The care for older and disabled people has been described as a core area of the Nordic model. The Nordic countries’ welfare model has also been described as women friendly, as women are not forced to make harder choices than men between work and family. The Swedish eldercare system has, during the last several decades, undergone significant changes. Previously, eldercare could be described as universal, meaning a publicly provided, comprehensive, high-quality service available to all citizens according to need and not (...) based on the ability to pay. In later years transformation of eldercare has been influenced by neoliberal politics, which emphasize economic efficiency and cost reduction through competition. Eldercare has become a more diverse multidimensional system, and a private market for home-based eldercare has been created. The numbers of eldercare providers have increased considerably, and new ways of organizing eldercare have been established. In January 2009, the Act on System of Choice in the Public Sector was introduced. The Act was supposed to provide an opportunity for interested municipalities and county councils to expose their publicly provided services to market competition, and to enable users to choose their providers. This article aims to illustrate how neoliberal reasoning dominated the policy process leading to adoption of the Act on System of Choice in the Public Sector. With the use of a discursive policy analysis the authors specifically explore how neoliberal logic dominated, and also how choice and equality were understood and interpreted in the policy process. They conclude that the neoliberal turn in eldercare claiming to centre on the individual choice of persons in need of care runs the risk of creating unequal care that decentres the eldercare worker and creates precarious work situations. (shrink)

Background: Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries. Research questions: What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes? Research design: Cross-sectional web-based survey. Participants and research context: A total of 1003 nurses recruited via the members’ bulletin of the Finnish Nurses Association and social media. Ethical considerations: Ethical approval was (...) obtained from the Committee on Research Ethics of the university to which the authors were affiliated. Findings: The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations. Discussion: The value of self-determination and the ability to choose the moment and manner of one’s death are emphasized in the nurses’ attitudes towards euthanasia. Conclusion: A continuous dialogue about euthanasia and nurses’ shared values is crucial due to the conflict between nurses’ attitudes and current ethical guidelines on nursing. (shrink)

Kvist seeks to ascertain, in terms of Kant’s own linguistic usage, his views on the topics mentioned. Though primarily historical, this procedure does not keep Kvist from raising objections. The resulting study resembles most Paton’s Kant’s Metaphysic of Experience—apparently Kvist’s model —both methodologically and in its massive scholarship. The text, containing countless references, is augmented by 629 footnotes, covering seventy pages of small print, and a bibliography of some thirty pages. The latter is fairly complete though omitting (...) the highly pertinent work of Kant’s immediate successors. Only Hegel’s Faith and Knowledge is mentioned, and set quickly aside on the curious ground that it is philosophically an original work. (shrink)

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress (...) of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

Recension av boken _Gravstenar berättar. Judiskt liv i Stockholm 1775-1875 _.

The interconnection between moral distress, moral sensitivity, and moral resilience was explored by constructing two hypothetical scenarios based on a recent Swedish newspaper report. In the first scenario, a 77-year-old man, rational and awake, was coded as “do not resuscitate” (DNR) against his daughter’s wishes. The patient died in the presence of nurses who were not permitted to resuscitate him. The second scenario concerned a 41-year-old man, who had been in a coma for three weeks. He was also coded as (...) “do not resuscitate” and, when he stopped breathing, was resuscitated by his father. The nurses persuaded the physician on call to resume life support treatment and the patient recovered. These scenarios were analyzed using Viktor Frankl’s existential philosophy, resulting in a conceivable theoretical connection between moral distress, moral sensitivity, and moral resilience. To substantiate our conclusion, we encourage further empirical research. (shrink)

