Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral (...) doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

In this paper I trace Husserl’s transformation of his notion of phantasy from its strong leanings towards empiricism into a transcendental phenomenology of imagination. Rejecting the view that this account is only more incompatible with contemporary neuroscientific research, I instead claim that the transcendental suspension of naturalistic (or scientific) pretensions precisely enables cooperation between the two distinct realms of phenomenology and science. In particular, a transcendental account of phantasy can disclose the specific accomplishments of imagination without prematurely deciding upon a (...) particular scientific paradigm for its experimental investigation; a decision that is best left to the sciences themselves. (shrink)

The allocation of vaccines and therapeutics for Covid‐19 obviously raises ethical questions, and physicians and ethicists have begun to address them. Writers have identified various criteria that should guide allocation decisions, but the criteria often conflict and need to be balanced against one another. This article proposes a model for thinking about how different considerations that are relevant to the distribution of vaccines and scarce treatments for Covid‐19 could be integrated into an allocation procedure. The model employs the construct of (...) a weighted lottery, which is a construct that has been employed in other contexts that involve the distribution of scarce resources. The article highlights the advantages of applying a weighted lottery to the Covid‐19 context and offers an illustration for how it might work in practice. The primary aim of the article is to articulate the structural features of a weighted lottery for this context and to bring out its advantages over other methods for allocating Covid‐19 medications. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic (...) optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term ‘therapeutic optimism’—one is ethically benign and the other is potentially worrisome. Distinguishing these two phenomena is crucial for understanding the nature and ethical significance of therapeutic optimism. The failure to draw a distinction between these phenomena also helps to explain why different writers on the topic often speak past one another. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

Scholars have recognized that contentious political action typically draws on relatively stable scripts for the enactment of claims making. But if such repertoires of political practice are generally reproduced over time, why and how do new modes of practice emerge? Employing a pragmatist perspective on social action, this article argues that change in political repertoires can be usefully understood as a result of situated political innovation—i.e., of the creative recombination of existing practices, through experimentation over time, by interacting political agents (...) for whom old repertoires were proving inadequate to the changing context of action. The utility of this approach is demonstrated by applying it to explain the historical emergence of a new set of populist mobilizing practices in early twentieth-century Peru. The results have implications for the study of political action and historical change. (shrink)

In this paper, we defend the ethics of clinical research against the charge of paternalism. We do so not by denying that the ethics of clinical research is paternalistic, but rather by defending the legitimacy of paternalism in this context. Our aim is not to defend any particular set of paternalistic restrictions, but rather to make a general case for the permissibility of paternalistic restrictions in this context. Specifically, we argue that there is no basic liberty-right to participate in clinical (...) research and that considerations of distributive fairness justify some paternalistic protections of research subjects. (shrink)

Much work in social ontology analyzes how social entities are based on collective intentionality. A neglected perspective is, however, the distinction between those social entities that are explicitly established (often called formal institutions, like marriages), those that are established but not explicitly (informal institutions, like friendships), and those that are not established at all (social macro entities, like episodes of inflation). To shed more light on this trichotomy, a collection of examples taken from the works of John Searle will be (...) discussed, comprising money, marriages, friendship, cocktail parties, natural language, and episodes of inflation. The chapter argues that explicit establishment confers certain typical characteristics on formal institutions that informal institutions lack, thus explaining the typical differences between marriages and friendship. The focus on explicit establishment further develops Khalidi’s classification of social kinds, and it contributes to Epstein’s quest for grounds and anchors of social entities. It can thus contribute to overcoming the narrow focus on collective intentionality. (shrink)

This article presents an analysis and evaluation of what I call the “I’m not stupid” argument. This argument has ancient roots, which lie in Aristotle’s famous description of the weak man’s and strong man’s arguments. An “I’m not stupid” argument is typically used in a context of accusation and defense, by a defendant who argues that they did not commit the act of which they have been accused. The analysis of this type of argument takes the shape of an argumentative (...) pattern, which displays a full-fledged representation of its argumentation structure. It is based on a collection of ten contemporary instances of the “I’m not stupid” argument. Although ten instances constitute a small collection, the wide variation in the argumentative elements that they express explicitly or leave implicit made it possible to identify five new key premises in comparison with previous analyses of the weak man’s and strong man’s arguments (Walton, Tindale and Gordon 2014 in _Argumentation_ 28:85–119, 2014; Walton 2019 in _Argumentation_ 33:45–74, 2019). These new premises show that the crucial point of an evaluation of this argument is the arguer's supposedly rational character in making a gain-loss calculation. They also show that we need empirical data to strengthen our analyses of argument schemes and argumentation structures. (shrink)

: "Clinical pragmatism" is an important new method of moral problem solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral problems can be solved experimentally, (...) it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving. (shrink)

Special Issue, n. I, ch. 1, On the Transcendental.

