Medical doctors are commissioned by the migration authorities and/or border police to assist in decision making about asylum seeker’s requests for residency permits in Sweden. They are asked to: (i) assess the formal written medical opinions made by physicians in support of asylum or humanitarian narratives in the asylum process and/or (ii) to make medical assessments of persons considered for deportation. This arrangement raises questions such as: How is the decision making process carried out? How is medical knowledge used, and (...) who ought to make decisions about medical evidence in the asylum process? Does this approach effect public health overall? There are longstanding concerns that medical assessments to certify whether a person is fit for transport or not, can have a direct, negative impact on persons in need of care and protection. A separate structure of doctors commissioned by the immigration authority seems to raise professional tensions, politicizes medical constructs and contributes to moral disengagement. Empirical data are used to illustrate this discussion with reference to medical issues, medical ethics, public health and legal discourses. I then reflect on key value conflicts using public health ethics theory and conclude with implications for public health ethic theory, policy and practice. (shrink)

There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted (...) Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect. (shrink)

The most recent (Fifth) revision of the Declaration of Helsinki, adopted in October 2000 by the World Medical Association (WMA), reinforces the longstanding prohibition against offering placebo instead of effective therapy. The WMA left no doubt that if a beneficial treatment for a condition has already been recognised, it is unethical to offer placebo in place of such treatment to anyone in a study of the same condition. We have previously drawn attention to the discrepancy between the spirit of the (...) Declaration and the common practice of using placebo controls in randomised trials even if effective treatment exists. Despite the mandates of the Declaration of Helsinki and concern from ethicists and scientists, the US Food and Drug Administration (FDA) continues to demand and defend placebo‐controlled evidence of efficacy and safety for the development of many new pharmaceuticals, even if effective therapy exists. We suggest that the FDA's arguments defending their practice are insufficient to justify medical research that violates the Declaration of Helsinki. (shrink)

The challenges associated with the issue of migration have led to growing conflicts over the distribution of resources and have put the existing legal order in peril. This has also created dilemmas when it comes to matters of religion. These circumstances have called into question the theory of contemporary liberalism in Germany. In order to show this, I will analyze a few representatives of contemporary liberal theory. Among them are the philosophers John Rawls, with his „Theory of Justice“; Ronald Dworkin (...) and his proposal to further develop Rawls’ theory through the creation of an equal starting position; Michael Walzer and his counter to Rawls’ theory found in the book „Spheres of Justice“ in which he presents the idea of a complex equality; as well as Charles Taylor and his theoretical analysis. Based on this analysis, I will present a new concept-proposal of a liberal theory. (shrink)

In October 2013, the Declaration of Helsinki was revised a seventh time in its 50 year history. While it is the most widely accepted set of ethical principles for the protection of patients participating in medical research, the Declaration of Helsinki has also been subject of constant controversy. In particular, its paragraph on the use of placebo controls in clinical trials divides the research community into active-control and placebo orthodox proponents, both continuously demanding revisions of the Declaration of Helsinki in (...) favour of their position. The goal of the present project is to compare the mainly theoretical controversy with regulatory implementation. We distributed a questionnaire to national drug regulatory authorities from different countries to collect information on the authorities’ respective approaches to interpretation and implementation of the Declarations’ placebo paragraph in the conduct of medical research. Our findings suggest that the majority of drug regulatory authorities have established a practice of a middle ground, allowing placebo controls in some instances. Various interpretations of “serious harm” and “methodological reasons” are proposed as well as safeguards to avoid abuse of the option to use placebo-controls. Leaving the placebo paragraph open to various interpretation is a result of the Declaration of Helsinki’s character as a guidance document. With the current version controversy will continue. The Declaration should be continued to be strengthened to enforce the appreciation of conducting medical research with the highest ethical standard. (shrink)

