RATIONALE, AIM AND OBJECTIVE: Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in (...) prescribing drugs, using a qualitative approach. (shrink)

Objectives To explore attitudes and reasoning among Swedish physicians and the general public regarding the withdrawal of life-sustaining treatment at a competent patient's request. Design A vignette-based postal questionnaire including 1202 randomly selected individuals in the county of Stockholm and 1200 randomly selected Swedish physicians with various specialities. The vignettes described patients requesting withdrawal of their life-sustaining treatment: (1) a 77-year-old woman on dialysis; (2) a 36-year-old man on dialysis; (3) a 34-year-old ventilator-dependent tetraplegic man. Responders were asked to classify (...) the act of terminating treatment and to prioritise arguments for/against. Results A majority in both groups prioritised arguments in favour of terminating treatment and classified the act as defensible in all vignettes. However, among the general public, 16% classified the act as euthanasia in all vignettes; among physicians this view was most expressed regarding ventilator treatment (26%). Some who classified the act as euthanasia prioritised arguments in favour of terminating treatment: among physicians 18% in vignette 1, 19% in vignette 2 and 34% in vignette 3; among the general public 35% in vignette 1, 20% in vignette 2 and 48% in vignette 3. Conclusion There is a widespread consensus regarding competent patients' right to abstain from life-sustaining treatment. An association between the hastening of death, caused by the withdrawal of life-sustaining treatment and the concept of euthanasia is proposed. The results also suggest that classifying the withdrawal of life-sustaining treatment as ‘euthanasia’ does not necessarily mean that the act is interpreted as ethically unacceptable. (shrink)

Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection (...) from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient’s dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient’s wishes and needs are the starting point. (shrink)

The Rule of Double Effect (RDE) holds that it may be permissible to harm an individual while acting for the sake of a proportionate good, given that the harm is not an intended means to the good but merely a foreseen side-effect. Although frequently used in medical ethical reasoning, the rule has been repeatedly questioned in the past few decades. However, Daniel Sulmasy, a proponent who has done a lot of work lately defending the RDE, has recently presented a reformulated (...) and more detailed version of the rule. Thanks to its greater precision, this reinvented RDE avoids several problems thought to plague the traditional RDE. Although an improvement compared with the traditional version, we argue that Sulmasy's reinvented RDE will not stand closer scrutiny. Not only has the range of proper applicability narrowed significantly, but, more importantly, Sulmasy fails to establish that there is a morally relevant distinction between intended and foreseen effects. In particular, he fails to establish that there is any distinction that can account for the alleged moral difference between sedation therapy and euthanasia. (shrink)

La presente investigación, tiene por objeto delimitar las consideraciones epistemológicas de la contabilidad ambiental desde tres categorías: funcionalista, interpretativo y crítico, cada una de ellas con 16 subcategorías. La metodología utilizada es de carácter exploratoria, cualitativa, basada en un análisis documental de artículos científicos arbitrados en la más alta exigencia científica (SCOPUS), bajo filtros de búsqueda exacta, con procesamiento sistemático a través de ATLAS.ti9. Los resultados muestran un mayor enraizamiento en el enfoque crítico, destacando el impulso al cambio, los estudios (...) de conflictos, la desigualdad estructural; seguido del enfoque funcionalista, donde predomina el interés por la claridad, el rigor conceptual, así como la pretensión demostrativa y el espíritu de precisión y certeza; finalmente, en el enfoque interpretativo se buscan prácticas racionalizadoras, con una intención comprensiva que impulse a un proceso de resolución. (shrink)

Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in ‘palliative psychiatry’, namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based (...) on WHO’s widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why. (shrink)

To explore Swedish physicians’ arguments and values for and against physician-assisted suicide (PAS) extracted from the free-text comments in a postal survey. A random selection of approximately 240 physicians from each of the following specialties: general practice, geriatrics, internal medicine, oncology, surgery and psychiatry. All 123 palliative care physicians in Sweden. A qualitative content analysis of free-text comments in a postal questionnaire commissioned by the Swedish Medical Society in collaboration with the Karolinska Institute in Stockholm. The total response rate was (...) 59.2%. Of the 933 respondents, 1107 comments were provided. The free-text comments entailed both normative and factual arguments for and against PAS. The analysis resulted in two main categories: (1) “Safe implementation of PAS is unachievable” (with subcategories “Criteria of PAS difficult to fulfil” and “PAS puts societal norms and values at risk”) and (2) “The role of PAS in healthcare” (with subcategories “No medical need for PAS”, “PAS is not a task for physicians”, “No ethical difference to other end-of-life decisions” and “PAS is in the patient’s best interest”). The respondents brought up well-known arguments from academic and public debate on the subject. Comments from physicians against PAS were more often emotionally charged and used devices like dysphemisms and slippery-slope arguments. (shrink)