It is widely assumed that human learning and the structure of human languages are intimately related. This relationship is frequently suggested to derive from a language-specific biological endowment, which encodes universal, but communicatively arbitrary, principles of language structure (a Universal Grammar or UG). How might such a UG have evolved? We argue that UG could not have arisen either by biological adaptation or non-adaptationist genetic processes, resulting in a logical problem of language evolution. Specifically, as the processes of language change (...) are much more rapid than processes of genetic change, language constitutes a both over time and across different human populations, and, hence, cannot provide a stable environment to which language genes could have adapted. We conclude that a biologically determined UG is not evolutionarily viable. Instead, the original motivation for UG arises because language has been shaped to fit the human brain, rather than vice versa. Following Darwin, we view language itself as a complex and interdependent which evolves under selectional pressures from human learning and processing mechanisms. That is, languages themselves are shaped by severe selectional pressure from each generation of language users and learners. This suggests that apparently arbitrary aspects of linguistic structure may result from general learning and processing biases deriving from the structure of thought processes, perceptuo-motor factors, cognitive limitations, and pragmatics. (shrink)

Memory is fleeting. New material rapidly obliterates previous material. How, then, can the brain deal successfully with the continual deluge of linguistic input? We argue that, to deal with this “Now-or-Never” bottleneck, the brain must compress and recode linguistic input as rapidly as possible. This observation has strong implications for the nature of language processing: (1) the language system must “eagerly” recode and compress linguistic input; (2) as the bottleneck recurs at each new representational level, the language system must build (...) a multilevel linguistic representation; and (3) the language system must deploy all available information predictively to ensure that local linguistic ambiguities are dealt with “Right-First-Time”; once the original input is lost, there is no way for the language system to recover. This is “Chunk-and-Pass” processing. Similarly, language learning must also occur in the here and now, which implies that language acquisition is learning to process, rather than inducing, a grammar. Moreover, this perspective provides a cognitive foundation for grammaticalization and other aspects of language change. Chunk-and-Pass processing also helps explain a variety of core properties of language, including its multilevel representational structure and duality of patterning. This approach promises to create a direct relationship between psycholinguistics and linguistic theory. More generally, we outline a framework within which to integrate often disconnected inquiries into language processing, language acquisition, and language change and evolution. (shrink)

Journal of Social Philosophy, EarlyView.

In a recent article, [Sergent, C. & Dehaene, S. . Is consciousness a gradual phenomenon? Evidence for an all-or-none bifurcation during the attentional blink, Psychological Science, 15, 720–729] claim to give experimental support to the thesis that there is a clear transition between conscious and unconscious perception. This idea is opposed to theoretical arguments that we should think of conscious perception as a continuum of clarity, with e.g., fringe conscious states [Mangan, B. . Sensation’s ghost—the non-sensory “fringe” of consciousness, Psyche, (...) 7, 18]. In the experimental study described in this article, we find support for this opposite notion that we should have a parsimonious account of conscious perception. Our reported finding relates to the hypothesis that there is more than one perceptual threshold [Merikle, P.M., Smilek, D. & Eastwood, J.D. . Perception without awareness: perspectives from cognitive psychology, Cognition, 79, 115–134], but goes further to argue that there are different “levels” of conscious perception. (shrink)

In this review article, Christiansen provides a historical perspective on the two research traditions, implicit learning and statistical learning, thus nicely setting the scene for this special issue of Topics in Cognitive Science. In this “tale of two literatures”, he first traces the history of both literatures before sketching a framework that provides a basis for understanding implicit learning and statistical learning as a unified phenomenon.

This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The importance of moral integrity for individuals and society, including its special role in health care, is advocated. Criteria for evaluating the acceptability of claims to conscientious objection are outlined. The (...) precise content of the criteria is dictated by the two main interests that are at stake in the dilemma of conscientious objection: the patient's interests and the health professional's moral integrity. Alternative criteria proposed by other authors are challenged. The bold claim is made that conscientious objection should be recognised by society as acceptable whenever the five main criteria of the proposed set are met. (shrink)

