Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include the recognition of (...) uncertain data, the introduction of a third alternative, namely suspension of judgement, and the possibility of modifying the choice of probabilities based on a clinical trial with reference to other available knowledge. I have not, however, shown in detail how this modification is done, but I think the concept is sufficiently promising to be applied to an actual clinical decision problem. (shrink)

This book, edited by a team of leading European bioethicists, is in all respects an innovative publication.

With a specific example from Norway and inspiration from Sara Ahmed’s The Promise of Happiness, this article demonstrates how today’s educational rhetoric lacks the language and will to recognise a key pedagogical dimension in education: what happens when the normative ambitions of education and students meet. At best, teaching students life skills to mitigate their mental health issues is naive. Inspired by Ahmed, such an initiative might actually work against its purpose. At a time when educational outcomes are emphasised in (...) local and international political contexts, I argue that the task of philosophy of education should be 1) to reclaim the significance of the pedagogical dimension in education and 2) to philosophise on what negative emotions such as unhappiness require of education. (shrink)

This paper gives an account of theory structure in the biomedical sciences with particular emphasis on cardiology. Rather than regarding theories as axiomatizable sets of statements (the so-called received view), theories are regarded as answers to questions which are accepted as legitimate and interesting by scientists within a field of investigation at a given time. This account of theory structure is used to distinguish between theories which are quite liable to be revised during the course of scientific investigation, here called (...) theories within the field, and theories which are more securely established, here called theories of the field. These latter theories can also be regarded as patterns of reasoning which are applied again and again to answer the questions of the field. It is argued that the distinction proposed in this paper fits our intuitive understanding of what it means for a theory to be securely established within a field of research. Several examples are given which show the problems of justifying clinical intervention solely on the basis of theories within the field. (shrink)

It is a remarkable fact about the development of medical ethics from the 1960s until today that there has been a dramatic shift from a position where it was taken for granted that the physician knows best, to a position where much greater emphasis is put on the patient’s treatment preferences. This shift is evident with regard to physician attitudes towards disclosing a cancer diagnosis. For example, in 1961, a survey of cancer physicians showed that almost 90% of the physicians (...) reported that their usual policy was not to tell their patients that they had cancer . The survey was repeated in 1979, and it showed a complete reversal in attitudes over this 20-year period. 90% reported that their usual policy was to tell their patients that they had cancer .One common way of justifying the new approach is to claim that patients have a right to make their own treatment decisions, referring to the basic value of patient autonomy. However, it is immediately obvious that physicians should not respect all choices made by patients. Consider the following case: A thirty-eight-year-old man with mild upper respiratory infection suddenly developed severe headache, stiff neck, and high fever. He went to an emergency room for help. The diagnosis was pneumococcal meningitis, a bacterial meningitis almost always fatal if not treated. If treatment is delayed, permanent neurological damage is likely. A physician told the patient that urgent treatment was needed to save his life and forestall brain damage. The patient refused to consent to treatment saying he wanted to be allowed to die .Very few, if any, physicians would respect this person’s treatment choice. The reason is that this patient is not competent to make his own decisions. Respect for autonomy only requires that the choices of patients who are competent to make their own decisions are honoured. Judgements about which patients are competent to make their own decisions therefore become crucial. (shrink)

In this article, the author traces the transformation of sexual work, or prostitution, in 20th-century Korea. The author stresses the power relations that create and sustain the changing social organization of sexual work. The traditional, state-organized female entertainers, kisaeng, waned with the collapse of the Yi dynasty. During their colonia rule, the Japanese enhanced the commercialization of sexuality and conscripted Korean women as sexual “comforters” for soldiers. In the postwar period, the U.S. military presence played a preponderant role in expanding (...) prostitution. In the 1970s, sex tours, dominated by the Japanese, proliferated. The 1980s witnessed a greater diversification of sexual labor. (shrink)

This article explores the relations between autobiography, fiction and history in the recent texts of Hélène Cixous. It examines the uses and limits of a range of generic categorizations in accounting for these relations. We suggest that most categorizations tend to rely on an underlying oppositionary and exclusive dynamic between autobiography and fiction in which one or the other may be privileged. Our contention is that Cixous's work should rather be understood within an inclusive dynamic in which all three elements, (...) the fictional, autobiographical and the historical coexist in a complex relation which cannot be disentangled. This inclusive dynamic, we suggest, is not only central to an understanding of the texts’ generic dimensions, but also to the specifics of the pact which Cixous establishes with her readers, as well as to the ethical thinking which underlies her oeuvre. (shrink)

Contemporary medical imaging technologies produce images on the level of human cells. As a result of such images, egg and sperm cells have become well-known artefacts of popular culture. Medical imaging technology has transformed these gametes from invisible matter integrated in biological processes within the body to identifiable objects. The visualisation of egg and sperm cells has literally lifted the process of human reproduction out of the female body and made the gametes appear as protagonists in the story of human (...) reproduction. The article argues that visualisation of the gametes and the central role they play in contemporary imaginations of reproduction may offer vital contributions to the rather rapid acceptance and normalisation of assisted reproduction. (shrink)