« Nous sommes tous sur le même bateau », s’écrient les collapsologues, comme s’il s’agissait d’un scoop. Seulement, ces catastrophes annoncées, ou déjà bien amorcées, sont principalement causées par l’Occident et son système économique destructeur. Il s’agit ici de s’interroger sur l’effondrement en adoptant une perspective inversée et d’exposer la démarche de l’autrice de science-fiction Octavia Butler et des continuatrices de son œuvre, qui excellent à rendre possible des histoires alternatives. L’effondrement peut être l’occasion rêvée de changer d’angle et d’échelle (...) et de revenir à l’essentiel. (shrink)

We introduce a new approach to the model theory of metric structures by defining the notion of a metric abstract elementary class (MAEC) closely resembling the notion of an abstract elementary class. Further we define the framework of a homogeneous MAEC were we additionally assume the existence of arbitrarily large models, joint embedding, amalgamation, homogeneity and a property which we call the perturbation property. We also assume that the Löwenheim-Skolem number, which in this setting refers to the density character of (...) the set instead of the cardinality, is ${\aleph_0}$ . In these settings we prove an analogue of Morley’s categoricity transfer theorem. We also give concrete examples of homogeneous MAECs. (shrink)

Since Hilary Putnam and Saul Kripke's first attacks on traditional, descriptivist theories of natural kind terms, it has become customary to speak of the ‘Putnam-Kripke’ view of meaning and reference. This article argues that this is a mistake, and that Putnam's account of natural kind terms is importantly different from that of Kripke. In particular, Putnam has from the very start been sceptical of Kripke's modal claims, and in later papers he explicitly rejects the proposal that theoretical identity statements are (...) metaphysically necessary (if true). I suggest that this is wholly in line with Putnam's earlier, Quine-inspired writings on general terms, and his preoccupation with the philosophy of science. Moreover, I argue that the picture of general terms that emerges from Putnam's writings is more plausible than that suggested by Kripke. However, contrary to Putnam, I also suggest that Putnam's later views on natural kinds and natural kind terms do not support standard Twin Earth externalism. (shrink)

Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the (...) study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions. (shrink)

Ever since Putnam and Burge launched their respective attacks on individualist accounts of meaning the individualist has felt squeezed for space.1 Very little maneuvering room, it seems, is left for the philosopher who wants to deny that meaning and mental content depend on the speaker's social environment. One option, popular amongst individualists, is to grant that reference is socially determined but argue that there is nevertheless a notion of meaning or content that can be understood individualistically. That is, the individualist (...) can opt for a. (shrink)

In the book Gibbard proposes, first, that statements about meaning are normative statements and, second, that they can be given an expressivist treatment, along the lines of Gibbard’s preferred metaethics. In my paper, I examine the first step: The claim that meaning statements are to be construed as being normative, as involving ‘oughts’. Gibbard distinguishes two versions of the normativity of meaning thesis – a weak version, according to which every means implies an ought, and a strong version, according to (...) which for every means, there is an ought that implies it. I argue that neither thesis withstands scrutiny. The weak thesis depends on assumptions about the notion of semantic correctness that the anti-normativist rejects, and the strong thesis does not solve the problems Gibbard wants it to solve: the problems of indeterminacy and meaning skepticism. I conclude that semantics does not need normativity. (shrink)

Crick and Koch’s 1990 “neurobiological theory of consciousness” sparked the race for the physical correlates of subjective experience. 30 years later, cognitive sciences trend toward consideration of the brain’s electromagnetic field as the primary seat of consciousness, the “to be” of the individual. Recent advancements in laboratory tools have preceded an influx of studies reporting a synchronization between the neuronally generated EM fields of interacting individuals. An embodied and enactive neuroscientific approach has gained traction in the wake of these findings (...) wherein consciousness and cognition are theorized to be regulated and distributed beyond the individual. We approach this frontier to extend the implications of person-to-person synchrony to propose a process of combination whereby coupled individual agents merge into a hierarchical cognitive system to which they are subsidiary. Such is to say, the complex mammalian consciousness humans possess may not be the tip of the iceberg, but another step in a succeeding staircase. To this end, the axioms and conjectures of General Resonance Theory are utilized to describe this phenomenon of interpersonal resonant combination. Our proposal describes a coupled system of spatially distributed EM fields that are synchronized through recurrent, entraining behavioral interactions. The system, having achieved sufficient synchronization, enjoys an optimization of information flow that alters the conscious states of its merging agents and enhances group performance capabilities. In the race for the neurobiological correlates of subjective experience, we attempt the first steps in the journey toward defining the physical basis of “group consciousness.” The establishment of a concrete account of the combination of consciousness at a scale superseding individual human consciousness remains speculation, but our suggested approach provides a framework for empirical testing of these possibilities. (shrink)