Naturally occurring speech contains only a limited amount of complex recursive structure, and this is reflected in the empirically documented difficulties that people experience when processing such structures. We present a connectionist model of human performance in processing recursive language structures. The model is trained on simple artificial languages. We find that the qualitative performance profile of the model matches human behavior, both on the relative difficulty of center‐embedding and cross‐dependency, and between the processing of these complex recursive structures and (...) right‐branching recursive constructions. We analyze how these differences in performance are reflected in the internal representations of the model by performing discriminant analyses on these representations both before and after training. Furthermore, we show how a network trained to process recursive structures can also generate such structures in a probabilistic fashion. This work suggests a novel explanation of people's limited recursive performance, without assuming the existence of a mentally represented competence grammar allowing unbounded recursion. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Arguably, emotion is always valenced—either pleasant or unpleasant—and dependent on the pleasure system. This system serves adaptive evolutionary functions; relying on separable wanting, liking, and learning neural mechanisms mediated by mesocorticolimbic networks driving pleasure cycles with appetitive, consummatory, and satiation phases. Liking is generated in a small set of discrete hedonic hotspots and coldspots, while wanting is linked to dopamine and to larger distributed brain networks. Breakdown of the pleasure system can lead to anhedonia and other features of affective disorders. (...) Eudaimonia and well-being are difficult to study empirically, yet whole-brain computational models could offer novel insights potentially linking eudaimonia to optimal metastability in the pleasure system. (shrink)

Background: Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities. Objectives: To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities. Research design: Two online questionnaires about the municipal ethics activities. Participants and research context: A total of 137 municipal contact persons for the ethics project answered the first survey (55% response rate), whereas 217 ethics facilitators responded to (...) the second survey (33% response rate). Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services. Findings: Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision. Discussion: This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators. Conclusion: It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors. (shrink)

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of (...) ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout. (shrink)

Blindsight is classically defined as residual visual capacity, e.g., to detect and identify visual stimuli, in the total absence of perceptual awareness following lesions to V1. However, whereas most experiments have investigated what blindsight patients can and cannot do, the literature contains several, often contradictory, remarks about remaining visual experience. This review examines closer these remarks as well as experiments that directly approach the nature of possibly spared visual experiences in blindsight.

This article has two objectives. In the first part, I present a critical overview of the extensive anthropological literature that may be deemed “phenomenological.” Following this critique, which is built up around a classification into four different varieties of phenomenological anthropology, I discuss the relationship between phenomenological anthropology and the ontological turn (OT). Contrary to received wisdom within the anthropological discipline, I suggest that OT has several things in common with the phenomenological project. For the same reason, I argue, it (...) is not accurate to posit OT and phenomenology as opposing or antagonistic projects, as they are often depicted among critics and advocates of OT alike. On the contrary, I go as far as suggesting, OT may be understood as one of the most concerted attempts anthropology has produced to realize a distinctly anthropological version of Husserl’s method of phenomenological bracketing, namely what could be called the ontological epoché. (shrink)

Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignity make room for a moderate and normatively richer position on the moral permissibility of AD. I do not think that we have seen the full potential of the said conceptions and interpretations. I try in this article to contribute my part. First, I briefly recapitulate some (...) of the paradoxical ways in which dignity is typically invoked in the debate and try to clear up some of the obvious confusions. Then, I go on to explore a particular Kantian line of thought in some recent works on dignity and AD that seems to pave the way for a moderate position with a more principled foundation than the usual compromise positions. (shrink)

In this paper, we will propose an idea of education as conversations between friends on matters of common concern. In a scholarly and pedagogical climate of competition, testing and accountability, there seems to be little room for true pedagogical and scholarly conversation. What we aim to develop here, is a vocabulary that is able to capture some educational experiences that are being repressed in the current educational and academic discourse and practice. Starting from our own experiences as higher education workers, (...) we argue for a way of speaking about educational practices that focus on the matters of common concern that gather – and put into conversation - students and teachers. We call this conversation a studious discourse so as to distinguish it from other forms of conversation and outline a definition of the kinds of friendships that potentially revolve around this form of communication. We base our argument on a reading of Jürgen Oelkers and Martin Wagenschein’s pedagogical and didactical reflections and propose ultimately that education is not about the inner development of measurable skills or competences, but rather about becoming part of particular forms of communication about matters of common concern. (shrink)

The importance of developmental agendas -- A capability framework for development goals -- A Republican account of local authority in development -- Third wave development expertise -- Selecting capabilities for a development agenda -- Methods for the selection of capabilities and functionings -- An inclusive framework for setting development agendas.