This paper analyses Steven Vogel's claim that his account of a post-natural environmental philosophy solves the dualism problem within the field. Through what I will call a novel critique of social constructionism, this paper examines whether Vogel's attempt succeeds or whether it reinforces the problem he wants to solve. Could the ontological foundations of social constructivism themselves be in conflict with Vogel's stated aim of overcoming the human/ nature dualism? The last part of the paper focuses on the significance and (...) role of a post-natural environmental philosophy for the field of environmental philosophy in general. (shrink)

ArgumentDuring the 1950s it became apparent that antibiotics could not conquer all microbes, and a series of tests were developed to assess the susceptibility of microbes to antibiotics. This article explores the development and standardization of one such testing procedure which became dominant in the Nordic region, and how the project eventually failed in the late 1970s. The standardization procedures amounted to a comprehensive scheme, standardizing not only the materials used, but also the methods and the interpretation of the results. (...) Focusing on Sweden and Norway in particular, the article shows how this comprehensive standardization procedure accounted for several co-dependent factors and demanded collaboration within and across laboratories. Whereas literature on standardization has focused mostly on how facts and artefacts move within and across laboratories, I argue for the importance of also attending to regions and territories. More particularly, while arguing that the practices, ideals, and politics related to what have been called the “Nordic welfare state” were contributing to the design of the standardized procedure in the laboratory, I also argue that Scandinavia was drawn together as a unified region with and by these very same practices. (shrink)

The emergence of key concepts in Reinhart Koselleck’s sense has been much discussed in conceptual history, but mainly for the eighteenth and nineteenth centuries. The article documents a post–World War II emergence of the concept of health, from relative anonymity to becoming a key concept, comparable to concepts such as politics, democracy, and culture. While previous research has emphasized conceptual mobility, this article focuses on conceptual aggregation, where the concept of health assembles and assimilates meanings, becoming essential to discourse. This (...) is explained with reference to the development of the welfare state and the political use of a positive, expanded health concept. The article utilizes a collocation analysis of Norwegian digitized newspapers 1950–2010, culled from the uniquely extensive database of the Norwegian National Library. (shrink)

The article analyses the debate on egg donation in Norway using source material from the parliamentary debate of amendments to the Biotechnology Law. In both policy documents on bioethics and the Biotechnology Law, gender is not a spoken issue, but bringing egg and sperm directly to the fore highlights how gender is implicated in bioethics debates. Gender perceptions affect the understanding of `what egg and sperm may do' at the same time as the debate sets established perceptions of gender in (...) motion. In Norway, gender equality is a valid and important premise within the general political debate. It is, however, contested as a valid argument in the context of egg donation, which therefore becomes a field of negotiations about the limits of equal opportunities. The article analyses the egg donation debate as a process of cultural co-production and asks how the Norwegian emphasis on gender equality influences the debate on egg donation and, vice versa, how debates of assisted reproductive technology reopen debates on gender in relation to reproduction and parenthood. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should (...) focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

In this paper, the author argues that the requirement to conduct randomised clinical trials to inform policy in cases where one wants to identify a cheaper alternative to known effective but expensive interventions raises an important ethical issue. This situation will eventually arise whenever there are resource constraints, and a policy decision has been made not to fund an intervention on cost effectiveness grounds. It has been thought that this is an issue only in extremely resource poor settings. This paper (...) gives an example from the United Kingdom illustrating that this is also a problem faced by richer countries. (shrink)

This article explores possibilities for establishing dialogues between feminism and constructivism in the field of technology studies. Based on an overview of Norwegian feminist debates about technology, it indicates several points where feminism and constructivism meet and can mutually benefit from each other. The article critically examines feminist studies questioning the problems of technological determinism, social deternacnism, and essentialism. It criticizes constructivism for a lack of concern for gender and politics but holds that it is still possible to use theoretical (...) tools from constructivism in feminist analyses. Fruitful dialogues require the application of the principle of symmetry to the dcalogues and sharing some common ground and mutual recognation of each other's strengths and weaknesses. (shrink)

The new reproductive technologies affect several of our conceptual distinctions, and most basically the one between nature and culture. This includes the understanding of reproduction as natural, biological processes and of the body as a product of nature. Nature and culture has been a basic conceptual distinction in western culture and it is paralleled in the division between sex, understood as nature, and gender, understood as culture. The process of reproduction is central to the understanding of sexual difference, in the (...) sense that the abilities to conceive and give birth to children are generally considered to be features that distinguish woman from man. Therefore changes in this process provide us with empirical material for exploring changes in people's understanding of sex and gender. The article explores reproductive technology as a provider of new cultural models for understanding the relationship between nature and culture and thereby the distinction of sex/nature and gender/culture. (shrink)

While necessary parts of the puzzle, cultural technologies are insufficient to explain peace. They are a form of second-order cooperation – a cooperative interaction designed to incentivize first-order cooperation. We propose an explanation for peacemaking cultural technologies, and therefore peace, based on the reputational incentives for second-order cooperation.