Six individuals with experience of psychosis were interviewed about their psychotic experiences. The material was analyzed using the empirical phenomenological psychological method. The results consist of a whole meaning structure, a gestalt, entailing the following characteristics: The feeling of estrangement in relationship to the world; the dissolution of time; the loss of intuitive social knowledge; the alienation of oneself, and finally; the loss of intentionality/loss of agency. In brief, the results show that an altered perception of the self and the (...) world was an essential part of the psychotic experience where subjects described themselves as changed; something was sensed as being wrong as psychosis is perceptible but hard to communicate. The normal life-world experience was altered and reality seemed strange. Time perception seemed to be changed as temporality appeared dissolved and the experience of time was focused on the current moment excluding the future. The subjects described loss of intentionality, they were no longer agents in their actions but partly steered by others and they could feel as if their experiences were not theirs. The patients also describe problems regarding their ability to socialize and communicate with others. They seem to lose their intuitive social capacity and were prone to suspiciousness. (shrink)

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, (...) or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication. (shrink)

What kind of a science is psychoanalysis? What constitutes its domain? What truth claims does it maintain? In this unique and scholarly work concerning the nature of psychoanalysis, Gunnar Karlsson guides his arguments through phenomenological thinking which, he claims, can be seen as an alternative to the recent attempts to cite neuropsychoanalysis as the answer to the crisis of psychoanalysis. Karlsson criticizes this effort to ground psychoanalysis in biology and neurology and emphasizes instead the importance of defining the (...) psychoanalytic domain from the vantage point of the character of consciousness. His understanding of the unconscious, the libido and the death drive offer new insights into the nature of psychoanalysis, and he also illuminates and develops neglected dimensions such as consciousness and self-consciousness. Karlsson's approach to psychoanalysis is rigorous yet original, and this book fills an intellectual gap with implications for both the theoretical understanding and clinical issues of psychoanalysis. (shrink)