My paper examines the popular idea, defended by Kripke, that meaning is an essentially normative notion. I consider four common versions of this idea and suggest that none of them can be supported, either because the alleged normativity has nothing to do with normativity or because it cannot plausibly be said that meaning is normative in the sense suggested. I argue that contrary to received opinion, we don’t need normativity to secure the possibility of meaning. I conclude by considering the (...) repercussions of rejecting semantic normativity on three central issues: justification, communication, and naturalism. (shrink)

This paper discusses whether it can be known a priori that a particular term, such as water, is a natural kind term, and how this problem relates to Putnams claim that natural kind terms require an externalist semantics. Two conceptions of natural kind terms are contrasted: The first holds that whether water is a natural kind term depends on its a priori knowable semantic features. The second.

Within the research field of computer-mediated communication, extensive attention has been paid to the differences between CMC and spoken conversation, particularly in terms of sequential structure. In this study, the aim is to analyse how participants maintain continuity and handle discontinuities in institutionally arranged, computer-mediated communication. The empirical material consists of chat log files from in-service training courses for professionals in the food production industry. In the chat sessions we analysed, participants initially had some problems in co-ordinating their postings, that (...) is, keeping track of the discussion’s threading.We also found, however, that methods for co-ordinating postings rather quickly were established among the participants. Two methods for making recognizable how postings were to be read were common in the material: 1) the use of personal names to address a specific participant, and 2) recycling part of the content of a previous posting or reformulating the content in the posting addressed in recognizable ways. We also found an emerging norm in their interaction: that of waiting for one’s turn. (shrink)

Background: The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described. Aim: The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century. Research design: This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the (...) journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson. Ethical considerations: This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met. Findings: Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century. Conclusion: History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife’s profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth. (shrink)

With this treatise, Mahan attempts to do justice to the subject of moral philosophy and, therefore, challenge the student who tries to fathom the depths and ascend the heights of thought.

When people die suddenly and unexpectedly ethical issues often come to the fore. The aim of the study was to describe experiences of members of stroke teams in stroke units of ethical problems and how the teams manage the situation when caring for patients faced with sudden and unexpected death from stroke. Data were collected through four focus group interviews with 19 team members in stroke-unit teams, and analysed using interpretive content analysis. Three themes emerged from the analysis characterized by (...) information, decisions about care and support for the next-of-kin in the changing and uncertain situation, with mutual trust as the core. Mutual trust, both within the stroke team and with next-of-kin was seen by the stroke-team members as a way of handling ethical problems by administering care with the patient’s best interest at heart. (shrink)

It is commonly held that there are internal links between understanding and assent such that being semantically competent with an expression requires accepting certain sentences as true. The paper discusses a recent challenge to this conception of semantic competence, posed by Timothy Williamson (2007). According to Williamson there are no understanding-assent links of the suggested sort, no internal connection between semantic competence and belief. I suggest that Williamson is quite right to question the claim that being semantically competent with an (...) expression e requires accepting a certain sentence S as true. However, Williamson does not merely wish to reject this version of the understanding-assent view, but the very idea that the connection with belief provides constitutive constraints on linguistic understanding and concept possession. This further move, I argue, is very problematic. Giving a plausible account of semantic competence requires accepting that there are constitutive links between understanding and assent, although these links should be construed holistically rather than atomistically. (shrink)

Externalism is widely endorsed within contemporary philosophy of mind and language. Despite this, it is far from clear how the externalist thesis should be construed and, indeed, why we should accept it. In this entry I distinguish and examine three central types of externalism: what I call foundational externalism, externalist semantics, and psychological externalism. I suggest that the most plausible version of externalism is not in fact a very radical thesis and does not have any terribly interesting implications for philosophy (...) of mind, whereas the more radical and interesting versions of externalism are quite difficult to support. (shrink)

This article discusses the thesis that a subject can have a concept, think thoughts containing it, that she incompletely understands. The central question concerns how to construe the distinction between having a concept and understanding it. Two important versions of the thesis are distinguished: a metasemantic version and an epistemic version. According to the first, the subject may have concept C without being a fully competent user, in virtue of deference to other speakers or to the world. According to the (...) second, the subject may have a concept without being able to provide a proper explication of it. It is argued that whereas the epistemic version is plausible, the metasemantic version faces some challenges. First, it needs to be explained precisely how deference enables a speaker to have C. Second, metasemantic incomplete understanding is in tension with the idea that concepts serve to capture the subject’s cognitive perspective. (shrink)

