Healthcare professionals encounter many moral challenges in their daily clinical practice. However, there have been few studies on the subject matter in Tanzania. This study aims to provide an account of moral challenges faced by healthcare professionals in Tanzanian hospitals, their understanding of clinical ethics, and the ethics education they have received. Many participants reported receiving some kind of ethics training through formal education and on-the-job training. Some participants understood ethics in healthcare settings as adherence to established laws, regulations, guidelines, (...) procedures, norms, and rules essential in clinical practice. Analysis of the data identified four themes of moral challenges. These challenges are related to 1) decision-making and communication in clinical practice, 2) scarcity of medical resources and prioritization in clinical practice, 3) withdrawal of curative treatment, and 4) conflicts between professional judgment, religious convictions and adherence to alternative treatments. Based on the findings, we suggest a context-sensitive form of clinical ethics training to prepare healthcare professionals to recognize and address these moral challenges. (shrink)

No philistine, Thorstein Veblen thought humankind's innate impulse to imbue experience with aesthetic unity advanced all knowledge, and that the most beautiful objects, ideas, and actions met a standard of communal benefit reflecting humanity's naturally selected sociability. Though German idealism was an early influence, it clashed with Veblen's historicist critique of Western institutions, and it was William James's psychology that refined his ideas into a coherent aesthetics with ethical and political applications, by clarifying how instinct, habit, and environment could interact (...) to institutionalize standards of beauty subverting the native altruism of the aesthetic impulse. Over years of association with John Dewey, Veblen concluded that a redeemed and reflective will to behold and create beauty in and through selfless activity could advance a more efficient and egalitarian society, and that humans cooperatively shaping their environments for the common good could approximate the German tradition's ideal of harmonizing personal freedom and external reality. (shrink)

Through an extended ethnography of a sports team of boys growing from 7 to 11 years old, I explore Norwegian parents' anxieties about the digital world encroaching on their children's lives. I compare parents' monitoring of their children's (non)digital leisure activities with how kids interact (non)digitally. On the surface, as parents observe how their children's bodies move from screens to sports, they see their kids' attentive hands shifting focus from electronic gaming and screen swiping to a more welcomed ballplaying and (...) high‐fiving with nonelectronic teammates. However, close inspection reveals that my interlocutors never completely enter or leave the digital, but dwell within both worlds simultaneously. The result shows the meaning of children sports as changed by the digital, how the digital appears in the foreground or the background of our interactions, and how an emphasis on attentive hands can help unearth how the digital passes through us to constitute our lifeworlds. (shrink)

Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with the (...) fewer lifetime Quality-Adjusted Life Years (QALYs). We contrast this proposal with several alternative specifications. (shrink)

The European Council called for a period of reflection in each of the member states of the European Union (EU) after the people of France and the Netherlands rejected the Constitutional Treaty in referendums in 2005. The present article offers a contribution to this process by reflecting on the prospects for institutional design and redesign in the EU, a topic that became even more relevant after the Irish ?no? to the Lisbon Treaty in June 2008. The discussions are based on (...) a historical perspective, and the article discusses what lessons can be drawn from Jean Monnet, viewed as an institutional designer on the European stage. The article argues that the successful establishment of the European Coal and Steel Community (ECSC) was a product of a robust deontological design in a constitutional moment for Europe, and that prospective designers in the EU can learn important lessons from how Monnet identified and exploited available spaces for institutional design. (shrink)

The ethical origins of James's pragmatism -- Religion and the refinement of James's pragmatism -- The ethical republic -- Citizen James -- Legacies and prospects.

In this essay I respond to critical readers of my book, William James and the Quest for an Ethical Republic. I argue that James’s ultimate preoccupations are ethical, and that his ethical and moral writings constitute a rich resource for pluralistic societies seeking democratic tools for negotiating deep ideological, cultural, and religious differences, and for building a thriving commons.

This volume is a Norwegian/German collaboration lead by Trygve Wyller and Hans-Gunter Heimbrock.