Despite the importance of knowing the cognitive capabilities of children with neurodevelopmental conditions, less than one-third of children with cerebral palsy participate in standardized assessments. Globally, approximately 50% of people with cerebral palsy have an intellectual disability and there is significant risk for domain-specific cognitive impairments for the majority of people with cerebral palsy. However, standardized cognitive assessment tools are not accessible to many children with cerebral palsy, as they require manual manipulation of objects, verbal response and/or speeded response. As (...) such, standardised assessment may result in an underestimation of abilities for children with significant motor and/or speech impairment. The overall aim of the project is to examine and compare the psychometric properties of standardised cognitive assessment tools that have been accommodated for use with either a switch device or eye-gaze control technologies, with the specific aims to: Examine the psychometric properties of accommodated assessment tools by comparing the performance of typically developing children on six cognitive assessment tools administered via standardised versus accommodated administration; Describe and compare the performance and user experience of children with cerebral palsy on six accommodated cognitive assessments administered via switch or eye-gaze control technologies. Secondary aims are to: Describe the completion rates and time to complete assessments of participants in each group; Within the group with cerebral palsy, examine the effects of condition-specific characteristics and demographics on participation. This protocol paper describes a two-phase validation and acceptability study that utilizes a mixed-model design. This study will collect concurrent data from 80 typically developing children and 40 children with cerebral palsy, who use switch or eye-gaze control technology as alternate access communication methods. The set of instruments will measure receptive vocabulary, fluid reasoning, sustained attention, vision perception, visuospatial working memory and executive functions. Data analyses will be conducted using SPSS v. 25 and R v 4.1.0. SPSS Sample Power 3 was used for power computation and allows for a 10% drop out rate. Quantitative descriptive statistics, measurement agreement data plotting, bivariate and multiple regressions analysis will be conducted using appropriate methods. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Epistemic Leaks and Epistemic Meltdowns: A Response to William Morris on Scepticism with Regard to Reason Mikael M. Karlsson I. In an excellent paper which appeared in the April, 1989 issue of this journal,2 William Morris attemptsto demonstrate thatthe arguments which make up Hume's notorious chapter, "Of scepticism with regard to reason, are, in the first place, coherent—both internally and with the overall strategy of the Treatise—and, in (...) the second place, successful. Morris' paper is an exercise in the noble art of what I style constructive exegesis, an enterprise to which many readers of Hume Studies, and myself as much as any, are committed. It is a guiding principle ofthis art that we donotunderstandaphilosophical textuntil we can interpret it in such a way as to render it both coherent and correct. From this point ofview, coherence and correctness are not as independent of one another as they may seem to be to others who are differently committed. Some texts, such as Hume's chapter, "Ofscepticism with regard to reason," are notoriously resistant to constructive exegesis, despite the formidable bag of tricks which scholars and interpreters have developed; so resistant, that in gloomier moments we may be brought to wonder about our interpretative enterprise itself. Constructive exegesis is indeed a strange, and peculiarly optimistic, enterprise. Someday, I imagine, in a leisurely moment, I will think more reflectively about the principles ofour art. But not now.6 As a fellow practitioner of constructive exegesis, I am in full sympathy with what Morris tries to do in his paper; and I think that he does contribute substantially to our understanding of what Hume is up to in the chapter, "Ofscepticism with regard to reason." The third section of Morris' paper is, in my judgement, particularly successful in showing how Hume's chapter fits into the larger framework of the Treatise: Hume is, we see, attacking both what Morris labels "intellectualist rationalism" and its counterpart, which we may call 'unmitigated scepticism', although the chapter's two main arguments go primarily to the former. I also think that Morris gives very helpful, Volume XVI Number 2 121 MIKAEL M. KARLSSON and to my mind accurate, accounts of these two arguments, which I dub, respectively, the epistemic leak argument, and the epistemic meltdown argument. However, I have personally never found either of these arguments remotely convincing; and I still do not, despite Morris' clarification and defense. In what follows, I shall indicate some ofthe reasons for my dissatisfaction.?. Theepistemicleakargumentpurportsto"prove"(in Hume's sense)that reason or demonstration cannot support knowledge. Morris rightlyreminds us that whatHume meansby knowledge is perfect assurance or conviction: Knowledge is, in short, subjective certainty. This has caused confusion, for this is not what we usually mean nowadays by knowledge; nor was it what people, philosophers included, generally meant prior to Descartes. In Hume itis the product ofthe attempttoresolve all epistemic statesintomental eventsorwhat he calls "perceptions." In any case, we must—as Morris rightly explains—be clear that the epistemic leak argument is aimed at showing that demonstration cannot supportperfect conviction. Inoutline, the argumentissimple: Itworks, asMorrismakes clear, by shifting attention away from the subject-matter or "objects" of demonstration, that is, relations of ideas, to the exercise of demonstrative reason by human agents. The necessity of relations of ideas may suggest to us that we can be certain about them. Against this, one may point out that people do err in the conclusions arrived at by demonstration; this presumably shows that our (rational) understandingis fallible. And once we recognize this, our confidence in any conclusion produced by exercising this facultyislessened—thus do we move from knowledge, or subjective certainty, toprobability: belief, or imperfect conviction. Arguments ofthis general type (we can call them, using Descartes' famous figure, Totten-apple arguments ) were around long before Hume, although they were more commonly directed against the senses than against reason. We find them in antiquity—in Plato and Sextus Empiricus, for instance —and in Descartes, in parallel passages in the Discourse on Method, the First Meditation and the Principles of Philosophy, wherein one can discern a version directed precisely against reason and demonstration.12 To find out what, if anything, Hume has... (shrink)

KARLSSON V, LINDAHL B and BERGBOM I. Nursing Inquiry 2012; 19: 247–258 Patients’ statements and experiences concerning receiving mechanical ventilation: a prospective video‐recorded studyProspective studies using video‐recordings of patients during mechanical ventilator treatment (MVT) while conscious have not previously been published. The aim was to describe patients’ statements, communication and facial expressions during a video‐recorded interview while undergoing MVT. Content analysis and hermeneutics inspired by the philosophy of Gadamer were used. The patients experienced almost constant difficulties in breathing and (...) lost their voice. The most common types of communication techniques patients used were nodding or shaking the head. Their expressions were interpreted as stiffened facial expression, tense body position and feelings of sadness and sorrow. Nursing care for patients’ conscious during MVT is challenging as it creates new demands regarding the content of the care provided. In caring for patients undergoing MVT while conscious, establishing a caring relationship, making patients feel safe and helping them to communicate seem to be most important for alleviating discomfort and instilling hope. (shrink)

