BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...) fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (shrink)

In recent years, it has become commonplace among the Global Burden of Disease study authors to regard the disability-adjusted life year primarily as a descriptive health metric. During the first phase of the GBD, it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the (...) DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning to the most recent releases. We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative. (shrink)

Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

_Systematic public vaccination constitutes a tremendous health success, perhaps the greatest achievement of biomedicine so far. There is, however, room for improvement. Each year, 1.5 million deaths could be avoided with enhanced immunisation coverage. In recent years, many countries have introduced mandatory childhood vaccination programmes in an attempt to avoid deaths. In Norway, however, the vaccination programme has remained voluntary. Our childhood immunisation programme covers protection for twelve infectious diseases, and Norwegian children are systematically immunised from six weeks to sixteen (...) years of age. In this article, we address the question of whether our country, Norway, should make the childhood vaccination programme mandatory. This question has received considerable public attention in the media, yet surprisingly little academic discussion has followed. The aim of the article is to systematically discuss whether it is morally justified to introduce a mandatory childhood vaccination programme in Norway. Our discussion proceeds as follows: We begin by presenting relevant background information on the history of vaccines and the current Norwegian childhood vaccination programme. Next, we discuss what we consider to be the most central arguments against mandatory childhood vaccination: the argument from the standpoints of parental rights, bodily integrity, naturalness, mistrust, and immunisation coverage. After that, we examine the central arguments in favour of mandatory childhood vaccination from the standpoints of harm, herd immunity, and as a precautionary strategy. We conclude that there are convincing moral arguments in favour of adopting a policy of mandatory childhood vaccination in Norway._ _Keywords_: autonomy, harm principle, herd immunity, parental rights, precautionary approach. (shrink)

In recent years, multifetal pregnancy reduction has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of (...) 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR. Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis to ascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intention argument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore — despite what several discussants seem to think — that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics, medical ethics, MFPR, selective MFPR. (shrink)

In recent years, multifetal pregnancy reduction (MFPR) has increasingly been the subject of debate in Norway, and the intensity reached a tentative maximum when Legislation Department delivered the interpretative statement § 2 - Interpretation of the Abortion Act in 2016 in response to the Ministry of Health (2014) requesting the Legislation Department to consider whether the Law on abortion allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that current abortion laws allow MFPR within the framework (...) the law otherwise stipulates. The debate has not subsided, and during autumn 2018, it was further intensified in connection with the Christian Democrat "crossroads" and signals from the Conservatives to consider removing §2.3c and to forbid MFPR. -/- Many of the arguments in the MFPR debate appear seemingly similar to arguments pending in the general abortion debate, and an analysis of what sets MFPR apart from other abortions is wanting. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments of the Norwegian debate, and highlight them with scholarly articles from the literature. The most important arguments against MFPR that we have identified we have dubbed the harm argument, slippery-slope argument, intent argument, grief argument, psychological long-term effects for the woman and sorting argument. We conclude that counter-arguments do not measure up in terms of detecting a morally relevant difference between MFPR of healthy fetuses and abortions. Our conclusion is therefore that—despite what several debaters seem to think—there is no morally relevant difference between the two. Therefore, when we allow abortion, we should also allow MFPR. (shrink)

The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational definition of existing measures. In this article, we argue that ‘premature death’ should be recognized as a normative concept. We propose that normative theories should be used to justify measures of premature (...) death to provide them with normative validity and public legitimacy. (shrink)

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something thathappens toan individual, loss of life itself (YLL) occurs when that individual’s life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. (...) This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life. (shrink)

While forgiveness is widely recognised as an example of a supererogatory action, it remains to be explained precisely what makes forgiveness supererogatory, or the circumstances under which it is supererogatory to forgive. Philosophers often claim that forgiveness is supererogatory, but most of the time they do so without offering an adequate explanation for why it is supererogatory to forgive. Accordingly, the literature on forgiveness lacks a sufficiently nuanced account of the supererogatory status of forgiveness. In this paper, I seek to (...) remedy this shortcoming by offering a systematic account of forgiveness as an example of a supererogatory action. In terms of explaining the supererogatory status of forgiveness, I will argue that, to qualify as supererogatory, a forgiving action must fulfil three conditions: (i) it must be permissible; (ii) it must not be obligatory; and (iii) it must be good or praiseworthy, that is, it must have a certain moral value. Moreover, a distinction is drawn between “unconditional” and “conditional” forgiveness. I argue that conditional forgiveness (i.e. forgiveness of repentant wrongdoers) is sometimes a duty and sometimes supererogatory, whereas unconditional forgiveness (i.e. forgiveness of unrepentant wrongdoers) is typically supererogatory or beyond duty. (shrink)

