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

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

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

In the past decades, narrative practices have been developed, and care has been conceptualized as being narrative in nature. More recently, narrative care has been developing both as a practice and a field of study. It is necessary to make the theoretical foundations of narrative care visible to avoid the risk of narrowly defining narrative care as a matter of storytelling and listening. In this article, we develop an understanding of narrative care grounded in early feminist pragmatist philosophy, with a (...) focus on social and political activism and experience. Pragmatism holds the possibilities to open spaces for realities that are constantly in flux and for emergent situations that must be considered across time, diverse places and social contexts. With the aid of Vera’s stories about her relationship with Tammy, we demonstrate the importance of recognizing that realities are multiple, complex and uncertain. Furthermore, we discuss how the stronghold of formula stories and issues of power, positioning and inequities, restrict people’s possibilities to be, become and co-author their stories. We also argue that the playfulness, imagination and world travelling of narrative care are in line with early feminist pragmatism, which draws on a wide and diverse range of experiences. Jane Addams linked democracy to dialogue, joint experiences and social equality. This calls for the development of ethical frameworks grounded in care that are more specifically focused on relational ethics and a commitment to dialogical and relational democracy and the prioritization of community. (shrink)

In this article, our point of departure is the ‘compassion crisis’ in the National Health Service in the UK and the initiatives introduced in the aftermath of scandals that were intended to strengthen healthcare professionals’ ability to show compassion. We look at the two main strategies, which we term the ‘recruitment and staff development strategy’ and the ‘amelioration of the quality systems strategy’ and the debate that has arisen related to them. Based on this analysis, we question whether compassion really (...) is a helpful concept to understand the crisis and hence to underpin relevant strategies. We introduce the concept of discretion as an alternative and better concept to comprehend the situation. One of the benefits of the concept of discretion is that it clarifies how problems can be addressed, both as structural problems and as epistemic problems and how these aspects are intertwined. It also helps us to see how solving these problems is complicated and demands comprehensive, in-depth approaches, involving formative aspects related to healthcare education, as well as development of new healthcare policies. (shrink)

Much has been written recently about both the urgency and efficacy of teaching business ethics. The results of our survey of AACSB member schools confirm prior reports of similar surveys: The teaching of business ethics is indiscriminate, unorganized, and undisciplined in most North American schools of business. If universities are to be taken seriously in their efforts to create more ethical awareness and better moral decision-making skills among their graduates, they must provide a rigorous and well-developed system in which students (...) can “live ethics” instead of merely learn ethics. A system must be devised to allow students to discover and refine their own values rather than simply learning ethical theories from an intellectual point of view.After reviewing the literature on business ethics in undergraduate curricula, we make a series of recommendations to deliver experiential ethical education for business students. The recommendations include student and faculty written codes of ethics, emphasis on ethical theory within the existing required legal environment course, applied ethics in the functional area capstones using alternative learning, a discussion of employee (and employer) rights and responsibilities during the curriculum capstone course, and a public service requirement for graduation. These recommendations may be implemented without substantive additional cost or programming requirements. (shrink)

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

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

In this chapter, ongoing discussions on powerful knowledge and democratic and inclusive practices are related to teaching existential questions and core values in religious education. In classrooms where both multi-religiousness and secularity characterize the students’ everyday life, it is urgent to offer the students possibilities to discuss norms and values, since they constantly move between various multicultural contexts. The students should be given the opportunity to reflect on questions of core values, ethics, and morality as well as to discuss what (...) democracy, solidarity, equality, and inclusion can mean. One way for teachers to work with these questions is to focus partly on subject literacy and on powerful knowledge in relation to inclusive teaching, partly on a subject content where existential questions and a plurality of norms and core values are expressed together with controversial issues.This chapter strive to contribute to ongoing epistemological and didactical discussions in religious education and by working with democratic practices such as deliberative conversations in relation to controversial issues, the content of conflicts is made visible, and the possibility for students to develop and assess their own opinions, as well as to recognize and respect each other’s diverse identities increase. Thereby, they may also gain an increased knowledge and understanding and consider new perspectives on various sensitive or complex questions. It is the aim of this chapter to explore and illuminate these issues and thus to contribute to the development of epistemological contexts of the subject religious education. (shrink)

Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation. Aim: To describe the elements of assisted bodily care, as performed in a nursing home. Research design: Data were (...) collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis. Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home. Ethical considerations: The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee. Findings: Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care. Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available. Conclusion: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

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

Although various benefits of cats and dogs have been extensively studied, their fundamental economic value is poorly understood. Economic values are, in contrast to monetary values, determined subjectively and guide individuals in their decisions. This study presents a conceptual economic model of the value of cats and dogs which provides a basis for future research. Benefits of cats and dogs identified in the literature are categorized in relation to the model. The multidimensional value of these nonhuman animals includes different use (...) and non-use values, for caretakers and other humans. Data from an online survey on the salience (importance of attributes in memory) of cats and dogs in Sweden provide support for the proposed model. It is argued that the subjective well-being approach developed in psychology provides a good starting point for estimating many of the economic values of these animals, but that different types of values may require different approaches. (shrink)

In global health, several practices rely on the assumption that death has a disvalue for those who die. This includes the fact that we prioritize extending human lives rather than creating new ones, the combination Y_ears Lived with Disability_ (YLD) and _Years of Life Lost_ (YLL) into _Disability-Adjusted Life Years_ (DALYs), as well as managing the trade-off between morbidity and mortality reduction in a health priority setting. According to Epicureanism, however, death cannot have any disvalue for those who die. Three (...) main arguments are offered on behalf of Epicureanism: the view that we cannot experience death (the experience argument), the view that there is no time where death harms us (the time argument), and the view that there is a symmetry between the nonexistence before and after our lives (the symmetry argument). I show that all three arguments fail to convince. (shrink)

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected (...) in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Recently, an overwhelming amount of philosophical works by women has been made available by historians of philosophy. However, this (re)discovery is not adequately reflected in the curricula of philosophy departments in general. This paper discusses which argumentative strategy is most feasible in order to include significantly more women in the philosophy curriculum. In From the Exclusion of Women to the Transformation of Philosophy: Reclamation and its Possibilities (2014), Sarah Tyson identifies four reclamation models, which feminist scholars have utilized to contend (...) why and how women should be included in the philosophy canon. It is shown that the key difference between the so-called corrective and transformative model is whether misogyny is considered an intrinsic feature of philosophy or merely an unfortunate development. It is argued that regardless of the ontological status of the philosophical discipline, both strategies promote engagement with women’s work in a way that revolutionizes current philosophical practice. (shrink)

When Gödel developed his functional interpretation, also known as the Dialectica interpretation, his aim was to prove consistency of first order arithmetic by reducing it to a quantifier-free theory with finite types. Like other functional interpretations Gödel’s Dialectica interpretation gives rise to category theoretic constructions that serve both as new models for logic and semantics and as tools for analysing and understanding various aspects of the Dialectica interpretation itself. Gödel’s Dialectica interpretation gives rise to the Dialectica categories, in: Contemp. Math., (...) vol. 92, Amer. Math. Soc., Providence, RI, 1989, pp. 47–62] and J.M.E. Hyland in [J.M.E. Hyland, Proof theory in the abstract, Ann. Pure Appl. Logic 114 43–78, Commemorative Symposium Dedicated to Anne S. Troelstra ]). These categories are symmetric monoidal closed and have finite products and weak coproducts, but they are not Cartesian closed in general. We give an analysis of how to obtain weakly Cartesian closed and Cartesian closed Dialectica categories, and we also reflect on what the analysis might tell us about the Dialectica interpretation. (shrink)