We present results from a study about women and employee-elected board members, and fill some of the gaps in the literature about their contribution to board effectiveness. The empirical data are from a unique data set of Norwegian firms. Board effectiveness is evaluated in relation to board control tasks, including board corporate social responsibility (CSR) involvement. We found that the contributions of women and employee-elected board members varied depending on the board tasks studied. In the article we also explored the (...) effects of the esteem of the women and employee-elected board members, and we used creative discussions in the boardroom as a mediating variable. Previous board research, including research about women and employee-elected directors, questions if the board members contribute to board effectiveness. The main message from this study is that it may be more important to ask how, rather than if, women and employee-elected board members contribute, and we need to open the black box of actual board behavior to explore how they may contribute. (shrink)

A central task for clinical ethics consultants and committees (CEC) is providing analysis of, and advice on, prospective or retrospective clinical cases. However, several kinds of biases may threaten the integrity, relevance or quality of the CEC's deliberation. Bias should be identified and, if possible, reduced or counteracted. This paper provides a systematic classification of kinds of bias that may be present in a CEC's case deliberation. Six kinds of bias are discussed, with examples, as to their significance and risk (...) factors. Possible remedies are suggested. The potential for bias is greater when the case deliberation is performed by an individual ethics consultant than when an entire clinical ethics committee is involved. (shrink)

ABSTRACTThis paper explores the role of exemplarity in education through a conceptualisation of two different dimensions of exemplarity in educational practice. Pedagogical exemplarity, which relates to the pedagogical and ethical dimension of educational practice. In other words, this dimension explores the educational moments when someone takes up an exemplary function in educational practice. Didactical exemplarity, which relates to the exemplary function of subject matter or educational content. In other words, this dimension explores the educational moments when something takes up an (...) exemplary function in educational practice. Through an initial conceptual exploration of these two dimensions, via the works of Linda Zagzebski and Martin Wagenschein, the paper sets out to lay the foundation for a deeper understanding of the role of exemplarity in education. (shrink)

Indigenous peoples are disproportionally vulnerable to climate change. At the same time, they possess valuable knowledge for fair and sustainable climate adaptation planning and policymaking. Yet Indigenous peoples and knowledges are often excluded from or underrepresented within adaptation plans and policies. In this paper we ask whether the concept of epistemic injustice can be applied to the context of climate adaptation and the underrepresentation of Indigenous knowledges within adaptation policies and strategies. In recent years, the concept of epistemic injustice has (...) gained prominence, indicating that someone has been unfairly discriminated against in their capacity as a knower. We argue that many climate adaptation policies are epistemically unjust towards Indigenous peoples because of the underrepresentation of Indigenous knowledges by showing how the case of Indigenous knowledges in climate adaptation planning and policy satisfies five conditions of epistemic injustice. We further consider what challenges there are to integrating local and Indigenous knowledges within development in general, and climate adaptation strategies in particular and how these can be addressed. Whether the lack of Indigenous knowledges in climate adaptation policies constitutes an epistemic injustice matters because an injustice denotes an unfair advantage to one group – whether by design or default – that ought to be remedied and redressed. (shrink)

In the generative tradition, the language faculty has been shrinking—perhaps to include only the mechanism of recursion. This paper argues that even this view of the language faculty is too expansive. We first argue that a language faculty is difficult to reconcile with evolutionary considerations. We then focus on recursion as a detailed case study, arguing that our ability to process recursive structure does not rely on recursion as a property of the grammar, but instead emerges gradually by piggybacking on (...) domain-general sequence learning abilities. Evidence from genetics, comparative work on non-human primates, and cognitive neuroscience suggests that humans have evolved complex sequence learning skills, which were subsequently pressed into service to accommodate language. Constraints on sequence learning therefore have played an important role in shaping the cultural evolution of linguistic structure, including our limited abilities for processing recursive structure. Finally, we re-evaluate some of the key considerations that have often been taken to require the postulation of a language faculty. (shrink)