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

Few remember Thorstein Veblen (1857-1929) as a connoisseur of beauty or champion of beauty’s importance to an institutionally modern and technologically sophisticated society. Similarly few credit Veblen with any constructive theory of politics. Yet Veblen’s conception of the beautiful, his account of its role in human cultural evolution, and his critique of its perversion in the industrialized societies of the nineteenth and early twentieth centuries are invaluable to contemporary social-aesthetic aims of political and economic reconstruction. In contrast to the Veblen (...) of memory, the real Veblen devoted significant intellectual energy to building a theory of what political thinkers today call public work: creative, negotiated, open-ended production of shared goods by individuals alert both to self-interest and collective needs. Partaking of the rich tradition of philosophical pragmatism, Veblen's social aesthetics also points to that tradition's continuing value for contemporary aesthetic, social, and political theory. Indeed, further augmented by recent advances in cultural evolutionary theory, Veblen’s pragmatist, public-work aesthetics suggests a vision of democratic citizenship defined by cooperative imagination, production, critique, and re-creation of a moral and material commonwealth. The so-called “bard of savagery,” therefore, is better understood as a “bard of democracy,” narrating the travails and affirming the ideals of a culture aspiring to self-government. His is a vision that might lend the fragmented field of social aesthetics a common, compelling narrative of its own. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:William James’s Ethical RepublicTrygve ThrontveitFor William James (1842–1910), all philosophical problems were ultimately ethical. In Pragmatism (1907), James invoked the logical theory of his friend Charles Peirce to argue that the “meaning” of any belief consisted solely in “what conduct it is fitted to produce.” There was “no difference in abstract truth,” he elaborated, “that doesn’t express itself in a difference in concrete fact and in conduct consequent upon (...) that fact, imposed on somebody, somehow, somewhere, and somewhen.” Indeed, James concluded that truth was not just reflected in the consequences of conduct but shaped by them: “Truth is made,” he wrote, “just as health, wealth, and strength are made, in the course of experience.”1 This major thesis of Pragmatism distilled a career spent describing an unfinished world, in which human thoughts and actions made differences for which thinkers and actors were responsible. As early as 1878, James insisted that beliefs imply action to advance goals, creating effects valued in light of those goals. The mind, he reiterated in his 1890 masterpiece The Principles of Psychology, is a “fighter for ends,” and thinking, a “moral act.” Later, in “The Will to Believe” (1896), James argued that when evidence is inconclusive, belief might create conditions in which hypotheses could be verified and potential goods realized—or lost. That frank (if often overlooked) assessment of the moral risks as well as rewards of intellectual life echoed James’s most explicitly ethical work, “The Moral Philosopher and the Moral Life” [End Page 255] (1891), where he asserted that when choosing what to believe, it is “simply our total character and personal genius that are on trial; and if we invoke any so-called philosophy, our choice and use of that also are but revelations of our personal aptitude or incapacity for moral life.”2In short, James, as John Dewey elegized in 1910, “was everywhere and always the moralist.”3 Yet for much of the twentieth century critics deemed James’s philosophy ethically vacuous, a warrant for moral solipsism. In 1909, Bertrand Russell criticized James for privileging belief over suspension of judgment, and thus encouraging people to live in private moral universes rather than seek objective grounding for common values. Today, some intellectual historians continue to echo Russell and likeminded contemporaries, judging ethical pragmatism tantamount to moral relativism, even moral apathy.4 Others, acknowledging James’s impassioned pronouncements on lynching, industrial conflict, imperialist expansion, and other public moral issues, have interpreted them as expressing a particularly cosmopolitan but otherwise unremarkable American liberalism, rather than a coherent moral philosophy.5These criticisms are unfounded, but understandable. They reflect a general [End Page 256] antipathy toward James’s broader conceptions of knowledge, truth, and experience, and frustration with his unorthodox mode of philosophizing. In Pragmatism, James followed Peirce in arguing that beliefs are not copies of reality, but “rules for action” resembling the probabilistic predictions guiding scientific inquiry. James, however, extended Peirce’s argument, claiming there is no static reality that beliefs can once-for-all describe. A self-proclaimed “radical empiricist,” James held that the universe is pluralistic, and the only reality accessible to human minds is constantly changing—not least through the ceaseless flux of human consciousness, a fact as natural and consequential as any other.6 This blurring of subject-object distinctions scandalized contemporaries. It also underpinned James’s equally scandalous claim that ideas not only demonstrate their meaning through conduct, but derive both meaning and value from their origins and verification in human activity. To ask what is true in such a world was to ask which ideas, moral or otherwise, allow people to navigate it successfully—which “carry us prosperously from any one part of our experience to any other part”—and which do not.7 Because of these commitments James never made hard distinctions between ethics and other branches of inquiry, or defined his ethics as a separable component of his philosophy easily analyzed on its own terms. Meanwhile, his further refusal to dislodge theory from practice has frustrated those conceiving ethics as a logically and temporally consistent program of conduct. Instead, James insisted that ethical principles emerge organically from individuals’ collective experience in... (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