The overarching aim of this article is to scrutinize how severity can work as a qualifier for the moral impetus of malady. While there is agreement that malady is of negative value, there is disagreement about precisely how this is so. Nevertheless, alleviating disease, injury, and associated suffering is almost universally considered good. Furthermore, the strength of a diseased person’s moral claims for our attention and efforts will inevitably vary. This article starts by reflecting on what kind of moral impetus (...) malady incites. We then analyze how severity may qualify this impetus. We do so by discussing the relationship between severity and need, well-being and disvalue, death, urgency, rule of rescue, and distributive justice. We then summarize our thoughts about severity as a moral qualifier. We conclude that severity is, and should continue to be seen, as a morally significant concept that deserves continued attention in the future. (shrink)

It is widely recognised in moral philosophy that there is only something to forgive in cases of unexcused and unjustified wrongdoing. I will call this the standard view. According to this view, forgiveness presupposes that the person to be forgiven has done something that warrants blame and resentment. This standard view has not prompted much discussion in the literature on forgiveness. Most writers on forgiveness seem to accept that it only makes sense to speak of forgiveness in those cases where (...) someone is strictly speaking to blame for having done wrong. I think, however, that the literature on forgiveness lacks an adequately nuanced account of the relationship between forgiveness, justifications and excuses. The present paper challenges the standard view among philosophers that we can only make sense of forgiveness in the context of unexcused and unjustified wrongdoing. I will propose and consider an alternative view according to which there is something to forgive in certain types of cases involving limited responsibility, that is, where a person has a justification or an excuse for her action. More precisely, the aim of this paper is twofold: First, to argue that there is something to forgive others for in certain cases where the other person is excused or justified (i.e. interpersonal forgiveness). Secondly, to argue that there is something to forgive oneself for in certain cases where one has an excuse or a justification for one’s action (i.e. self-forgiveness). (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and after- testing and symptom (...) tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

Ruth Tallman has recently offered a defense of the modified youngest first principle of scarce resource allocation [1]. According to Tallman, this principle calls for prioritizing adolescents and young adults between 15–40 years of age. In this article, I argue that Tallman’s defense of the modified youngest first principle is vulnerable to important objections, and that it is thus unsuitable as a basis for allocating resources. Moreover, Tallman makes claims about the badness of death for individuals at different ages, but (...) she lacks an account of the loss involved in dying to support her claims. To fill this gap in Tallman’s account, I propose a view on the badness of death that I call ‘Deprivationism’. I argue that this view explains why death is bad for those who die, and that it has some advantages over Tallman’s complete lives view in the context of scarce resource allocation. Finally, I consider some objections to the relevance of Deprivationism to resource allocation, and offer my responses. (shrink)

The aim of this article is to study the relationship between Epicureanism and pandemic priority-setting and to explore whether Epicurus's philosophy is compliant with the later developed utilitarianism. We find this aim interesting because Epicurus had a different way of valuing death than our modern society does: Epicureanism holds that death—understood as the incident of death—cannot be bad (or good) for those who die (self-regarding effects). However, this account is still consistent with the view that a particular death can be (...) bad for everyone else but those who die, such as family, friends, and society (other-regarding effects). During the pandemic, the focus has been on the number of deaths more than on the suffering and reduced well-being of those infected and the rest of society. However, since the pandemic requires prioritization, it is, on a utilitarian account, important to consider priorities that do the most good overall. In this article, we approach the harm of death from an Epicurean point of view, seeking to flesh out potential implications for pandemic priority-setting, and healthcare in general, using a case study of COVID-19 priority-setting. We also explore whether this would conflict with utilitarianism. We conclude that an Epicurean pandemic priority-setting approach would be different but, surprisingly, not radically different from many of the actual priority-setting decisions we saw under the COVID-19 pandemic. (shrink)