Recent global advances in available technology to prevent mother-to-child HIV transmission necessitate a rethinking of contemporary and previous ethical debates on HIV testing as a means to preventing vertical transmission. In this paper, we will provide an ethical analysis of HIV-testing strategies of pregnant women. First, we argue that provider-initiated opt-out HIV testing seems to be the most effective HIV test strategy. The flip-side of an opt-out strategy is that it may end up as involuntary testing in a clinical setting. (...) We analyse this ethical puzzle from a novel perspective, taking into account the moral importance of certain hypothetical preferences of the child, as well as the moral importance of certain actual preferences of the mother. Finally, we balance the conflicting concerns and try to arrive at an ethically sound solution to this dilemma. Our aim is to introduce a novel perspective from which to analyse testing strategies, and to explore the implications and possible benefits of our proposal. The conclusion from our analysis is that policies that recommend provider-initiated opt-out HIV testing of pregnant mothers, with a risk of becoming involuntary testing in a clinical setting, are acceptable. The rationale behind this is that the increased availability of very effective and inexpensive life-saving drugs makes the ethical problems raised by the possible intrusiveness of HIV testing less important than the child's hypothetical preferences to be born healthy. Health care providers, therefore, have a duty to offer both opt-out HIV testing and available PMTCT (preventing mother-to-child transmission) interventions. (shrink)

Recent health legislation in Norway significantly increases access to specialist care within a legally binding time frame. The paper describes the contents of the new legislation and introduces some of the challenges with proliferations of rights to health care. The paper describes some of the challenges associated with the proliferation of legal rights to health care. It explains the benefits of assessing the new law in the light of a rights framework. It then analyses the problematic aspects of establishing additional (...) priority rules as solutions to rights conflicts. It then defends adequacy criteria for acceptable priority rules when such rules are unavoidable. It finally defends our proposed method and explores concrete applications. (shrink)

BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available (...) knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells. (shrink)

ABSTRACTPeer action coordination has been often studied in terms of its underlying cognitive mechanisms, and little is known about its emotional processes. The aim of the present study was to inves...

It has been assumed that at the whole organismal level, the mitochondrial reactive oxygen species (ROS) production is proportional to the oxygen consumption. Recently, a number of researchers have challenged this assumption, based on the observation that the ROS production per unit oxygen consumed in the resting state of mitochondrial respiration is much higher than that in the active state. Here, we develop a simple model to investigate the validity of the assumption and the challenge of it. The model highlights (...) the significance of the time budget that mitochondria operate in the different respiration states. The model suggests that under three physiologically possible conditions, the difference in ROS production per unit oxygen consumed between the respiration states does not upset the proportionality between the whole animal ROS production and oxygen consumption. The model also shows that mitochondrial uncoupling generally enhances the proportionality. (shrink)

Kindergartens in Norway are looked upon as the first step in children’s education. There is a discussion in the early childhood field about how to best prepare children for lifelong education. In this paper we want to discuss critical thinking in relation to children’s everyday life in kindergarten. We want to focus on how kindergarten teachers can practice critical thinking together with children by using documentation as a starting point. We wish to emphasized children’s active participation in relation to critical (...) thinking, and further on we points out some aspects that we find important in doing critical thinking in kindergarten. We would argue that critical thinking must take into account the social practice of the thinking; both the power relations in the dialogue and children’s movement, experimentation and way of being. It seems to be important to fight for children’s rights when political goals seems to reduce children’s active participation, and it is in relation to this we find it interesting to discuss critical thinking, and how early childhood teacher’s best can arrange and prepare for such thinking in kindergarten. (shrink)

To what extent do the mother's and father's jobs and occupational sex-typing influence the status and sex-typing of their children's occupation at first entry into the labour market? Referring to a database containing 5027 respondents of two merged Dutch surveys held between 1992 and 1995, this study finds that the effect of the mother's occupational status on her daughter's is significant, but smaller than either the effect of father's status on his son's or his daughter's status. The mother's occupational sex-typing (...) is related to her daughter's occupational sex-typing. The more female sex-typed the daughter's occupation, the lower her occupational status. In the same way, the father's occupational sex-typing is related to his son's occupational sex-typing. While the extension of the classical status attainment models by the mother's occupation and occupational sex-typing leads to interesting and new coefficients, the authors conclude that the more elementary classical model is not invalidated by these new perspectives. (shrink)

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

One theme of this special issue is an incitement to reconsider the relationship between pragmatism and critical realism. While their advocates sometimes come into conflict, there are also clearly b...