Australia’s punitive policy towards people seeking asylum deliberately causes severe psychological harm and meets recognised definitions of torture. Consequently, there is a tension between doctors’ obligation not to be complicit in torture and doctors’ obligation to provide best possible care to their patients, including those seeking asylum. In this paper, we explore the nature of complicity and discuss the arguments for and against a proposed call for doctors to boycott working in immigration detention. We conclude that a degree of complicity (...) is unavoidable when working in immigration detention, but that it may be ethically justifiable. We identify ways to minimise the harms associated with complicity and argue that it is ethical to continue working in immigration detention as long as due care and attention is paid to minimising the harms of complicity. (shrink)

ABSTRACT When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end‐of‐life contexts, when patients are receiving ‘artificial’ life‐support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten (...) his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self. (shrink)

The ethical standards that regulate clinical research have multiple rationales. Among them is the need to protect potential subjects from making imprudent decisions, which extends beyond the soft paternalistic concern to protect people from making uninformed decisions to participate in trials. This article argues that a plausible risk/benefit restriction on clinical trials is presumptively justified by hard paternalism, which in turn is supported by a deeper fairness-based rationale. This presumptive case for hard paternalism in research is not defeated by the (...) alleged right to participate in clinical trials, by concerns about insult or status, by the need to conduct early phase trials that promise little to no benefit to participants, or by the recognition that some potential subjects are altruistically motivated. (shrink)

Margaret Gilbert has defended the claim that her plural subject theory can give a reasonable account of retrospective (or backward-looking) collective responsibility. On one occasion, publishing in this periodical, she writes that she deliberately left out the discussion of prospective (or forward-looking) collective responsibility, or the “responsibilities” of a collective. In the present paper, I want to show that plural subject theory, in fact, also allows accounting for prospective responsibilities of groups and institutions. In order to do so, I will (...) first sketch the social ontological background of my discussion which is, in fact, an amended version of Gilbert’s theory of plural subjects (§ 2). Based on the assumption that a prospective responsibility accrues from some kind of commissioning, I will then discuss a variety of possible sources of prospective collective responsibilities: self-commissioning, third-party commissioning and what I will call commissioning by unique capability (§ 3). Having done so, I will discuss some consequences of this account and defend it against objections (§ 4). (shrink)

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as well as the nature and limits (...) of the authority they exercise over them. (shrink)

We are currently in the midst of a revival of interest in thevirtues. A number of contemporary moral philosophers havedefended a virtue-based approach to ethics. But does thisrenewal of interest in the virtues have much to contributeto medical ethics and medical practice? This paper criticallydiscusses this question. It considers and rejects a number ofimportant arguments that purport to establish the significanceof the virtues for medical practice. Against these arguments,the paper seeks to show that while the virtues have a genuinerole to (...) play in medical ethics, it is a limited role, one thatis subordinate to the role that other moral concepts such asrules and principles play. (shrink)

Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. (...) Drawing on the experience of multiple clinical trials at a single academic medical centre in the USA, we posit that concurrent COVID-19 trials are liable to unfair and inequitable subject selection on account of scientific uncertainty, lack of transparency, scarcity and, lastly, structural barriers to equity compounded by implicit bias. To address the critical gap in the current literature and international regulation, we propose new ethical guidelines for research design and conduct that bolsters fair and equitable subject selection. Although the proposed guidelines are tailored to the research design and protocol of concurrent trials in the COVID-19 pandemic, they may have broader relevance to single COVID-19 trials. (shrink)

The network society is generally challenging for today's communication practitioners because they are no longer the sole entities responsible for communication processes. This is a major change for many of them. In this paper, it will be contended that the normative practice model as developed within reformational philosophy is beneficial for clarifying the structure of communication practices. Based on this model, we argue that government communication should not be considered as primarily an activity that focuses on societal legitimation of policy; (...) rather, it focuses on clarifying the meaning of the actions of the government. If the government can convincingly answer the question about the reason for their actions, societal legitimation will subsequently follow. Hence, it is argued that government communication is primarily linguistically qualified. (shrink)

Although many studies have revealed the importance of study skills for students' first?year performance and college retention, the extent of the impact of study skills preparation on students' academic achievement is less clear. This paper explores the impact of pre?university study skills preparation on students' first?year study experiences, academic achievement and persistence. The setting for this study is a large law school in the Netherlands which attracts students from more than 100 schools for secondary education. The results show that the (...) perceived study skills preparation concerning time management and learning skills does have a positive impact on college students' first?year study behaviour and academic achievement. However, the study also shows that the impact of perceived college preparation is far less important for college retention than other factors such as satisfaction about the chosen degree programme and tutorial attendance. (shrink)

(2010). The representation of animals in the early modern period. Annals of Science: Vol. 67, The Representation of Animals in the Early Modern Period, pp. 299-301. doi: 10.1080/00033790.2010.488139.