Adopting the methods of Ethnomethodology and Conversation Analysis, this article aims to add to our knowledge of the dynamics and resistance in professional-client encounters. It does this by examining the argumentative function of second-hand assessments in the setting of vocational rehabilitation. In the situated negotiation of appropriate work-targeted initiatives, the practice of reporting second-hand assessments functions either as ‘opposing’ the professional’s investigations, or, when used in initiating turns, as ‘promoting’ the client’s case. Regarding the first, second-hand assessments provide opportunities to (...) oppose and redirect the institutional agenda. That is, the issue introduced by the professional is fended off more or less openly through second-hand accounts, which provide a presumptive better grasp on the matter at hand. (shrink)

In this paper, I discuss some central ethical aspects of self-forgiveness. A first comparison is made between interpersonal forgiveness and self-forgiveness. It would seem that self-forgiveness follows much of the same structure as interpersonal forgiveness, although with some exceptions. One noticeable difference is that with self-forgiveness, the forgiver and forgiven is one and the same person. The main ethical question discussed is when self-forgiveness is morally permissible. I argue that self-forgiveness is only morally permissible when the wrongdoer acknowledges wrongdoing and (...) display genuine repentance. He must also, insofar as possible, ask the victim for forgiveness before contemplating self-forgiveness. (shrink)

In welfare encounters, clients may from time to time report about other peoples’ doings in ways that are heard as more or less downgrading. This article examines how these reports are brought off in Norwegian vocational rehabilitation encounters, and especially, how the professional party aligns. Do such practices represent what Levinson calls ‘allowable contributions’ in the vocational rehabilitation meeting or are they treated as matter out of place? The analysis of five data extracts suggests that it is very important for (...) the reception that the report is well contextualized and attuned to the institutional agenda. The counsellors displayed a neutral but cooperative alignment to reports integrated neatly in the business-at-hand in a top-down fashion. Here, the reports served as a tool to inform the recipient about the client’s own character and/or her experience of the rehabilitation process. However, in the two latter cases, where the client had a more initiating role, the reports appeared to have a more humorous or entertaining function. In response, the counsellors did not display alignment but searched for institutional relevance before re-contextualizing the report into a proper context. This suggests that out-of-frame reports about other people delivered on a humorous footing do not straightforwardly fall into the category of ‘allowable contributions’ in this setting. (shrink)

It is a useful exercise to reflect, sometimes, on the way philosophy is carried out, and on how we think philosophy should be carried out in the future. We need to accept that academia is undergoing some important changes, which means that academic philosophy is also changing. The aim of this article is to discuss what gives philosophy its legitimacy in Norway. I will argue that the justification for having philosophy in Norway, in one way or the other, must be (...) that it has societal value. In this respect, I believe that teaching and public outreach are philosophy's most important areas of focus. Even though I mainly concentrate on academic philosophy in Norway, much of what I say is relevant for understanding the legitimacy of academic philosophy in other countries. (shrink)

The purpose of this paper is to consider the question of whether we have a duty to forgive those who repent and apologize for the wrong they have done. I shall argue that we have a pro tanto duty to forgive repentant wrongdoers, and I shall propose and consider the norm of forgiveness. This norm states that if a wrongdoer repents and apologizes to a victim, then the victim has a duty to forgive the wrongdoer, other things being equal. That (...) someone has a pro tanto duty to forgive a repentant wrongdoer means that he or she ought to forgive unless other considerations outweigh the norm of forgiveness. Furthermore, a distinction is made between what are termed 'general considerations' and 'case-relative considerations', and it is argued that only after all the relevant considerations have been examined can it be determined whether there is a duty to forgive, all things considered. (shrink)

The welfare of the child is the prevailing principle and concern regarding access to assisted reproduction in Western countries today, and there is a wish to avoid harm to future children. New research fields have developed in order to provide scientific evidence on the welfare of children living with different “types” of parents. Assisted reproductive technologies (ART) seems to be heading in a responsible direction where the care and concern for future children is vital. However, the claim of this article (...) is that the principle of the welfare of the child confuses the ethical framing of ART. Several philosophers in the past have argued that potential people must be regarded as outside the moral domain, and therefore cannot be harmed or benefitted. This message has not reached the policymakers, probably because the welfare of the child principle seems to fit so elegantly with common sense. In this article a different ethical framing of ART is proposed. The author argues that “futile care” and not “the welfare of the child” should be the guiding principle for eventually rejecting access to ART. The desired goal of ART treatment should be understood to be the production of functional families. Assisted reproduction is primarily about us, actual people in an actual society, and how potential children may affect us. (shrink)