Food images are useful stimuli for the study of cognitive processes as well as eating behavior. To enhance rigor and reproducibility in task-based research, it is advantageous to have stimulus sets that are publicly available and well characterized. Food Folio by Columbia Center for Eating Disorders is a publicly available set of 138 images of Western food items. The set was developed for the study of eating disorders, particularly for use in tasks that capture eating behavior characteristic of these illnesses. (...) It contains foods that are typically eaten, as well as those typically avoided, by individuals with eating disorders. Each image has now been rated across 17 different attributes by a large general United States population sample via Amazon’s Mechanical Turk. Ratings included subjective attributes as well as estimates of nutrient content. Each participant rated a subset of stimulus set food items on all 17 dimensions. Additional description of the image set is provided in terms of physical image information and accurate nutritional information. Correlations between subjective ratings were calculated and an exploratory factor analysis and exploratory cluster analysis completed. Outcomes of the factor analysis suggested foods may be described along three latent factors of healthiness, tastiness, and umami taste; the cluster analysis highlighted five distinct clusters of foods varying on these same dimensions. Descriptive outcomes indicated that the stimulus set includes a range of foods that vary along multiple dimensions and thus is likely to be useful in addressing various research questions surrounding eating behavior and cognition in healthy populations, as well as in those with eating disorders. The provision of comprehensive descriptive information allows for stimulus selection that is optimized for a given research question and promotes strong inference. (shrink)

Late Medieval and Early Modern Fight Books offers insights into the cultural and historical transmission and practices of martial arts, based on the corpus of the Fight Books (Fechtbücher) in 14th- to 17th-century Europe. The first part of the book deals with methodological and specific issues for the studies of this emerging interdisciplinary field of research. The second section offers an overview of the corpus based on geographical areas. The final part offers some relevant case studies. This is the first (...) book proposing a comprehensive state of research and an overview of Historical European Martial Arts Studies. One of its major strengths lies in its association of interdisciplinary scholars with practitioners of martial arts. Contributors are Sydney Anglo, Matthias Johannes Bauer, Eric Burkart, Marco Cavina, Franck Cinato, John Clements, Timothy Dawson, Olivier Dupuis, Bert Gevaert, Dierk Hagedorn, Daniel Jaquet, Rachel E. Kellet, Jens Peter Kleinau, Ken Mondschein, Reinier van Noort, B. Ann Tlusty, Manuel Valle Ortiz, Karin Verelst, and Paul Wagner. (shrink)

It is argued that medical science requires a classificatory system that (a) puts functions in the taxonomic center and (b) does justice ontologically to the difference between the processes which are the realizations of functions and the objects which are their bearers. We propose formulae for constructing such a system and describe some of its benefits. The arguments are general enough to be of interest to all the life sciences.

In teaching statistics in secondary schools and at university, two visualizations are primarily used when situations with two dichotomous characteristics are represented: 2×2 tables and tree diagrams. Both visualizations can be depicted either with probabilities or with frequencies. Visualizations with frequencies have been shown to help students significantly more in Bayesian reasoning problems than probability visualizations do. Because tree diagrams or double-trees (which are largely unknown in school) are node-branch-structures, these two visualizations (compared to the 2×2 table) can even simultaneously (...) display probabilities on branches and frequencies inside the nodes. This is a teaching advantage as it allows the frequency concept to be used to better understand probabilities. However, 2×2 tables and (double-) trees have a decisive disadvantage: While joint probabilities (e.g., P(AB)) are represented in 2×2 tables but no conditional probabilities (e.g., P(A|B)), it is exactly the other way around with (double-) trees. Therefore, a visualization that is equally suitable for the representation of joint probabilities and conditional probabilities is desirable. In this article, we present a new visualization—the frequency net—in which all absolute frequencies and all types of probabilities can be depicted. In addition to a detailed theoretical analysis of the frequency net, we report the results of a study with 249 university students that shows that “net diagrams” can improve reasoning without previous instruction to a similar extent as 2×2 tables and double-trees. Regarding questions about conditional probabilities, frequency visualizations (2×2 table, double-tree, or net diagram with natural frequencies) are consistently superior to probability visualizations. The frequency net performs as well as the frequency double-tree. Only the 2×2 table with frequencies—the only visualization that participants were already familiar with —led to higher performance rates. If, on the other hand, a question about a joint probability had to be answered, all implemented visualizations clearly supported participants’ performance, and no uniform format effect becomes visible. Participants reached the highest performance in the versions with probability 2×2 tables and probability net diagrams. Furthermore, after conducting a detailed error analysis, we report interesting error shifts between the two information formats and the different visualizations and give recommendations for teaching probability. (shrink)

Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, treatment effect, cost effectiveness (...) and evidence for neonates born at 28 and 32 GAW. Results The ethical analysis sketches out two possibilities: (a) It is not ethically permissible to limit treatment to neonates below 32 GAW when assigning high weight to health maximisation and overall health equality. Neonates below 32 GAW score high on severity of disease and efficiency and cost-effectiveness of treatment if one gives full weight to early years of a newborn life. It is in the child's best interest to be treated. (b) It can be considered ethically permissible if high weight is assigned to reducing inequality of welfare and maximising overall welfare and/or not granting full weight to early years of newborns is considered acceptable. From an equity-motivated health and welfare perspective, we would not accept (b), as it relies on accepting the lack of proper welfare policies for the poor and disabled in India. Conclusion Explicit priority processes in India for financing neonatal care are needed. If premature neonates are perceived as worth less than other patient groups, the reasons should be explored among a broad range of stakeholders. (shrink)

String theory has been the dominating research field in theoretical physics during the last decades. Despite the considerable time elapse, no new testable predictions have been derived by string theorists and it is understandable that doubts have been voiced. Some people have argued that it is time to give up since testability is wanting. But the majority has not been convinced and they continue to believe that string theory is the right way to go. This situation is interesting for philosophy (...) of science since it highlights several of our central issues. In this paper we will discuss string theory from a number of different perspectives in general methodology. We will also relate the realism/antirealism debate to the current status of string theory. Our goal is two-fold; both to take a look at string theory from philosophical perspectives and to use string theory as a test case for some philosophical issues. (shrink)

One of the near-to-invariant hallmarks of early apoptosis (programmed cell death) is mitochondrial membrane permeabilization (MMP). It appears that mitochondria fulfill a dual role during the apoptotic process. On the one hand, they integrate multiple different pro-apoptotic signal transducing cascades into a common pathway initiated by MMP. On the other hand, they coordinate the catabolic reactions accompanying late apoptosis by releasing soluble proteins that are normally sequestered within the intermembrane space. In a recent study,(1) Li et al. described a nuclear (...) transcription factor (Nur77/TR1/NGFI-B) that can translocate to mitochondrial membranes to induce MMP. Moreover, two groups(2,3) identified a novel intermembrane protein (Smac/DIABLO) that specifically neutralizes the inhibitor of apoptosis (IAP) proteins, thereby facilitating the activation of caspases, a class of proteases activated during apoptosis. These findings refine our knowledge how MMP connects to the cellular suicide machinery. BioEssays 23:111–115, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

The present review on dyadic coping (DC) aims at providing a critical integration of both the conceptual and empirical DC literature and overcoming the limitations of past reviews by (a) describing, comparing, and integrating all the DC models, (b) presenting and integrating findings from studies based on DC models, and (c) suggesting directions for further research. The DC models identified and compared include: The congruence model (Revenson, 1994 ), the relationship-focused model (Coyne and Smith, 1991 ; O'Brien and DeLongis, 1996 (...) ), the communal coping model (Lyons et al., 1998 ), the systemic-transactional model (Bodenmann, 1995, 1997 ), the relational-cultural model (Kayser et al., 2007 ), and the developmental-contextual coping model (Berg and Upchurch, 2007 ). After discussing each DC model, we advance a conceptual integration of all models, which serves as the framework to organize the review of the empirical literature. This integration includes the following DC dimensions: (a) Stress Communication, (b) Positive DC by One Partner (supportive DC, empathic responding, delegated DC, active engagement), (c) Positive Conjoint DC (common, collaborative, communal, mutual responsiveness); (d) Negative DC by One Partner (protective buffering, overprotection, and hostility/ambivalence), and (e) Negative Conjoint DC (common negative DC, disengaged avoidance). Developmental, relational, and contextual variables are included as factors shaping DC. To be included in the empirical review, articles had to be published in or a peer-reviewed journal in English and/or German before 2017 and include an original empirical study guided by one of the DC models. The review included 139 studies and, with the exception of the congruence model whose findings were discussed separately, findings were presented for overall DC and each of the dimensions identified in the conceptual integration. Findings were grouped also according to whether the stressor related or not to a medical or mental health condition. Demographic and cultural factors affecting DC were discussed. Overall, the empirical review suggests that in Western couples, positive individual, and conjoint DC forms, taken together or separately, have individual and relational benefits for couples coping with stress in general and/or mental health or medical stressors. Research on DC can be expanded to include other populations and stressors and use improved designs. (shrink)

It is argued that medical science requires a classificatory system that (a) puts functions in the taxonomic center and (b) does justice ontologically to the difference between the processes which are the realizations of functions and the objects which are their bearers. We propose formulae for constructing such a system and describe some of its benefits. The arguments are general enough to be of interest to all the life sciences.

