upon whether the patient had smoked or never smoked ). There was no such difference in the ‘value-neutral’ group. Conclusion This study shows that compared to value-neutral physicians, value-influenced physicians are more likely to base decisions of medical indication on medically irrelevant factors. Moreover, medical indication is used in an ambiguous manner. Hence, we recommend that the usage of ‘medical indication’ be disciplined. (shrink)

Among the foundations of the sciences and the humanities should be counted the norms and values which they necessarily presuppose. This argument requires us to view science and scholarship (systematic cognitive activity) as deliberate and complex forms of human activity . Human action can be ('rationally') guided and legitimated only by reference to norms and values. It is shown that, historically, there are at least three distinct traditions: (1) The Platonic-Aristotelian, (2) the Baconian, and (3) the Weberian. The first is (...) based on the value of 'self-realization'; the second on welfare as a function of technological control; and the third on the justification of science through the Wertfreiheit of its practitioners. It is then argued that when we add (4), a set of general methodological norms, and (5), the ideal of academic freedom or autonomy, we have before us an 'ideology of cognitive activity' which it is now important to study, historically, critically, and constructively. For some such ideology is as indispensable as internal and external demands for legitimation (of science, etc.) are now both inescapable and justified. (shrink)

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent (...) exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes. (shrink)

BackgroundPatients not attending their appointments without giving notice burden healthcare services. To reduce non-attendance rates, patient non-attendance fees have been introduced in various settings. Although some argue in narrow economic terms that behavioural change as a result of financial incentives is a voluntary transaction, charging patients for non-attendance remains controversial. This paper aims to investigate the controversies of implementing patient non-attendance fees.ObjectiveThe aim was to map out the arguments in the Norwegian public debate concerning the introduction and use of patient (...) non-attendance fees at public outpatient clinics.MethodsPublic consultation documents (2009–2021) were thematically analysed (n=84). We used a preconceived conceptual framework based on the works of Grant to guide the analysis.ResultsA broad range of arguments for and against patient non-attendance fees were identified, here referring to the acceptability of the fees’ purpose, the voluntariness of the responses, the effects on the individual character and institutional norms and the perceived fairness and comparative effectiveness of patient non-attendance fees. Whereas the aim of motivating patients to keep their appointments to avoid poor utilisation of resources and increased waiting times was widely supported, principled and practical arguments against patient non-attendance fees were raised.ConclusionA narrow economic understanding of incentives cannot capture the breadth of arguments for and against patient non-attendance fees. Policy makers may draw on this insight when implementing similar incentive schemes. The study may also contribute to the general debate on ethics and incentives. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well (...) as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

BackgroundSwedish healthcare providers are supposed to be value-neutral when making clinical decisions. Recent conducted studies among Swedish physicians have indicated that the proportion of those whose personal values influence decision-making vary depending on the framing and the nature of the issue.ObjectiveTo examine whether the proportions of value-influenced and value-neutral participants vary depending on the extent to which the intervention is considered controversial.MethodsTo discriminate between value-neutral and value-influenced healthcare providers, we have used the same methods in six vignette based studies including (...) 10 more or less controversial interventions. To be controversial was understood as being an intervention where conscientious objections in healthcare have been proposed or an intervention that is against law and regulations.ResultsEnd of life decisions and female reproduction issues are associated with conscientious objection and more or less against regu... (shrink)

Happiness is typically reported as an important reason for participating in challenging activities like extreme sport. While in the middle of the activity, however, participants do not seem particularly happy. So where does the happiness come from? The article proposes some answers from a study of facially expressed emotions measured moment-by-moment during a backcountry skiing event. Self-reported emotions were also assessed immediately after the skiing. Participants expressed lower levels of happiness while skiing, compared to when stopping for a break. Moment-to-moment (...) and self-reported measures of emotions were largely unrelated. These findings are explained with reference to the Functional Wellbeing Approach ( Vittersø, 2013 ), which argues that some moment-to-moment feelings are non-evaluative in the sense of being generated directly by the difficulty of an activity. By contrast, retrospective emotional feelings are more complex as they include an evaluation of the overall goals and values associated with the activity as a whole. (shrink)

Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be responsible for their children’s obesity, and if so, whether parental responsibility ought to be addressed in the physician–patient/parent encounter. We illustrate how different ideal-typical models of the physician–patient/parent interaction emphasise different understandings of patient autonomy (...) and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents’ role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children’s welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents’ capacities. A deliberative-oriented physician–patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule. (shrink)

This wide-ranging collection of essays contains eighteen original articles by authors representing some of the most important recent work on Wittgenstein. It deals with questions pertaining to both the interpretation and application of Wittgenstein s thought and the editing of his works. Regarding the latter, it also addresses issues concerning scholarly electronic publishing. The collection is accompanied by a comprehensive introduction which lays out the content and arguments of each contribution. Contributors: Knut Erik Tranoy, Lars Hertzberg, Georg Henrik von Wright, (...) Marie McGinn, Cora Diamond, James Conant, David G. Stern, Eike von Savigny, P.M.S. Hacker, Hans-Johann Glock, Allan Janik, Kristof Nyiri, Antonia Soulez, Brian McGuinness, Anthony Kenny, Joachim Schulte, Herbert Hrachovec, Cameron McEwen.". (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

Luck egalitarianism assigns a central role to personal responsibility in egalitarian justice. In the context of healthcare, luck egalitarianism is the view that the distribution of medical and healthcare resources—or common resources in general—should respond to the (im)prudence of individuals. Recently, Joar Björk, Gert Helgesson, and Niklas Juth have argued that it is impractical to use luck egalitarianism as a normative framework in healthcare because it has no reasonable way of dealing with the imprudent. In response to their argument, (...) this paper first suggests that the epistemic problems of applying luck egalitarianism to the healthcare context raised by Björk et al. can be circumvented by using the exemption system as a policy application of luck egalitarian healthcare justice. This paper then shows that an _ex ante_ policy, a tax system with refunds, can reasonably be adopted as a luck egalitarian institutional design of healthcare policy. We argue that the proposed conception of luck egalitarianism can deal with the problem of differential option luck. Finally, we show that the threshold problem for the definition of imprudence does not refute the proposed _ex ante_ policy. (shrink)