This paper questions the widespread supposition that artifact kinds are kinds of artifacts. I will argue that this supposition rests on a one-sided diet of examples taken from inanimate physical things and the neglect of social and biological artifacts. I will argue that belonging to an artifact kind and being an artifact are independent Features: The first divides off artifacts from non-artifacts, the second rests on the distinction between instances of artifacts kinds and instances of natural kinds. I claim that (...) these two distinctions are orthogonal to each other, and besides the two canonical combinations of artificial instances of artifact kinds and non-artificial instances of natural kinds there are also non-artificial instances of artifact kinds and artificial instances of natural kinds. Moreover, as some artificial living beings are self-reproducing, some instances of an artifact kind are not themselves artifacts. Hence artifact kinds are not of necessity kinds of artifacts. (shrink)

When patients enrolled in early‐phase cancer treatment trials are asked later to explain their decision to participate, they often reveal unrealistically high expectations for therapeutic benefit from participation. This phenomenon has given rise to a complex and ongoing debate over the quality and validity of informed consent to these trials. Bioethicists and researchers must better understand these expectations and why research participants so often have them. This article presents a new explanation for this phenomenon by drawing on social psychology research (...) on mindsets and, in particular, on a distinction between deliberative and implementation mindsets. (shrink)

BACKGROUND -/- In biomedical ontologies, mereological relations have always been subject to special interest due to their high relevance in structural descriptions of anatomical entities, cells, and biomolecules. This paper investigates two important subrelations of has_proper_part, viz. the relation has_grain, which relates a collective entity to its multiply occurring uniform parts (e.g., water molecules in a portion of water), and the relation has_component, which relates a compound to its constituents (e.g., molecules to the atoms they consist of). -/- METHOD -/- (...) We distinguish between four kinds of complex entities and characterize them in first order logic. We then discuss whether similar characterizations could be given in description logics, and finally apply the results to mixtures. -/- RESULTS -/- At first sight, collectives and compounds seem to be disjoint categories. Their disjointness, however, relies on agreement about what are uniform entities, and thus on the granularity of description. For instance, the distinction between isomeric subtypes of a molecule can be important in one use case but might be neglected in another one. We demonstrate that, as implemented in the BioTop domain upper level ontology, equivalence or subsumption between different descriptions of same or similar entities cannot be achieved. Using OWL-DL, we propose a new design pattern that avoids primitive subrelations at the expense of more complex descriptions and thus supports the needed inferences. (shrink)

Digitalization has become a cornerstone of competitiveness in the industrial arena, especially in the cases of small lot sizes with many variants in the goods produced. Managers of industrial facilities have to handle the complexity that comes along with Industry 4.0 in diverse dimensions to leverage the potentials of digitalization for their sites. This article describes major drivers of this complexity in current industrial automation to outline the environment of today’s challenges for managers of this technical transition—and shows how managed (...) industrial security services can contribute to stabilize the industrial system. An outlook is given to future automation scenarios as well as the major concepts involved in their protection. (shrink)

Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...) bias in other contexts. Results One hundred and seventy-one patient-subjects agreed to be interviewed for our study. Significant levels of perceived controllability were found with respect to all nine research-related questions. Perceptions of control were found to predict unrealistic optimism. Two other risk attribute variables, awareness of indicators and mental image, were correlated with unrealistic optimism. However, in multivariate regression analysis, awareness and mental image dropped out of the model and perceived controllability was the only factor independently associated with unrealistic optimism. Conclusion Patient-subjects reported that they can, at least partially, control the benefits they receive from participating in an early-phase oncology trial. This sense of control may underlie unrealistic optimism about benefiting personally from trial participation. Effective interventions to counteract unrealistic optimism may need to address the psychological factors that give rise to distorted risk/benefit processing. (shrink)

This article analyses how recent critiques of secularism in political philosophy and cultural anthropology might productively be combined and contrasted with each other. I will show that Jürgen Habermas' postsecularism takes insufficient account of elementary criticisms of secularism on the part of anthropologists such as Talal Asad and Saba Mahmood. However, I shall also criticize Saba Mahmood’s reading of secularism by arguing that, in the end, she replaces the secular–religious divide with a secularity–piety divide; for example, in her reading of (...) Nasr Abu Zayd’s secular Islamic hermeneutics. This inhibits the use of her framework of analysis for a criticism of a problem central to Habermas' postsecularism, namely that it remains focused on specific intensities of belief. I shall then argue that, combined with the anthropological critiques of the secular, the political-historical nature of the fanaticism–piety–violence nexus should be integrated into political philosophical debates on secularism and postsecularism. (shrink)