Criminologists have long acknowledged the link between a number of cognitive deficits, including low intelligence and impulsivity, and crime. A new wave of research has demonstrated that pharmacological intervention can restore or improve cognitive function, particularly executive function, and restore neural plasticity. Such restoration and improvement can allow for easier acquisition of new skills and as a result, presents significant possibilities for the criminal justice system. For example, studies have shown that supplements of Omega-3, a fatty acid commonly found in (...) food such as tuna, can decrease frequency of violent incidents in an incarcerated population. Research has also begun to explore the use of selective serotonin reuptake inhibitors to reduce impulsivity in some violent offenders. However, there are significant legal and ethical implications when moving from dietary supplements to prescription pharmaceuticals and medical devices for cognitive intervention. This paper will explore the legal and ethical issues surrounding the use of pharmacological intervention on prisoners as an effort to reduce crime and recidivism. (shrink)

What is the best way to approach our environmental problems? Or what kind of environmental ethics or philosophy is best suited to address and possibly solve some of the most serious environmental problems of our time? These questions have been discussed several times over the last decades and various alternative answers have been proposed for how to deal with contemporary environmental problems. One influential approach in the early 1970s was deep ecology, launched by Arne Naess in his article «The Shallow (...) and the Deep, Long-Range Ecology Movement: A Summary». Deep ecology or the deep ecological movement was for a long time a dominant theme in environmental philosophy and it has given rise to numerous articles, books and conferences. Deep ecology flourished in the 1970-80s, but its standing today is severely diminished. Why has deep ecology lost its standing as a leading environmental philosophy and movement? In this paper, I discuss some of the reasons why I think deep ecology has such a limited appeal today. I will argue that the flaw of deep ecology lies in its adherence to ontology rather than ethics. Supporters of deep ecology, such as Naess himself, have tended to attach great importance to our experience of reality as a source of environmental attitudes. But I believe that this focus on environmental ontology has been a recipe for disaster rather than a success for deep ecology and its supporters. I suggest that a proper environmental position should be based on critical thinking and moral principles rather than on ontological assumptions about human experiences of the world. (shrink)

This study explores how and why simulation training facilitates professional learning by investigating how simulators and simulations are used and conceptualized in two professional domains, nursing and maritime navigation, and offer a reconceptualization. Our aim is to move beyond past theorizing of simulators and simulations that has mainly centered on representational issues like validity, fidelity, and authenticity. Instead, we approach simulators as epistemic objects and simulations as epistemic practices. These concepts offer a lens to examine the situated and sociomaterial practices (...) that make simulators into simulations and simulations into entry points to the epistemic culture of a profession. As a result, we pinpoint three central mechanisms for transforming the simulation experience into an event that facilitates the enrollment of students into their future profession. The first mechanism involves the instructional practice of “filling in” aspects of the work context that might be missing in the simulator. The second mechanism, sometimes labeled the “as-if” mode of simulations, manifests through the participants’ ongoing commitment to treat the simulation as-if it was a real professional encounter. The third relates to how simulation-based learning activities afford a crucial pedagogical orientation towards defining what constitutes exemplary professional practice in specific training situations. (shrink)

Families have a right to privacy, but we know little about how the public–private boundary is negotiated at the micro level in educational settings. Adopting ethnomethodology, the paper examines how talk about the home situation was occasioned and managed in ten parent–teacher conferences in early childhood education and care (ECEC), with a special focus on the ECEC teacher’s strategies for eliciting family information. The paper demonstrates a continuum of interactional practices which, in various degrees, make parents accountable for providing family (...) information. The analysis shows that parents both volunteer and provide the pursued information, thus actively orienting to the norm of visibility in child rearing. However, although both parties orient to questioning and fishing as business as usual, the parents’ accounts sometimes had an excusing quality or they adopted a reserved communication style, suggesting a certain ambivalence as well. The paper outlines different ways of understanding the present partnership ideal in parent–teacher teacher cooperation with implications for the negotiation of privacy. The paper also addresses training, which can contribute to staff and student reflections on the management of the public–private boundary. (shrink)