Military activities with the framework of the IDF [Israel Defense Force] is carried out by citizens in a variety of positions. In addition to the ordinary positions of career officers and NCOs, the IDF consists of conscripted men and women as well as reservists. Some of the latter serve under an ordinary command to serve for a certain relatively short period. Other reservists, including pilots and special forces officers have served since they volunteered to serve. Facing the political clash between (...) the government, who have been viewed as trying to change the democratic nature of the state, and the popular opposition, who have tried to protect the judiciary and other elements of democracy, many officers who belong to the latter reservist group have suspended their voluntary service or even retired. Their decision has raised the obvious issue of whether such decisions can be justified, morally, ethically, and democratically. This is the topic of the present paper. (shrink)

The purpose of this article is to outline a systematic answer to the question of collective autonomy, its conceptual nature and lmimits, and apply it by way of example to the case of the engineering profession.In the first section, it is argued that a professional activity involves systematic knowledge and proficiency, a form of continuous improvement of the related bodies of knowledge and proficiency, as well as two levels of understanding: a local one, which is the ability to justify and (...) explain professional acts, and a global one, which involves a conception of the whole profession and its ethical principles.The second section is devoted to a conceptual analysis of professional ethics. It is argued that it consists of a general conception of professionality, a particular conception of the profession under consideration, and a conception of the normative requirements made by the societal envelope of the professional activity, in particular basic norms of democracy.The third section draws conclusions with respect to the nature and limits of professional autonomy. It is shown that such autonomy is much more restricted than its apparent extent. Examples from engineering and other professions are provided. (shrink)

Natural Logic is the science of valid argumentation in natural languages. Every native speaker of any natural language has logical intuitions, pronounceable by his assent or dissent to arguments presented to him in his natural language, like.

Cultural evolution, the propagation and transfer of ideas from generation to generation, as well as from one person to another and from one culture to another, is much faster than normal, genetic evolution. This could account for the speedy proliferation of humankind on this planet, at the expense of other life forms.

The paper discusses the thesis of extended belief and its implications for the possibility of extending ordinary, personal level knowledge. A common worry is that knowledge will overextend, that there will be ‘cognitive bloat’. If the subject’s standing beliefs can be realized in devices such as notebooks and smart phones, what is there to prevent the conclusion that she knows everything stored on such devices? One response to this worry is to block the move from belief to knowledge, and argue (...) that these externally stored beliefs, although reliable, do not qualify as knowledge. I argue, instead, that the fundamental problem arises at the level of belief. We prevent bloating of knowledge by preventing the bloating of belief. To do so, I argue, we need to take seriously Clark and Chalmers’ suggestion that what is distinctive of belief is its role in folk psychological explanations. Paying attention to this role shows that the usual examples, such as Otto’s notebook information, do not qualify as beliefs. To qualify, the external information would have to be much more directly connected to, and deeply integrated into, the subject’s overall system of beliefs and desires. (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT in (...) Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

The thesis examines a central and controversial question in the philosophy of mind and language: Is meaning normative? Are there rules we must follow for our words to have meaning? ;Philosophers are sharply divided over this question. One side, often associated with Wittgenstein and more recently Kripke, sees meaning as essentially normative. If a sign is to be meaningful, then surely, it is argued, there must be a distinction between the correct and incorrect use of that sign. The other side (...) eschews the appeal to rules. This line of thought goes back to Quine, and has been vigorously defended by Davidson, who argues that linguistic rules are no more essential to speaking a language than the rules of etiquette at a dinner table are to consuming food. ;The dissertation proposes that we approach the question by asking whether there is a notion of linguistic incorrectness which is essential to meaning. Various common versions of the notion of linguistic incorrectness are considered, including the one appealed to by Saul Kripke in his discussion of Wittgenstein, the suggestion that going against the communicative conventions is making a linguistic error, and Tyler Burge's idea that we err when we violate certain constitutive community norms. Neither of these suggestions, it is argued, supports the idea that rules are essential to meaning. ;But we should not conclude from this, as does Davidson, that we can reject the notion of linguistic incorrectness altogether. If a speaker is to be interpretable there must be certain constraints on her linguistic use, and a plausible construal of these constraints, it is argued, presupposes a notion of linguistic incorrectness. The conclusion is that there is a notion of linguistic incorrectness which is essential to meaning, although this notion is not to be understood along the ordinary lines. (shrink)

How ethical praxis is shaped by different contexts and situations has not been widely studied. We performed a follow-up study on stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. A number of ways for handling ethical problems emerged, which we have now explored further. Data were collected through a three-part form used as base for individual interviews with 15 stroke team members and (...) analyzed using both quantitative and qualitative content analysis. In the analysis, the approaches in the form were condensed into strategies, and the two different ways those strategies were preferred and used by the team members were shown. Hindrances perceived by the team members to impede them from working the preferred way were also revealed and grouped into eight categories. (shrink)