This article takes its point of departure in a research project studying the psychosocial problems of living with HIV. The project was intended to participate in changing practices dealing with these problems. It became a project including many differently situated and intersecting personal and generalized perspectives. The article researches the development of the HIV project as a contribution to discussions related to Participatory Action Research and Practice Research. In mainstream approaches methodological indications are often presented as rules to follow in (...) order to ensure the quality of the obtained knowledge. But situated historical and societal processes are involved in the effectuation of the HIV project, like they are in any other project. Researching the project heightens the awareness of the necessity of reflecting on situated and historical issues of power and marginalization and on the positions of the researcher in a given field of research. Methodological flexibility may also be necessary in order to encompass different perspectives. Such reflections and strategies are necessary precisely to ensure the development of knowledge and practice alike. (shrink)

The aim of this qualitative study was to gain an understanding of the meaning that community psychiatric nurses impart to their everyday interactions with patients in depot neuroleptic treatment situations. Nine experienced community psychiatric nurses were interviewed using semistructured, open-ended questions. Data analysis was by the phenomenological descriptive method according to Giorgi. Four themes were identified, highlighting aspects of the moral meaning of treating patients with depot neuroleptics: (1) ‘benevolent justification’ occurs when nurses perceive that the patient’s welfare is at (...) stake; (2) ‘inability to advocate the patients’ best interest’ occurs when nurses feel they are at a disadvantage; (3) ‘accommodative interactions’ occur when nurses are able to respond to a patient’s expressed needs; and (4) ‘acceptable advocacy’ occurs when physicians are sensitive to nurses’ suggestions on patients’ treatment. The findings indicate that treatment care planning involving both patients and nurses is essential to enhance patients’ autonomy, which is a precondition for satisfactory interactions. This phenomenological study describes the meaning that nurses give to administering depot neuroleptic injections to patients in the context of community psychiatric clinics. The phenomenon of concern was identified as the moral aspect in the interactions with individual patients in the treatment situation. (shrink)

Volume 19, Issue 5, May 2019, Page 31-33.

Asks what sorts and sources of knowing we should consider compelling as we seek to live morally responsible lives. Contends that Martin Luther's theology of the cross provides a solid theological and ethical basis for a surprisingly congenial conversation with feminist thought and scholarship on these issues.

Det er muligens ikke lenger et spørsmål om, men når mennesker med Downs syndrom ikke lenger finnes blant oss. Moderne medisinsk teknologi brukt i masseundersøkelser av gravide, tilsier at det nesten ikke behøver å bli født mennesker med Downs syndrom i fremtiden. I den politiske debatten i flere av de nordiske landene er dette kontroversielt. Det handler om et samfunn der det er plass til alle, hevdes det. På samme tid tas moderne genteknologi i bruk for bl.a. å forhindre at (...) mennesker disponert for Huntingtons sykdom eller arvelig brystkreft blir født. Om noen generasjoner kan slike sykdommer være utryddet. Dette påkaller imidlertid ikke henvisninger til «sortering» og «seleksjon». I denne artikkelen undersøkes de viktigste forutsetningene for hvorfor fosterdiagnostikk på noen indikasjoner vekker etisk debatt, mens det ikke skjer i andre tilfeller. Det argumenteres for at den medisinske forståelsen av alvorlighetsgrad ved en sykdom/funksjonshemming ikke gir oss nøkkelen til å forstå den etiske bekymringen rundt seleksjon. Identitets- og anerkjennelsesproblematikk, hevdes det, er kjernen i kontroversene rundt fosterdiagnostikk i Norden. Derfor står det noe vesentlig på spill i fosterdiagnostikkdebatten. Men bare for noen grupper. (shrink)

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

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

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

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

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

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

Dette nummeret av Etikk i praksis er i utgangspunktet ikke et temanummer. Profesjonsetiske utfordringer synes likevel å utgjøre et gjennomgangstema i de fleste av artiklene som utgis i dette nummeret. Det er en påminnelse om at en aldri blir ferdig med etiske problemstillinger innenfor et fagfelt, siden fagfeltene og profesjonelle oppgaver samt forventninger til profesjonen forandres hele tiden.

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

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the (...) consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion. (shrink)

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

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

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the (...) child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (shrink)