In a recent paper— The disvalue of death in the global burden of disease 1—we question the commensurability of the two components of the disability-adjusted life year (DALY)— years lived with disability (YLDs) and years of life lost (YLLs)—and offer a tentative solution to this problem. In an exciting and constructive reply— Is consistency overrated? 2—philosopher S Andrew Schroeder argues that our concern about the DALY may be missing the mark by accepting the DALY as what he refers to as (...) an index reflecting nothing ‘beyond the importance we place in each (DALY component)’. According to Schroeder, our consistency requirement is then made redundant. Recall our main argument: the DALY is the arithmetical sum of two components, YLDs and YLLs. The YLDs represents the individual disease burden that occurs while we are alive, while YLLs represents the individual disease burden resulting from our death. ‘Death’, in this context, is not the process of dying, which happens within life and which is captured by YLDs, but rather the incidence in which the life of a person has ended. Understood this way, the DALY is the aggregate of life and death, and we argue that these are incommensurables. Why are YLDs and YLLs incommensurables? In our article, we present several reasons for this. Briefly, YLDs measure disease burden that happens to an individual, whether it be painful experiences or loss of function. YLDs have a duration and are usually something we experience, such as pain. YLLs, on the other hand, are instantly generated when the life of that individual has expired. We do not experience YLLs, and they happen where we are not. When YLLs are generated, the life in question has already ended. On a secular account, death is the irreversible cessation of the mind and the senses, and …. (shrink)

There is no doubt that Spinoza values what he calls living under the guidance of reason, and that he somehow equates such a life with happiness. What is less clear is exactly how he conceives of such a life, and thus how he conceives of human happiness. According to Arne Naess's interpretation of Spinoza, the virtuous and free person will prefer the life of action, and happiness is best realised through living an active life “in the world”. Other scholars, however, (...) have interpreted Spinoza as suggesting that the maximally free person will prefer a life of contemplation “outside the world”. In this paper, I address Naess's relationship with this aspect of Spinoza's practical philosophy, and propose my own interpretation of Spinoza where happiness, or living under the guidance of reason, consists in a combination of activity and contemplation. (shrink)

Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support int...

Few sports-related events have generated as much controversy as the steroid crisis in baseball. Both ardent fans and casual observers wonder why professional baseball players would choose to use such substances when their use was viewed as outside the bounds of fair play. This article attempts to answer that question by applying concepts from the area of organizational culture. Understanding the culture of baseball and the ways leaders embedded and strengthened that culture adds insight into the decisions by athletes to (...) engage in steroid use. In general, such use was consistent with the already-existing culture. In addition, key decisions and events likely created the conditions in which steroid use was more likely. (shrink)

The legalization of physician-assisted suicide (PAS) in various U.S. states draws into question the interpretation of the cardinal virtues of medicine, including beneficence, non-maleficence, auton...

Ethics, Policy & Environment, Volume 14, Issue 3, Page 307-312, October 2011.

Norway’s liberal abortion law allows for abortion on social indications, yet access to screening for fetal abnormalities is restricted. Norwegian regulation of, and public discourse about prenatal screening and diagnosis has been exceptional. In this study, we wanted to investigate whether the exceptional regulation is mirrored in public attitudes. An electronic questionnaire with 11 propositions about prenatal screening and diagnosis was completed by 1617 Norwegian adults (response rate 8.5%). A majority of respondents supports increased access to prenatal screening with ultrasound (...) (60%) and/or full genome sequencing of fetal DNA (55%) available for all pregnant women. Significant minorities indicate, however, that a public offer of prenatal screening for all pregnant women would signal that people with Down syndrome are unwanted (46%) or could be criticized for contributing to a ‘sorting society’ (48%). Results indicate deeper ambivalences and a cultural sensitivity to the ethical challenges of prenatal screening and subsequent abortions. The specific diagnosis of Down syndrome and the fear of becoming a ‘sorting society’ which sorts human life due to diagnoses, appear to play prominent roles in citizen deliberations. The low response rate means that a non-response bias cannot be excluded, yet reasons why results are still likely to be of value are discussed. (shrink)