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau‐Ponty. Merleau‐Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient (...) goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine‐based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind–body–world continuum. The core of intraoperative care is to provide support and promote well‐being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience. (shrink)

This study aims at discovering the essential constituents involved in the experiences of guilt and shame. Guilt concerns a subject’s action or omission of action and has a clear temporal unfolding entailing a moment in which the subject lives in a care-free way. Afterwards, this moment undergoes a reconstruction, in the moment of guilt, which constitutes the moment of negligence. The reconstruction is a comprehensive transformation of one’s attitude with respect to one’s ego; one’s action; the object of guilt and (...) the temporal-existential experience. The main constituents concerning shame are its anchorage in the situation to which it refers; its public side involving the experience of being perceptually objectified; the exclusion of social community; the bodily experience; the revelation of an undesired self; and the genesis of shame in terms of a history of frozen now-ness. The article ends with a comparison between guilt and shame. (shrink)

One important distinction in psychology is between inferences based on associative memory and inferences based on analysis and rules. Much previous empirical work conceive of associative and analytical processes as two exclusive ways of addressing a judgment task, where only one process is selected and engaged at a time, in an either-or fashion. However, related work indicate that the processes are better understood as being in interplay and simultaneously engaged. Based on computational modeling and brain imaging of spontaneously adopted judgment (...) strategies together with analyses of brain activity elicited in tasks where participants were explicitly instructed to perform similarity-based associative judgments or rule-based judgments ( n = 74), we identified brain regions related to the two types of processes. We observed considerable overlap in activity patterns. The precuneus was activated for both types of judgments, and its activity predicted how well a similarity-based model fit the judgments. Activity in the superior frontal gyrus predicted the fit of a rule-based judgment model. The results suggest the precuneus as a key node for similarity-based judgments, engaged both when overt responses are guided by similarity-based and rule-based processes. These results are interpreted such that similarity-based processes are engaged in parallel to rule-based-processes, a finding with direct implications for cognitive theories of judgment. (shrink)

This article examines how one of the most striking differences between the central doctrines of the Catholic Church and the secular context of Swedish society, attitudes to abortion, is managed by the Swedish church hierarchy and commentators in the official newsletter of the Catholic Church of Sweden. Using Foucauldian concepts of power, the article concludes that in its marginal position, the Catholic Church in Sweden mixes the traditional pastoral and sovereign power of the church with the way pastoral power is (...) exerted in modern society, in its efforts to continue asserting its influence over the possible courses of action for pregnant women. While traditionally abortion has been a woman’s crime, in the Swedish Catholic context it becomes rather the crime of the secular society. This means also that the image of woman as being responsible for her decisions and in need of forgiveness gives way to an image of woman as a victim in need of understanding. (shrink)

It is a contradictory argument to say on the one hand that social systems are always open and that there is nothing between closed and open systems, and on the other that there are pseudo-closed systems. Further, Petter Næss has shown that multivariate regression analysis can be used to help uncover mechanisms, something that should be impossible if social systems were always open. He has in addition found that the meaningful activity of urban planning requires for its existence the possibility (...) to make crude, qualitative predictions, which should also be impossible for the same reason. Critical realists therefore need to rethink the whole question of closed and open social systems. (shrink)

In spite of stricter provisions inthe new EU directive on deliberate release ofgenetically modified organisms (GMOs), criticsstill advocate a moratorium on permits forcultivation of GMOs. However, in an attempt tomeet concerns raised by the public, thedirective explicitly gives Member States thepossibility to take into consideration ethicalaspects of GMOs in the decision-making. Thisarticle investigates the potential effects ofsuch formulation by means of an empiricalanalysis of experiences gained the last yearsfrom similar Swedish regulations for GMOs,aiming at promoting sustainable development.The faulty implementation shown (...) in the Swedishcase indicates that legal stipulations forethics as such have limited importance. It issuggested that public participation is animportant factor for successful implementationof the ethics of sustainable development. (shrink)

The distinction between acting and suffering underlies any theory of agency. Among contemporary writers, Fred Dretske is one of the few who has attempted to explicate this distinction without restricting the notion of action to intentional action alone. Aristotle also developed a global account of agency, one which is deeper and more detailed than Dretske's, and it is to Aristotle's account (with some modifications) that the bulk of this paper is devoted. Dretske's sketchier theory faces at least two ground-level problems. (...) It is shown in the course of the paper how these can be handled by the Aristotelian account, in a way which is friendly to Dretske's approach. (shrink)