This study investigated 204 doctors' and nurses' perceived knowledge of bloodborne pathogens and their attitudes towards bloodborne pathogen-infected health care workers. A structured questionnaire examined: (1) their perceived knowledge of bloodborne pathogens; (2) their attitudes towards bloodborne pathogen-infected personnel; and (3) their opinions on limitation of employment of bloodborne pathogen-infected personnel and restrictions on performing clinical procedures. The levels of HIV-related knowledge were significantly higher than for hepatitis C and B viruses. Although the participants demonstrated more positive attitudes towards hepatitis (...) C- and B-infected health care workers, 64% recommended restricting infected personnel from performing invasive procedures. Attitudes were negatively correlated with opinions on restricting infected personnel from health care work or limiting their involvement in clinical activities. This study highlights the need to formulate a policy to cope with the professional and moral dilemmas related to infected health care workers employed in hospitals, especially for those involved in invasive procedures. (shrink)

Das Buch ist den vier ältesten illustrierten und mit Kommentarkatenen versehenen Hss. des Buches Hiob gewidmet, die zwischen dem 9. und dem 11. Jh. entstanden sind: Patmos, Johanneskloster, Cod. 171 (nachfolgend Patm.); Rom, Biblioteca Apostolica Vaticana, Cod. Vat. gr. 749 (Vat.); Sinai, Katharinenkloster, Cod. 3 (Sin.); Venedig, Biblioteca Nazionale Marciana, Cod. gr. 538 (Ven.). Insgesamt sind 15 illustrierte griechische Katenenhss. allein des Buches Hiob erhalten (siehe die Übersicht p. 9–11). Das in ihnen enthaltene Bildmaterial zu Hiob wird ergänzt durch Illustrationen (...) in weiteren Mss. unterschiedlichen Textinhalts (p. 11–14). Während seitens der Textkritik fundamentale Arbeit zur wissenschaftlichen Erschließung des griechischen Hiob-Textes und seiner Kommentare geleistet wurde, stellt das Buch von Bernabò (B.) die erste nennenswerte Publikation mit primär kunstwissenschaftlicher Ausrichtung dar. Rund 2000 (p. VII), überwiegend noch unpublizierte, byzantinische Miniaturen zum Buch Hiob sind überkommen, was erahnen läßt, welcher Schatz auf diesem Gebiet zukünftig noch zu heben ist. Ursprünglich war eine komplette Publikation der bebilderten Hiob-Mss. im Rahmen des Corpus of the Illustrations in the Manuscripts of the Septuagint der Universität Princeton geplant – ein Projekt, das vor allem wegen seines erheblichen Umfangs nicht hat realisiert werden können. Kurt Weitzmann hatte bis zu seinem Tod im Jahre 1993 Bildmaterial in großem Umfang zusammengetragen. Dieses konnte B. nicht nur für sein Buch verwenden, sondern löste mit selbigem gleichzeitig das seinem Lehrer noch zu Lebzeiten gegebene Versprechen ein, das gemeinsam begonnene Projekt nach dessen Tod fortzuführen (p. X–XI). Im Aufbau, wenngleich nicht in Seitenumfang und Buchformat, richtet sich die vorliegende Publikation nach den bereits er-schienenen Bänden des Princetoner Corpus. (shrink)