Rosamond Rhodes and John Harris have both recently argued that we all have a general moral duty to participate in medical research. However, neither Rhodes' nor Harris' arguments in support of this obligation stand up to scrutiny, and severe and convincing criticism has been levelled against their case. Still, to refute their arguments is not to refute the conclusion. There seems to be some truth in the view that when people are asked to take part in medical research, their choice (...) is not completely morally neutral. In this article, we argue that the proper question to ask is when, rather than if, a certain moral duty to volunteer for medical research can be appealed to. To answer this question, we need a denser description of relevant research projects and their context rather than just describing medical research in general. Drawing on our study of participants in the Norwegian HUNT biobank, we use the normative implications of the Norwegian concept «dugnad» as an analogy to discuss the requirement of providing neutral information to potential biobank participants in order to promote their free and informed decision as to whether or not to take part. We suggest that normative recruitment is not just a question of principles and ethics. It is also a question of research design and the creation of the common good in the community where the research takes place. (shrink)

Published in 1721 by the prominent Puritan clergyman Cotton Mather, The Christian Philosopher was the first comprehensive book on science to be written by an American. Building on natural theology, Mather demonstrated the harmony between religion and the new science associated with Sir Isaac Newton. His survey of all the known sciences from astronomy and physics to human anatomy presented evidence that both celestial and terrestrial phenomema imply an intelligent designer. Winton Solberg's introduction places Mather's treatise in its widest (...) historical context. In addition to tracing the origins and sources of Mather's work, Solberg analyzes the book's contents, its reception, and its significance in American intellectual and cultural history. This edition affirms Mather's importance to American thought as a deeply religious intellectual who introduced the Enlightenment to America. (shrink)

The unknown nature of tomorrow’s research makes informed consent in biobank research a challenge. Whether the consent given by biobank participants is ‘broad’ or ‘narrow’, the ever present question remains the same: are new activities covered by the original consent? In this article, we focus on the meaning of, and the relation between, broad consent and re-consent in biobank research. We argue that broad consent should be understood as consenting to a framework—a framework which covers aims, core conditions for acceptable (...) use, governance and how these affect participants. Changes that alter the framework in a fundamental way call for re-consent. Three biobank cases of current international interest are used to debate when re-consent is an ethical necessity: whole-genome sequencing, data sharing and commercial utilization. These reflections give us a more nuanced view on what consent is for. We claim that the introduction of broad consents in biobank research has not represented a betrayal of individual participant interests, as some critics have asserted. Broad consents combined with the possible use of re-consent are in certain settings not inferior, but rather ethically superior to narrow consents. In population-based research biobanks, they allow for a reconciliation between individual interest and public matters in society at large. (shrink)

This introduction attempts to map out the educational and philosophical landscape in which the individual papers move. The movement from the familiar to the unknown, from alienation to homeliness, has been central to theories of Bildung since their emergence, while the role of the specific materiality of places in which Bildung takes place has remained somewhat unexplored. This special issue engages the perennial tensions and questions emerging with the notion of Bildung as these appear in literature and philosophy from the (...) vantage point of place. (shrink)

Ethics, Policy & Environment, Volume 14, Issue 3, Page 361-375, October 2011.

A rapidly growing proportion of health research uses ‘secondary data’: data used for purposes other than those for which it was originally collected. Do researchers using secondary data have an obligation to disclose individual research findings to participants? While the importance of this question has been duly recognised in the context of primary research, it remains largely unexamined in the context of research using secondary data. In this paper, we critically examine the arguments for a moral obligation to disclose individual (...) research findings in the context of primary research, to determine if they can be applied to secondary research. We conclude that they cannot. We then propose that the nature of the relationship between researchers and participants is what gives rise to particular moral obligations, including the obligation to disclose individual results. We argue that the relationship between researchers and participants in secondary research does not generate an obligation to disclose. However, we also argue that the biobanks or data archives which collect and provide access to secondary data may have such an obligation, depending on the nature of the relationship they establish with participants. (shrink)

