Background: A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. Objective: This study’s aim was to describe Swedish nurses’ perceptions of influencers on patient advocacy. Research design and context: Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. Ethical considerations: Ethical revisions were made in accordance with national legislation and guidelines by committees for (...) research ethics at Karlstad University. Findings: Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse’s character traits, was described in the perceptions that advocacy is influenced by nurse’s having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse’s bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. Discussion: The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. Conclusion: The nurse’s character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies. (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)

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)

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: 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)

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 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)

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)

Tbe role of Swedish royal family has been reduced to an almost exclusively ceremonial one during the 20th century, and this reduction of functions has possibly been carried out further in Sweden than in any other monarchy - with the exception of Japan. The Swedish King is for example no longer responsible even pro forma for the formation of the Government, but it took a long time before he was thus stripped of all his power.By the mid-1800s his influence on (...) the economy had been greatly diminished, and by 1905 bis influence on foreign policy had also vanished. Tbe last time a Swedish King ex erts any real power is in 1914, when he insisted on choosing bis own advisors. In reality he only managed to substitute a government he disliked for one which he liked better. But after 1917, when the King is forced to accept a government which included Social Democrats, his influence is reduced to virtually nothing. Officially, however, the King is not reduced to figure-head until 1974, when the new Swedish constitution was passed. Tbe new constitution stated, after a great deal of negociating between the Social Democrats and the nonsocialist parties, that Sweden should remain a monarchy hut the Head of State should only have a ceremonial role. Apparently no one in the royal f amily had any serious objections to this new order and they didn 't try to stop it. Power and influence is not, however, only related to the laws of a country. The King and the whole royal family still exert a good deal of influence over the Swedish people by setting an example. The image the royal family wants to project is that of traditional conservative values ; they are all in f a vor of a strong defence, church going and f amily life. The present King has given bis opinion on a few occasions on rather controversial issues - whether this has been part of a strategy or simply a mistake is impossible to say. All in all the present royal family seems to be quite satisfied with their position as figure-head on the Swedish barge, which, according to the public opinion polls, the Swedish people consider to be a very fitting role for a modern monarch. (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)

ABSTRACTColin Hay's constructivist institutionalism and Vivien A. Schmidt's discursive institutionalism are two recent attempts to theorize ideas as potential explanations of institutional change. This new attention to the causal role of ideas is welcome, but Hay and Schmidt do not take into consideration the constitutive and structural aspects of ideas. Instead they reduce ideas to properties of individual conscious minds, scanting the respects in which ideas are intersubjectively baked into the practices shared by individuals. This aspect of ideas—arguably, the institutional (...) side of ideas—is developed in post-structuralist thought, which therefore demands a place in ideational research. (shrink)

Colin Hay’s and Vivien Schmidt’s responses to my previous critical engagement with their respective versions of neo-institutionalism raise the issue of how scholars may account for the ideational power of political processes and how ideas may generate both stability and change. Even though Hay, Schmidt, and I share a common philosophical ground in many respects, we nevertheless diverge in our views about how to account for ideational power and for actors’ ability to navigate a social reality that is saturated with (...) structures and meaning. There continues to be a need for an analytical framework that incorporates discourse and a constitutive logic based upon the power in ideas. Post-structural institutionalism (PSI) analyzes discourse as knowledge claims by means of the concept of a constitutive causality, analytically identified in respect to institutions, such that the substantive content of ideas/discourse provides ideational power and generates immanent change. (shrink)

In relation to semantics, “grounding” has two relevant meanings. “Symbol grounding” is the process of connecting symbols to perception and the world. “Communicative grounding” is the process of interactively adding to common ground in dialog. Strategies for grounding in human communication include, crucially, strategies for resolving troubles caused by various kinds of miscommunication. As it happens, these two processes of grounding are closely related. As a side-effect of grounding an utterance, dialog participants may adjust the meanings they assign to linguistic (...) expressions, in a process of semantic coordination. Meanings of at least some expressions include perceptual aspects which enable DPs to classify entities as falling under the expression or not based on their perception of those entities. We show how perceptual grounding of symbols can be achieved in a process of interactively adding to common ground. This requires that perceptual aspects of meaning can be updated as a result of participating in linguistic interaction, thereby enabling fine-grained semantic coordination of perceptually grounded linguistic meanings. A formal semantics for low-level perceptual aspects of meaning is presented, tying these together with the logical-inferential aspects of meaning traditionally studied in formal semantics. The key idea is to model perceptual meanings as classifiers of perceptual input. This requires a framework where intensions are represented independently of extensions, and structured objects which can be modified as a result of learning. We use Type Theory with Records, a formal semantics framework which starts from the idea that information and meaning are founded on our ability to perceive and classify the world, that is, to perceive objects and situations as being of types. As an example of our approach, we show how a simple classifier of spatial information based on the Perceptron can be cast in TTR. (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)

Drawing upon the literature on action research and case-study research, this paper discusses similarities and differences between these two forms of research practice. The paper also highlights some of the criticisms and challenges action researchers face. It suggests ways in which action researchers may enhance the discussability of action research by: (a) increasing the transparency of their research processes, (b) declaring the intellectual frameworks brought into action research projects, (c) discussing transferability of findings, and (d) defining accumulation of results. This (...) may require an extension to scientific discourse. In particular, the paper suggests that action researchers could change the ways in which action research results are reported to increase their reach among a wider audience. (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)