Introduction - This paper is aimed at gaining more insight into the effects of camera-surveillance on behavior. This study investigates the effects of three different ways of ‘framing’ camera presence on cheating behavior and pro-social behavior. First, we explore the effect of presenting the camera as the medium through which an intimidating authority watches the participant. Second, we test the effect of presenting the camera as being a neutral, non-intimidating viewer. Third, we investigate whether a participant watching themselves via a (...) camera has an effect on their behavior. In contrast to most studies of camera surveillance, we will conduct our experiments in an indoor setting, enabling us to investigate behavior to a much greater detail. We will also explore possible moderating effects of personality traits. Methods - 86 students participated in this experiment, distributed over four conditions: three different ways of framing the camera presence, plus a control condition. Our main dependent variables were various kinds of cheating and pro-social behavior. We established the participant’s relevant personality traits in a separate session. Results - For cheating behavior, findings showed that the ‘authorative’ way of framing camera presence and the situation in which participants viewed themselves, differed significantly from a situation without camera-surveillance. We did not find significant effects of camera surveillance on pro-social behavior during the experiment. Looking at personality traits, we found an indication that people with an internal locus of control are more inclined to cheat when there is no camera present compared to people with an external locus of control. However, the effects of our manipulations were stronger. Conclusion - These results support the idea that the framing of a camera’s presence does indeed influence cheating behavior, adding to the preventive effects of camera-surveillance. Additionally, this study provides some valuable insights into the influence of camera presence on behavior in general. (shrink)

There is broad agreement among research ethicists that investigators have a duty to obtain the informed consent of all subjects who participate in their research trials. On a common view, the duty to obtain this informed consent follows from the need to respect persons and their autonomous decisions. However, the nature of informed consent and the demands it places on investigators are open to dispute and recently have been challenged. Respect for persons, it has been claimed, does not require investigators (...) to guarantee that the subjects enrolled in their trials comprehend the risk/benefit information disclosed to them or even that they appreciate the difference between research and therapy. According to this critique, the significance of defects in informed consent, like therapeutic misconception or unrealistic optimism, has been greatly exaggerated. This article reevaluates informed consent in clinical research in light of this critique. It not only rebuts the main points the critics raise, but also shows that other points they raise can be accepted by a doctrine of informed consent that resembles the common view in maintaining that autonomous authorization is central to informed consent. (shrink)

This paper discusses idiomatic expressions like ‘that says it all’, ‘that says a lot’ etc. when used in presenting an argument. These expressions are instantiations of the grammatical pattern that says Q, in which Q is an indefinite quantifying expression. By making use of the pragma-dialectical theory of argumentation and the linguistic theory of construction grammar it is argued that instantiations of that says Q expressing positive polarity can fulfil the role of an argumentation’s linking premise. Furthermore, an analysis of (...) these expressions as presentational devices shows that an arguer can use them for strategic reasons, i.e. to leave the exact formulation of the standpoint implicit and to present the argument as self-evident. Using these devices derails into fallaciousness when the context offers insufficient clues to reconstruct the standpoint or when the argument does not offer the kind of support that would be required by the specific instantiation of Q. The argumentative function of instantiations of that says Q expressing negative polarity is that an antagonist can use them to attack the justificatory power of the protagonist’s argument. (shrink)

This study examines the extent to which the highly diverse and volatile Dutch electorate received a diverse offer of political newspaper coverage during the 2006 general election campaign. We measured the level of diversity of five subscription based national newspapers with a partisan history and two free dailies. Two forms of diversity were examined: party diversity and issue diversity. The diversity of party coverage in the free dailies was greater than the diversity across all newspapers. Whereas free dailies paid a (...) relatively large amount of attention to new and opposition parties, traditional newspapers paid a relatively large amount of attention to the parties with whom they were aligned during the period of “pillarization”. Conversely, we only found small differences in the distribution of attention to issues. The diversity of issue coverage across newspapers was larger than the diversity within newspapers. (shrink)

Lærdom der lyser -- Calderón : livet er en drøm -- Carl von Linné : Nemesis Divina -- Friedrich Schlegel -- Grundtvig og Kierkegaard -- F.C. Sibbern : meddelelser af indholdet af et skrift fra aar 2135 -- Sjælens triumf -- Fantasiens Janushoved : den historiske roman og fremtidsvisionen -- Når oldtid bliver til nutid -- Angsten der helbreder : David Lodge og Kierkegaard som terapeut.