During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were (...) pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination. (shrink)

Background: While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women’s experiences with these encounters have rarely been examined. Objective: The objective of this study was to explore ambivalent abortion-seeking women’s experiences of their encounters with health personnel. Research design: The data were collected in individual interviews and analysed with dialogical narrative analyses. Participants and research context: A total of 13 women (aged 18–36 years), who were uncertain of whether to (...) terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. Ethical considerations: Approval was granted by the Regional Committee for Medical and Health Research Ethics. Findings: The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women’s experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. Discussion: The findings are discussed in terms of the ambivalent pregnant woman’s autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. Conclusion and implication: Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women’s values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence. (shrink)

The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a (...) phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants’ lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants’ narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger’s concept of homelikeness and Arthur Frank’s typologies of illness narratives. In conclusion listening to and acknowledging the patients’ lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients’ lived experience of critical illness and its aftermaths. (shrink)

Dennett’s story “Where am I?” is used to set up the difficulty of locating the self in the natural world. The story is told from a first-person point of view in which the narrator maintains his identity across exchanges of brain and body, but there is no physical thing in the story that can act as bearer of his identity. The story seems to present a dilemma between Cartesian dualism and Dennett’s a “no-self” view. This chapter argues for a third (...) option. Prepersonal processes in the brain stabilize separable conceptions of self and world out of patterns in sensory information. The conception of self starts out as a mere sensorimotor point of view but gradually develops into something richer. Seeing how the first-person point of view arises is seeing how the self arises, because the self is nothing but the proper subject of a first-person point of view. (shrink)

Like any other group of philosophers, scholastic thinkers from the Middle Ages disagreed about even the most fundamental of concepts. With their characteristic style of rigorous semantic and logical analysis, they produced a wide variety of diverse theories about a huge number of topics. The Routledge Companion to Medieval Philosophy offers readers an outstanding survey of many of these diverse theories, on a wide array of subjects. Its 35 chapters, all written exclusively for this Companion by leading international scholars, are (...) organized into seven parts: I Language and Logic II Metaphysics III Cosmology and Physics IV Psychology V Cognition VI Ethics and Moral Philosophy VII Political Philosophy In addition to shedding new light on the most well-known philosophical debates and problems of the medieval era, the Companion brings to the fore topics that may not traditionally be associated with scholastic philosophy, but were in fact a veritable part of the tradition. These include chapters covering scholastic theories about propositions, atomism, consciousness, and democracy and representation. The Routledge Companion to Medieval Philosophy is a helpful, comprehensive introduction to the field for undergraduate students and other newcomers as well as a unique and valuable resource for researchers in all areas of philosophy. (shrink)

There is evidence that asexual reproduction has a long-term disadvantage when compared to sexual reproduction. This disadvantage is usually assumed to arise from the more efficient incorporation of advantageous mutations by sexual populations. We consider here the effect on asexual and sexual populations of changes in the fitness of harmful mutations. It is shown that the re-establishment of equilibrium following environmental change is generally faster in sexual populations, and that the mutational load experienced by the sexual population can be significantly (...) less during this period than that experienced by an asexual one. Changes in the fitness of harmful mutations may therefore impose a greater long-term disadvantage on asexual populations than those which are sexual. (shrink)

This book examines the central ideas that defined the debate about divine production in the Trinity in the late 13th and early 14th centuries, namely those of Henry of Ghent, John Duns Scotus, and William Ockham. Their discussions are significant for the history of trinitarian theology and the history of philosophy.

The papers in this volume reflect much of the current unease of a world that perceives itself once more at the edge of chaos. The authors present different vistas of that experience and their inherent dialectic, expressed in numerous and ceaseless conflicts between ordering and disordering processes. They can be read as comments on the ongoing processes that lead toward greater complexity.

This chapter begins with a discussion of Dennett's view of self-representation. It introduces the so-called “Joycean Machine”, special narrative module in the brain charged with production of an autobiography. It is argued that the synchronic unity of the thinking subject is the unity of voice and agency wrought by the unifying activity of the Joycean Machine. In dynamical terms, the collective voice can have a causal role. Turned outward, it can mediate the communication between systems, allowing them to act as (...) unified agents in interaction with one another. Turned inward, it can govern the activity of the components. (shrink)

This essay is a critique of medical/clinical ethics from the personal perspective of a medical historian in an academic health science centre who has interacted with ethicists. It calls for greater transparency and accountability of ethicists involved in ‘bedside consulting;’ it questions the wisdom of the four principles of biomedical ethics and their American cultural origins with respect to training; challenges the authority of ‘core competencies’ for ethicists as identified by the American Society for Bioethics and Humanities; and muses over (...) the apparent reintroduction of religion into clinical medicine through the medium of bioethics. This essay is designed to provoke reflection on the putative ‘professionalism’ of the consulting ethics enterprise for which educational baselines and curricula are not standardized. By analysing sources such as the professional material communicated by the Canadian Bioethics Society, it also critiques the collective ethical shortcoming... (shrink)