Anthropomorphism has long been considered a cardinal error when describing animals. Ethicists have feared the consequences of misrepresenting animals in their reasoning. Recent research within human- animal studies, however, has sophisticated the notion of anthropomorphism. It is suggested that avoiding anthropomorphism merely creates other morphisms, such as mechanomorphism. Instead of avoiding anthropomorphism, it is argued that it is a communicative strategy that should be used critically. Instances of anthropomorphism in animal ethics are analyzed in this paper. Some analogies made between (...) people and non-human animals in present theories of animal ethics are clear instances of psychological anthropomorphism. Other analogies are implicit cases of cultural anthropomorphism. It is argued that animal ethics needs to take the wider discourse of critical anthropomorphism into account in order to sophisticate the understanding and use of anthropomorphic projections. Anthropomorphism is an efficient tool of communication, and it may be made an adequate one as well. (shrink)

Two experiments with undergraduates as subjects tested explanations of how a prior temporary income change influences choices between buying and deferred buying. In Experiment 1 predictions from the behavioral life-cycle theory (Shefrin & Thaler, 1988), the renewable resources model (Linville & Fischer, 1991) and the loss-sensitivity principle (Garling & Romanus, 1997) were contrasted. The results are inconsistent with the latter two explanations since the framing of buying as positive (buying a new model of a product) or negative (replacing a broken (...) product) did not interact with the income change. Congruent with the behavioral life-cycle theory, willingness to buy was greater when subjects received a temporary income increase than when they received a temporary income decrease although total assets were equal. Further support for the behavioral life-cycle theory is obtained in Experiment 2 where four income-change conditions and durable and nondurable goods are compared. (shrink)

This book offers a comprehensive, authoritative, and accessible introduction to journalistic transparency. Pulling from historical and theoretical perspectives, Transparency in Journalism explains the concept of transparency and its place in journalistic practice, offering a critical assessment of what transparency can and cannot offer to journalism. The author also reviews the key theoretical claims underlying transparency and how they have been researched in different parts of the world, ultimately proposing a communication model that can be used to study the concept of (...) transparency across journalism research. Other topics discussed include the use of algorithmic forms of transparency, the limitations of the transparency myth, and suggestions for future avenues for research. Transparency and Journalism is an important resource for students and scholars in the field of journalism and media studies, as well as for journalists and researchers interested in delving into an ever-relevant topic for the field. (shrink)

Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which (...) focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible. (shrink)

While structural approaches to sustainability have remained unable to muster wider political support, green political theory has for some time taken a voluntarist turn, arguing that deep changes in attitudes and behaviour are necessary to reduce the ecological debt of the rich countries. Within environmental citizenship theory it is believed that justice requires each individual to start living within his or her 'ecological space'. Firmly rooted in the pollution paradigm, environmental citizenship theory holds that the path to sustainability goes through (...) a dramatic reduction in economic activity and international trade. Since such cuts in material welfare run counter to the preferences of many, doubts can be had about their political plausibility. More seriously, with a world population of more than seven billions, it is doubtful that even such harsh sacrifices would suffice to ensure environmental sustainability. This article challenges environmental citizenship theory by arguing that it is tied to a conception of sustainability which is both theoretically misleading and strategically unfortunate in a rapidly industrialising world. Instead of further individual guilt, there is an urgent need to define new collective progressive projects aimed at universal affluence and natural restoration. Fashionable as a sense of individual guilt may be, it fails to recognise the responsibility of the rich world to provide new technologies capable of securing global environmental sustainability. (shrink)

This study focuses on troubles-tellings in calls to the Swedish Board for Student Support, where the caller wants to negotiate the repayment contract of a student loan. The study relates to research on the organization of troubles-tellings in institutional interaction, and the overall question of how talk about money is a delicate matter that is shaped by moral concerns. The data consist of 94 calls in which the caller proposes either a reduction or a temporal suspension of repayment. The analysis (...) shows that troubles-tellings are launched to account for past failures to adhere to the contracted payment schedule. These tellings are met with minimal responses, which in turn engender a shift towards solutions that resonate with the institutional agenda. The study explores the resources recruited by the participants to deal with a potentially stigmatic situation by formulating the troubles as merely temporary and projecting a future situation where payments are made on time. (shrink)