This paper discusses the formation of Castoriadis’s concept of imaginary significations and relates it to his changing readings of Marx and Weber. Castoriadis’s reflections on modern capitalism took off from the Marxian understanding of its internal contradictions, but he always had reservations about the orthodox version of this idea. His writings in the late 1950s, already critical of basic assumptions in Marx’s work, located the central contradiction in the very relationship between capital and wage labour. Labour power was not simply (...) transformed into a commodity, as Marx had argued; rather, the instituted attempt to treat it as a commodity was a contradiction in itself, between the subjectivity and the objectification of labour. Castoriadis then moved on to link this claim to Weber’s analysis of the interconnections between capitalism and bureaucracy. The main contradiction of modern capitalism, whether wholly bureaucratised as in the Soviet model or increasingly bureaucratised as in the West, now seemed to be a matter of incompatible systemic imperatives: the need to control and to mobilise the workforce. Finally, difficulties with this model – and with the revolutionary expectations based on it – led to a more decisive break with classical theories and to the formulation of a bipolar image of modernity, where the vision of an autonomous society is opposed to the logic of calculation and domination, embodied in capitalist development. On both sides there is an imaginary component, irreducible to empirical givens or systemic principles. In this regard, Castoriadis remained closer to Weber than to Marx, but he also anticipated, in a distinctive way, later emphasis on the cultural dimension of modernity, and more specifi cally the notion of modernity as a new civilisation. (shrink)

Background: Physical impairment and dependency on others may be a threat to dignity. Research questions: The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents. Research design: This study has a hermeneutic design. Participants and research context: In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study. Ethical considerations: This study has been evaluated (...) and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries. Findings: Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II). Discussion: A common understanding was that stress and business was a daily challenge. Conclusion: Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach. (shrink)

Band 10 der Gesammelten Schriften Sulzers enthalt den gesamten Briefwechsel zwischen J. G. Sulzer (1720-1779) und J. J. Bodmer (1698-1783), der hier zum ersten Mal vollstandig nach den Handschriften transkribiert und kommentiert wird. Fur die Edition von Sulzers Schriften ist dieser Briefwechsel geradezu fundamental: Mit seinen 453 Briefen, die in 35 Jahren (1744-1779) entstanden sind, zahlt er zu den umfangreichsten Korrespondenzen Sulzers und liefert zahlreiche neue Informationen zu zentralen Themenfeldern der europaischen Aufklarung, zur Genese von Sulzers und Bodmers Schriften, zu (...) ihrem Netzwerk, insbesondere in Preuaen und in der Schweiz, sowie zu Aspekten ihres Privatlebens. Damit erweist sich dieser Briefwechsel als eine unumgangliche Quelle, will man die Formierung des literarischen und akademischen Feldes in der Aufklarungsepoche untersuchen. (shrink)

This World Bank Report offers a new conception of fair decision processes in health financing. It argues that such procedural fairness can contribute to fairer outcomes, strengthen the legitimacy of decision processes, build trust in authorities, and promote the sustainability of reforms on the path to health coverage for all.

Much is known about the phenomenon of dignity, yet there is still a need for implementing this understanding in clinical practice. The main purpose of this study was to find out how persons suffering from multiple sclerosis experience and understand dignity and violation in the context of a rehabilitation ward. A phenomenological-hermeneutic approach was used to extract the meaningful content of narratives from 14 patients with multiple sclerosis. Data were collected by personal research interviews. The findings revealed three main themes: (...) (1) ‘invisibly captured in fatigue’; (2) ‘fighters’ law: one who does not ask will not receive’; and (3) ‘dignity is humanity’. The essence of the findings in this study is that dignity is humanity. According to the participants, dignity requires time and is experienced only in a context of empathy and mutual confidence. (shrink)

Most proposals for new international agreements aim to address important global challenges. If the goal is to solve problems, then the value of these agreements depends on their ability to influence the world — to shape norms, constrain behavior, facilitate cooperation, and mobilize action. A recent review of empirical studies has suggested that many international agreements fail to achieve their aspirations. The review indicates that the form in which states make commitments to each other — through an international legal agreement (...) or through other means — may not be as important as commonly thought. It is the content of the commitments and how these are supported by mechanisms to encourage implementation that matter the most. When developing proposals for new international agreements, like the one that has recently been proposed to address antibiotic resistance, attention to implementation mechanisms should therefore be equal to if not greater than the attention paid to its form. (shrink)

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies (...) show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for the worse off, and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.