The relation between first and higher order mental states is currently unknown. In particular, the relation between conscious experience and introspection is difficult as the same methods are used to investigate them. In order to make progress in the scientific understanding of consciousness, introspection or both, it is fundamental to understand whether their relation is serial or reciprocal. Although the amount of empirical evidence directly addressing this question is sparse, the little that exists suggests a more complex situation that must (...) be taken into account in order to characterise the relationship between first and higher order mental states. We propose a testable integrative model in an attempt to explain the existing data and to make new empirical predictions. (shrink)

How may clinical ethics committees inspire ethical reflection among healthcare professionals? How may they deal with organizational ethics issues? In recent years, Norwegian CECs have attempted different activites that stretch or go beyond the standard trio of education, consultation, and policy work. We studied the novel activities of Norwegian CECs by examining annual reports and interviewing CEC members. Through qualitative analysis we identified nine categories of novel CEC activities, which we describe by way of examples. In light of the findings, (...) we argue that some novel working methods may be well suited to promote ethical reflection among clinicians, and that the CEC may be a suitable venue for discussing issues of organizational ethics. (shrink)

This Special Issue on Connectionist Models of Human Language Processing provides an opportunity for an appraisal both of specific connectionist models and of the status and utility of connectionist models of language in general. This introduction provides the background for the papers in the Special Issue. The development of connectionist models of language is traced, from their intellectual origins, to the state of current research. Key themes that arise throughout different areas of connectionist psycholinguistics are highlighted, and recent developments in (...) speech processing, morphology, sentence processing, language production, and reading are described. We argue that connectionist psycholinguistics has already had a significant impact on the psychology of language, and that connectionist models are likely to have an important influence on future research. (shrink)

Controversies arise over abortion, assisted dying and conscientious objection in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main (...) “driver” for support for assisted dying and opposition to conscientious objection. This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority. (shrink)

Dienes and Seth (2010) conclude that confidence ratings and post-decision wagering are two comparable and recommendable measures of conscious experience. In a recently submitted paper, we have however found that both methods are problematic and seem less suited to measure consciousness than a direct introspective measure. Here, we discuss the methodology and conclusions put forward by Dienes and Seth, and why we think the two experiments end up with so different recommendations.

Would primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient autonomy, competence and coercion; professionalism; cooperation (...) and disagreement with next of kin; and priority setting, resource use and quality. Nursing homes and home care were the primary care services most often involved. Next of kin were present in 10 case deliberations, whereas patients were never present. The investigation indicates that it might be feasible for new CECs to attain a high level of activity including case deliberations within the time frame. It also confirms that significant, characteristic and complex moral problems arise in primary care services. (shrink)

Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physician–patient relationship (“bedside rationing”) is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physician–patient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of (...) his argument yet build on his genuine insights. In our analysis, Wyller’s critique of bedside rationing is instructive both for harbouring some very common misconceptions that must be exposed and refuted, but also for offering important words of caution. In particular, bedside rationing must be performed in ways that do not harm the physician–patient relationship. Read irenically, Wyller’s critique is a reminder of what must not be lost in our painful endeavour to update the ethics of medicine to encompass the unavoidability of rationing. (shrink)

The likely adverse effects of climate change call for political action. In this paper, we argue that the public reason framework—with its insistence on justifiability to all reasonable citizens, in spite of their profound disagreements—despite initial misgivings recommends itself as a framework for debate and decisions pertaining to climate change. We address two possible stumbling blocks: the exclusion of non-anthropocentric points of view, and the controversy over intergenerational justice. We argue that public reason can deal with these problems. Moreover, we (...) argue that both strongly idealized and moderately idealized versions are able to address these issues. Moreover, public reason, as a family of views emphasizing disagreement and justifiability to all reasonable citizens, can help secure the stability of political orders, and hence contribute to sustained and demanding efforts to combat the adverse effects of climate change. (shrink)