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses (...) can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring. (shrink)

The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008, the Swedish Parliament adopted an overarching “Vision Zero for Suicide” and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against the background of clinical experience and alleged empirical (...) claims regarding the consequences of regulating suicide prevention. This study is part of a larger research project in medical ethics with the overarching aim to explore whether the VZ is ethically justifiable. The aim is to enrich the normative discussion by investigating empirically how the VZ is perceived in healthcare. Interviews based on a semi-structured interview guide were performed with 12 Swedish psychiatrists. The interviews were analysed with descriptive qualitative content analysis aiming for identifying perceptions of the Vision Zero for Suicide as well as arguments for and against it. Though most of the participants mentioned at least some potential benefit of the Vision Zero for Suicide, the overall impression was a predominant skepticism. Some participants focused on why they consider the VZ to be unachievable, while others focused more on its potential consequences and normative implications. The VZ was perceived to be impossible to realize, nonconstructive or potentially counterproductive, and undesirable because of potential conflicts with other values and interests of patients as well as the general public. There were also important notions of the VZ having negative consequences for the working conditions of psychiatrists in Sweden, in increasing their work-related anxiety and thwarting the patient-physician relationship. (shrink)

What follows is a modest example of theorizing an existent theory (Karlsson and Bergman 2017; Swedberg 2014). The theory in question is Margaret S. Archer’s (1995, 2000a) Morphogenesis/Morphostasis...

Aus dem Inhalt: Views from the North: Hans Petter Graver: Law, Justice and the State: Nordic Perspectives u Jacob Dahl Rendtorff: The Danish Welfare State: Philosophical Ideals and Systemic Reality u Sigri!Dur *orgeirsdottir: Feminist Ethics and Feminist Politics u Kuellike Lengi: The Situation of Human Rights in Estonia u Einar Palsson: Pythagoras and Early Icelandic Law u Law, Discourse and Rationality: Mats Flodin: Internal and External Rationality of Legal Systems u Logi Gunnarsson: A Discourse About Discourse u Hjordi!s Hakonardottir: Legal (...) Language: A Tool of Justice u Ghita Holmstrom-Hintikka: On the Use of Expert Witness in Legal Reasoning and Inquiry u Law, State and Nation: Agust H. Ing*orsson: Democracy, Bureaucracy and Marginalization of the State u Aleksander Peczenik: Law-State, Legal Certainty and Legitimacy of Law u Ove K. Pedersen/Sverre Raffnsoe: Reorganizing Society u Juha Raikka: Mill on National Sentiment u Pall Skulason: Concepts of the State and Classes of Value u Problems of Law and Rights: Britt-Mari Blegvad: How to Cope With Uncertainty: Trust and Law u Jon Wetlesen: Animal Rights or Human Duties?. (shrink)

Two experiments with undergraduates as subjects were carried out with the aim of replicating and extending previous results showing that the implication of the behavioral life-cycle hypothesis (H. M. Shefrin & R. H. Thaler, 1988) that people classify assets in different mental accounts (current income, current assets, and future income) may explain how consumption choices are influenced by temporary income changes. In both experiments subjects made fictitious choices between paying for a good in cash or according to a more expensive (...) installment plan after they had received an income which was either less, the same, or larger than usual. In Experiment 1 subjects were supposed to have savings so that the total assets were equal, whereas in Experiment 2 the total assets varied. The results of both experiments supported the role of mental accounts in demonstrating that subjects were unwilling to pay in cash after an income decrease even though they had access to saved money. Thus, in effect they chose to pay more for the good than they had to. Indicating a need for further refinement of the concept of mental account, choices to pay in cash after an income decrease tended to be more frequent when the consumption and savings motives were compatible than when they were incompatible. Furthermore, increasing the total assets made subjects more willing to pay in cash after an income decrease. (shrink)

The thesis of this article is that the notion of an ethical food consumer is untenable unless it is coupled with a conception of food citizenship. The main arguments delivered against the notion of ethical food consumption are that consumption does not take the operations of moral psychology into account, nor afford means to tackle structural problems inherent in the relation between consumer and producer. The notion of an ethically aware food citizen is on the other hand capable of handling (...) these problems head on. Hence, a realistic food ethics has to operate with an integrative view of consumption and citizenship. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The (...) aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

BackgroundInvoluntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.MethodsIn-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.ResultsThe answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable (...) to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish Mental Care Act, healthcare organisation and the care environment.ConclusionsInvoluntary treatment was generally seen as an unwanted exception to standard care. The respondents’ judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation. (shrink)

From good intentions to real life: introducing crisis resolution teams in Norway In Norway, as in most western countries, the adult services for people experiencing mental health problems have gone through major changes over the last decades. A report submitted to the Norwegian Parliament in 1997 summarized several areas of improvement in the provision of mental health‐care to its population, and led to the introduction of a national mental health programme in 1998 for its implementation to be completed by 2008. (...) The most significant recent development in Norway is ‘Crisis Resolution/Home Treatment’ (CRHT) teams that provide an alternative to acute hospital care services. The major aim of this study is to explore an emerging form of community mental health‐care, and present a framework for establishment and examination of CRHT teams applying the user perspectives. An illustration of user experiences in an already established CRHT team provides a background for understanding implications of this form of service in relation to service users’ needs in acute crises. (shrink)

This phenomenological-psychological study aims at discovering the essential constituents involved in congenitally blind people's spatial experiences. Nine congenitally blind persons took part in this study. The data were made up of half structured (thorough) interviews. The analysis of the data yielded the following three comprehension forms of spatiality; (i) Comprehension in terms of image-experience; (ii) Comprehension in terms of notions; (iii) Comprehension in terms of knowledge.Comprehension in terms of image experience is the form which is most concretely and clearly experienced. (...) It is important to notice, that this kind of image experience is not synonymous with a visually based image experience — a fact which is discussed in the article. The following three features, which are to be understood as a description of what characterizes congenitally blind people's image experience, are presented; (i) Experience of the whole; (ii) Synthesizing/Harmonizing; (iii) Spontanous presentation of the whole. Furthermore, comprehension in terms of image experience is made up of the following four constituents, which aim at specifying the conditions for the possibility of having an image experience; (i) The image experience is based on tactile experiences; (ii) The inner horizon of the object has to be limited in order for the tactile sense to constitute an image experience; (iii) The person must have reached a certain degree of familiarity with the object; (iv) The importance of the emotional investment in the object. (shrink)

We describe how a model of effective interactions between quantum fluctuations under certain assumptions can be constructed in a way so that the large-scale limit gives an effective theory that matches general relativity (GR) in vacuum regions. This is an investigation of a possible scenario of spacetime emergence from quantum interactions directly in the spacetime, and of how effective quantum behaviour might provide a useful link between detailed properties of quantum interactions and GR. The quantum fluctuations are assumed to entangle (...) sufficiently for a cohesive spacetime to form, so that their effective properties can be described relative to a D-dimensional reference frame. To obtain the desired features of a smooth metric with a vanishing Ricci tensor, the quantum fluctuations are modelled as Gaussian probability distributions, with a shape set relative to the interactions coming from the surroundings. At small scales, the propagation through the spacetime is modelled by a Gaussian random walk. (shrink)

The phenomenon of entrepreneurship has attracted researchers from a variety of disciplines and a diverse number of analytical approaches. Currently, there is a considerable amount of confusion and a variety of conflicting theories which are being used interchangeably and ambiguously. In this important new book, the authors argue that there are analytically distinct forms of entrepreneurship, each of them having an individual logic of their own. They highlight the role of individual economic agents with endowments of new knowledge or new (...) combinations of old knowledge as entrepreneurs, and thus identify them as dynamic factors in the knowledge economy. Overall, this book not only provides a contemporary overview of current research in the field, but also summarizes the policy conclusions that can be drawn from current research. (shrink)

Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to explore ethical challenges in relation to (...) person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. (shrink)

Lessons of history are often referred to in public discourse, but seldom in scholarly discussions. This book wants to change this by introducing an innovative scholarly, analytical model of historical lessons, starting from the basic three-fold perspective that you simultaneously are history, share history, and make history. Not any history is useful for extracting or using lessons. Here, what are denoted as borderline historical events, demonstrating both time-specific and time-transcending qualities, are suggested as useful materials. Scholarly works on the Holocaust (...) and Soviet terror, from Raul Hilberg's and Robert Conquest's classical works of the 1960s to more recent books by Jan Gross and Timothy Snyder, are analyzed to identify lessons of history, and their change during a full half-century. (shrink)

BackgroundVascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient.MethodsQualitative, semi-structured interviews were conducted with 19 (...) vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.ResultsThe surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course.ConclusionsThis study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care. (shrink)

Platelet‐derived growth factor (PDGF) was originally identified in platelets and in serum as a mitogen for fibroblasts, smooth muscle cells (SMC) and glia cells in culture. PDGF has since expanded to a family of dimers of at least four gene products, whose biological actions are mediated through two receptor tyrosine kinases, PDGFRs. The present review summarizes and discusses the biological functions of PDGFs and PDGFRs in developmental processes, mainly as revealed through genetic analysis in mice. Such studies have demonstrated multiple (...) critical roles of PDGFs and PDGFRs in embryonic and postnatal development. PDGFs seem to act upon specific populations of progenitor cells that give rise to several different cell types with distinct functions in a variety of developmental processes. Analogies are seen between the cell functions and the developmental processes controlled by PDGFs. This suggests that ancestral PDGF and PDGFR expression patterns and functions may have been iterated in related sets of morphogenetic processes in the course of evolution. BioEssays 23:494–507, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

The life-cycle theory of saving behavior (Modigliani, 1988) suggests that humans strive towards an equal intertemporal distribution of wealth. However, behavioral life-cycle theory (Shefrin & Thaler, 1988) proposes that people use self-control heuristics to postpone wealth until later in life. According to this theory, people use a system of cognitive budgeting known as mental accounting. In the present study it was found that mental accounts were used differently depending on if the income change was positive or negative. This was shown (...) both in a representative nationwide sample of households and in a student sample. Respondents were more willing to cut down on their propensity to consume when faced with an income decrease than to raise it when the income increased. Furthermore, contrary to the predictions of behavioral life-cycle theory, it was found that the respondents adjusted their propensity to consume the most when the income increases or decreases took place immediately. Hence, it is suggested that theories of intertemporal choice (e.g., Loewenstein, 1988; Loewenstein & Prelec, 1992) provide a better account of the data than does the behavioral lifecycle theory. (shrink)

The acknowledgement of basic human vulnerability in relationships between mental health service users and professionals working in community-based mental health services (in Norway) was a starting point. The purpose was to explore how users of these services describe and make sense of their meetings with other people. The research is collaborative, with researcher and person with experienced-based knowledge cooperating through the research process. Data is derived from 19 interviews with 11 people who depend on mental health services for assistance at (...) least three times a week. Data is analysed according to the Interpretative Phenomenological Analysis (IPA). Results confirm that reciprocity is fundamental for relationships, and that recognizing the individual entails personal involvement. The participants describe a struggle, and recognizing this struggle may help the professional to achieve a deeper understanding of the individual. (shrink)

Mental accounting is a concept associated with the work of Richard Thaler. According to Thaler, people think of value in relative rather than absolute terms. They derive pleasure not just from an object’s value, but also the quality of the deal – its transaction utility (Thaler, 1985). In addition, humans often fail to fully consider opportunity costs (tradeoffs) and are susceptible to the sunk cost fallacy. Why are people willing to spend more when they pay with a credit card than (...) cash (Prelec & Simester, 2001)? Why would more individuals spend $10 on a theater ticket if they had just lost a $10 bill than if they had to replace a lost ticket worth $10 (Kahneman & Tversky, 1984)? Why are people more likely to spend a small inheritance and invest a large one (Thaler, 1985)? According to the theory of mental accounting, people treat money differently, depending on factors such as the money’s origin and intended use, rather than thinking of it in terms of the “bottom line” as in formal accounting (Thaler, 1999). An important term underlying the theory is fungibility, the fact that all money is interchangable and has no labels. In mental accounting, people treat assets as less fungible than they really are. Even seasoned investors are susceptible to this bias when they view recent gains as disposable “house money” (Thaler & Johnson, 1990) that can be used in high-risk investments. In doing so, they make decisions on each mental account separately, losing out the big picture of the portfolio. (See also partitioning and pain of paying for ideas related to mental accounting.) . (shrink)