La Pythaïde est une théorie athénienne envoyée de façon irrégulière à Delphes pour honorer Apollon Pythien. On connaît surtout les quatre théories grandioses envoyées de 138/7 à 98/7, après une longue interruption. La Pythaïde est l’occasion pour les Athéniens de mettre en scène dans le sanctuaire de Delphes l’image qu’ils se font de leur cité, notamment par l’intermédiaire d’un nouvel assemblage de récits « mythiques » mêlant la légende apollinienne et les origines autochtones de la cité. Cette réactualisation de récits (...) traditionnels n’est pas un simple message politique, mais dit profondément l’univers religieux de la fête et de la cité à la basse époque hellénistique. En replaçant ces récits dans leur contexte de production et d’énonciation, on peut préciser la définition indigène de ce que appelons le mythe. Cette mise en situation des « mythes » de la Pythaïde montre que ce n’est pas leur nature qui les caractérise, mais bien leur fonction dans le cadre de la cérémonie.Apollo, Athens and Pythaïs. Pythaïs is an Athenian festival in honour of Apollo in Delphi. It is mostly known through the lists of about a thousand citizens who took part in the four ceremonies of the 2nd and the 1st century B.C., when the Athenians revived the tradition interrupted since the 4th century B.C. of sending a theoria. Pythaïs offers in the Pythian sanctuary a representation of the Athenian city, especially through a new composition of old “myths” dealing with Apollo and Athenian autochtony. These “myths” cannot be reduced to a political message, but also have a religious purpose. Studying the narrative context helps us to understand the ancient Greek definition of our so called “myth”. The example of Pythaïs shows that this definition depends much less on the nature of this type of narratives than on their function in the ceremony. (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to explore ethical challenges in relation to (...) person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. (shrink)

ABSTRACT In this article we argue for the need to take the moral voices of children and youth seriously particularly in times of the Anthropocene. Drawing on theories in ethics by John Wall, moral development according to Mark B. Tappan, and education in line with the works by Vygotsky, we construct a conceptual framework where the notions ‘narrative,’ ‘moral authorship’ and ‘free will’ can open new creative understandings of human ethical competence; a competence based in a relational, contextual and societal-cultural (...) understanding of human existence. The use of our framework is illustrated in interpretations of empirical research with children demonstrating concerns of theirs in relation to climate change. The article concludes with reflections on the kind of education that can be inspired by this framework and the taking of children’s voices seriously, as well as pointing to challenges also to the grown-up world. (shrink)

Recently Robert B. Talisse has put forth a socio-epistemic justification of liberal democracy that he believes qualifies as a public justification in that it purportedly can be endorsed by all reasonable individuals. In avoiding narrow restraints on reasonableness, Talisse argues that he has in fact proposed a justification that crosses the boundaries of a wide range of religious, philosophical and moral worldviews and in this way the justification is sufficiently pluralistic to overcome the challenges of reasonable pluralism familiar from Rawls. (...) The fascinating argument that Talisse furthers is that when cognitively functional individuals reflect on some of their most basic epistemic commitments they will come to see that, in virtue of these commitments, they are also committed to endorsing key liberal democratic institutions. We argue that the socio-epistemic justification can be reasonably rejected on its own terms and thus fails as a public justification approach. This point is made by illustrating the significance of deep epistemic disagreements in liberal democracies. (shrink)

BÄCKSTRÖM B, ASPLUND K and SUNDIN K.Nursing Inquiry2010;17: 257–268 The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischargeStroke consequences present a great long‐term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle‐aged female spouses’ lived experience of their relationship with a partner who has suffered a stroke, during the first year (...) postdischarge. Four middle‐aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio‐taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners’ cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge. (shrink)

From an aging research and life-course perspective, the transition to retirement marks a significant life-event and provides a unique opportunity to study psychological health and coping during a period of substantial change in everyday life. The aim of the present paper is to: (a) outline the rationale of the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) study, (b) describe the study sample, and (c) to present some initial results from the two first waves regarding the association between retirement status (...) and psychological health. The HEARTS study is designed to annually study psychological health in the years before and following retirement, and to examine change and stability patterns related to the retirement event. Among a representative Swedish population-based sample of 14 990 individuals aged 60 to 66 years, 5 913 completed the baseline questionnaire in 2015. The majority of the participants (69%) completed a web-based survey, and the rest (31%) completed a paper version. The baseline HEARTS sample represents the general population well in terms of gender and age, but is more highly educated. Cross-sectional findings from the first wave showed that retired individuals demonstrated better psychological health compared to those who were still working. Longitudinal results from the first and second waves showed that individuals who retired between waves showed more positive changes in psychological health compared with those still working or previously retired. (shrink)