The paper describes a methodology to be used for analysis and design of human activity systems. The methodology is based on an analysis of the decision settings whereas most other decision analysis methodologies are analysing the process. The decision concept is analysed and discussed. A distinction between programmed and programmable as well as non-programmed and non-programmable decisions is proposed. A classification of different information types for decision making is presented. A methodology based on a systemic and systematic analysis of the (...) information requirements of an organization is proposed. This methodology also indicates organizational discrepancies and information imbalances. The methodology focuses the settings of the decisions on all levels of organizations. The methodology can be regarded as a dynamic, learning system. The author proposes further research on the individuals decision making abilities. (shrink)

In this article I look at two works by Swedish video artist Lina Selander and explore how underlying visual patterns unfold in these works that are connected to certain worldly phenomena. Borrowing from Jacques Derrida, I describe the tendency of being en mal d'archive as an obsession to structure the world into particular recognizable patterns. I argue that Selander's works can be understood as the unfolding of such structures, the result being that the very impulse itself, the obsession Derrida speaks (...) of, comes to the forefront. In several of Selander's works, light is explored both as a basis and prerequisite for photography and as a metaphor for this potentially destructive desire for all-encompassing knowledge and structure. As such, I argue, the unfolding that takes place in her works can be understood as paradoxically increasing the shadows ‐ as a way of undoing the totalizing effect of light and articulating modes of not knowing or mystery in relation to the phenomena explored. (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)

The author of Look Back in Anger, Inadmissible Evidence, and The Entertainer has created a brilliant dramatization of this classic about a man who retains his youth while the decay of advancing years and moral corruption appears on a portrait painted by one of his lovers.

The article uses embodiment and the experiential basis of conceptual metaphor to argue for the metaphorical essence of abstract legal thought.concepts like ‘law’ and ‘justice’ need to borrow from a spatial, bodily, or physical prototype in order to be conceptualised, seen, for example, in the fact that justice preferably is found ‘under’ law. Three conceptual categories of how law is conceptualised is examined: law as an object, law as a vertical relation, and law as an area. The Google Ngram Viewer, (...) based on the massive library of books that Google has scanned, has been used to study legally relevant conceptions over time within each of these three categories, from 1800 to 2000. In addition, the article suggests a type of analytical method of ‘metaphor triangulation,’ that is, the replacement of prevailing metaphors with unusual ones in order to increase the level of awareness of what conceptual content the prevailing metaphors involve. (shrink)

To develop students’ critical thinking is one of the primary goals of a modern democratic school system. However, what is to be developed has been the matter of long-standing debate. One particular area of conflict has been what role is played by the knowledge concerning the object to be critically thought about. The ‘specifists’ have asserted that knowledge about the object is the core. The ‘generalists’ have claimed that there is no need for any actual profound knowledge. Typically, this debate (...) has been held at a theoretical and philosophical level. In this paper, I will make an empirically based contribution to the debate. In a unique approach, I will use a number of student essay responses to argue in favour of a specifist view, and at the same time to question some of the generalists’ basic assumptions. The paper ends with an appeal to the generalists to provide us with proper clarification regarding the questions I raise. This is important as they hold the dominant position in the field. If they are to continue to do so, we need to be clear about the accuracy of their basic assumptions. This becomes even more essential as the generalist research has been severely criticised for producing inconclusive results, as well as the fact that the generalist view on critical thinking has been adopted by major policymakers both in Europe and the United States. (shrink)

Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the (...) views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older (>75) persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person. (shrink)

ABSTRACT The technocratic dimension of government—its reliance upon knowledge claims, usually in scientific guise—is of great importance if we wish to understand modern power and governance. In Power Without Knowledge: A Critique of Technocracy, Jeffrey Friedman investigates the often-overlooked question of the relationship between technocratic knowledge/power and ideas. Friedman’s contribution to our understanding of technocracy can therefore be read as a contribution to governmentality studies, one that introduces the possibility of adding normative solutions to this critical tradition.

Recent studies of conceptual metaphors in a legal context have often dealt with the power of embodiment. However, the connotations of culturally originated metaphors could be different when they appear in laws and regulations. In particular, the role of metaphor when the legislator wishes to define intention in hybrid organizations is investigated here. The case studied is how a conceptual metaphor of ‘business’ manifesting itself in the Swedish simile adjective affärsmässig has spread over 40 years. ‘Business’ early on acquired connotations (...) such as impartiality and methodical approach, and can be used metaphorically. Introduced in the regulation of public procurement, ‘businesslike’ was later used to regulate conflicts of interest, restrict state aid and also entered tax legislation. Analysis of Swedish court decisions where ‘businesslike’ occurs shows how the emphasis has shifted from public sector efficiency to neo-liberal principles of competition, while stronger social norms related to environmental effects have led to the term being removed from the Public Procurement Act. Elements of a mixed jurisdiction arise from reliance on EU case-law, and national use of ambiguous cultural metaphors in legal texts and court decisions is a plausible response. (shrink)

1This work was supported in part by the projects TRINDI (Task Oriented Instructional Dialogue), EC Project LE4-8314, SDS (Swedish Dialogue Systems), NUTEK/HSFR Language Technology Project F1472/1997, INDI (Information Exchange in Dialogue), Riksbankens Jubileumsfond 1997-0134, and SIRIDUS (Specification, Interaction, Reconfiguration in Dialogue Understanding Systems), EC Project IST-1999-10516, and ILT (Interactive Language Technology), Vinnova Project 2001-6340. To appear in Presuppositions and Discourse ed. by Rainer Bäuerle, Uwe Reyle and Thomas Ede Zimmermann, Elsevier, Amsterdam.