Three hypotheses are presented in this article, each supported by observations and theory. The first is that party distinctions in Scandinavian politics no longer involve coherent ideas related to political ideologies, but that parties instead have become machines to maintain power and keep supporters employed. The second is that the tradition among political parties in Scandinavia, and especially in Sweden, for accepting federalist measures as a response to central state inefficiencies has been checked by the development of the welfare state; (...) it can only regain momentum through external pressure, in the form of increased competition through the phenomenon known as…. (shrink)

PurposeSocial media has increased as a marketing channel, and Facebook is the biggest social media company globally. Facebook contains both positive and negative information about companies; therefore, it is important for companies to manage their Facebook page to best serve their own interests. Although most users are familiar with business and marketing activities on Facebook, they use it primarily for fun and personal purposes. The most effective methods for companies to use Facebook have not been clear. The personal nature of (...) Facebook presents unique challenges for companies by raising ethical and social responsibility issues that are important to users. The purpose of this paper is to discover how companies can optimize their use of Facebook as a marketing channel.Design/methodology/approachA survey was conducted. The respondents were 158 users of Facebook in Sweden; complete answers were provided by all respondents. In a series of specific questions and comments, the respondents were asked to describe an optimal marketing solution on Facebook for companies. They rated different functions, which were illustrated with pictures, to help in the cognitive process and to avoid misunderstandings.FindingsMost users who have an opinion on the issue accept marketing on Facebook, but only in the right amount. There are basically two groups: those who think that companies have no place on Facebook and those who want companies to be active on Facebook. The latter group emphasizes the importance of meaningful posts without unsolicited sales messages, and would prefer to search for the companies themselves rather than being bombarded by company messages. By far, status updates and pictures/images were found to be the most important functions to respondents.Research limitations/implicationsThe sample consisted of only Swedish users. Another limitation was that, since many Facebook users do not normally think about the implications of being exposed to marketing on Facebook, they have difficulty taking a position on many issues related to the service.Practical implicationsThe results give companies a clear idea of how to effectively use Facebook in their marketing efforts.Originality/valueA large number of companies are currently asking themselves, “How can we use Facebook in an optimal way?” The results in this study answer this question and lead directly to saving time and resources for these companies. (shrink)

ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. (...) The overarching theme was “Holding back and struggling to open up,” which included four subthemes: fearing the intensity and consequences of negative emotions; experiences of being incapable and bodily stuck; being insecure about one’s worthiness and right to share inner experiences with the therapist; and struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work. (shrink)

Physicians anecdotally report inquiring about incarcerated patients’ crimes and their length of sentence, which has potential implications for the quality of care these patients receive. However, there is minimal research on how a physician’s awareness of their patient’s crimes/length of sentence impacts physician behaviours and attitudes. We performed regression modelling on a 27-question survey to analyse physician attitudes and behaviours towards incarcerated patients. We found that, although most physicians did not usually try to learn of their patients’ crimes, they often (...) became aware of them. We observed associations between awareness of a patient’s crime and poor physician disposition towards their patients and between physicians’ poor dispositions and lower reported quality of care. These associations suggest that awareness of a patient’s crime may reduce quality of care by negatively impacting physicians’ dispositions towards their patients. Future quantitative and qualitative studies, for example, involving physician interviews and direct patient outcome assessments, are needed to confirm these findings and further uncover and address hurdles incarcerated patients face in seeking medical care. (shrink)

During the recent debates on whether to prioritize health care workers for COVID-19 vaccines, two main lines of arguments emerged: one centered on maximizing health and one centered on reciprocity. In this article, we scrutinize the argument from reciprocity. The notions of fittingness and proportionality are fundamental for the act of reciprocating. We consider the importance of these notions for various arguments from reciprocity, showing that the arguments are problematic. If there is a plausible argument for reciprocity during the pandemic, (...) this is most likely one that centers on the risk that health care workers take on while working. We argue that the scope of this argument is not plausibly extended only to health care workers. Other essential workers at risk are in the position to make the same arguments. We also argue that there is no compelling argument from reciprocity that makes reciprocating with vaccines, rather than by other means, necessary. Furthermore, allocating vaccines based on reciprocity will conflict with utility-maximizing. Given the weak state of the arguments, overriding concerns for utility seem unreasonable. (shrink)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)