Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support inspired by Habermas’ theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this (...) study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved. (shrink)

Background Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. Aim The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. Research design The first part of this study concerns the translation of MDT to the (...) Swedish context, and the second part the psychometric testing of the Swedish version. Participants and research context 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done. Ethical considerations The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. Results The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. Conclusion The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. (shrink)

Background Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated. Aim To explore post-graduate nursing students’ experiences of practicing ethical communication in groups Research design The study design is qualitative. Participants and research context The study comprised 12 nursing students on a post-graduate course (...) for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis. Ethical considerations The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University Results An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches. Discussion Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations. Conclusions The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts. (shrink)

BackgroundMoral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one’s convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to (...) the Swedish context.MethodsThe questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0–4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts.ResultsThe Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items’ had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible.ConclusionThe Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context. (shrink)

Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to (...) present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire. Method: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed. Ethical considerations: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results. Findings: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82. Discussion: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole. Conclusion: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole. (shrink)

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of (...) communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

According to modal empiricism, our justification for believing possibility and necessity claims is a posteriori. That is, experience does not merely play an enabling role in modal justification; it isn’t simply that experience explains how, say, we acquire the relevant concepts. Rather, the view is that modal claims answer to the tribunal of experience in roughly the way that claims about quarks and quails answer to it. One serious objection to modal empiricism is the problem of empirical conservativeness: it doesn’t (...) seem that experience can distinguish between modal claims. And if experience can’t manage that, it’s hard to see how it can provide evidence for one claim over the other. So if modal empiricism is true, we ought to be modal skeptics. On the assumption that we shouldn’t be modal skeptics, we should reject modal empiricism. I have two aims here: first, to reply to this objection to modal empiricism; second, to sketch a modal epistemology that fits with the reply I offer. (shrink)

This is the introduction to the Special Issue ‘Foundational Issues in Conceptual Engineering’. The issue contains contributions by James Andow, Delia Belleri, David Chalmers, Catarina Dutilh Novaes, Eugen Fischer, Viktoria Knoll, Edouard Machery and Amie Thomasson. We, the editors, provide a brief introduction to the main topics of the issue and then summarize its contributions.

Some people have moral objections to insect consumption. After explaining the philosophical motivations for such objections, I discuss three of them, suggesting potential replies. The first is that insect consumption ignores the precautionary principle, which we can gloss here as “Don’t know, don’t farm.” In other words, while there might be evidence that insects are not conscious, we do not know that they are not; so, we should not take the moral risk associated with killing them en masse. The second (...) concern is driven by a different way of assessing moral risk — namely, by calculating expected utility. The short version: even if it is incredibly unlikely that insects are conscious, farming them involves harming so many of them that it is better simply to grow plants instead. The third concern is about whether insects live “net negative lives,” with more pain than pleasure. The thought is that if they do, then their lives are not worth living overall, in which case it is wrong to bring them into existence. I conclude by considering the prospects for strategic alliances between animal advocates and those who promote insect consumption, in the even that they are unable to resolve their moral disagreements. (shrink)

Papers presented at a meeting organized by the èOsterreichische Sektion of the International Association for Philosophy of Law and Social Philosophy and the Institut fèur Rechtsphilosophie, Methodologie der Rechtswissenschaften und Allgemeine Staatslehre, Universitèat Salzburg, and held May 18-20, 1983 at the Bildungshaus Virgil, Salzburg.

We show when and how the principles of efficiency and equality might come together and develop a fairness compensation test. A simple graphical analysis is applied. If the faimess compensation test fails, efficiency and justice cannot be fully connected and a wedge between econornic and faimess principles remains. We discuss how important this wedge might be and argue that there does not exist a principle of systematic antinomy between efficiency and faimess.

This paper argues that the value of acting freely and responsibly is a species of the value of self-expression. When I act freely, I write a sentence in the story of my life, and this gives my life the shape of a narrative, which, in turn, gives my life a unique sort of meaning and value.

At many slaughterhouses, if a pregnant cow is killed, then medical companies pay to harvest the fetus's blood. When you communicate the details of this process to people, many of them are disgusted. I submit that those who are repulsed thereby acquire a reason to believe that this practice is morally wrong. However, it is controversial to maintain that disgust can provide moral guidance. So, I develop a theory of disgust’s moral salience that fits with the empirical work that’s been (...) done on it, and I apply it to the collection of bovine fetal blood. I conclude by suggesting how this theory may be of use in animal ethics generally. (shrink)

Converse in the Spirit is a comparative study of the writings of William Blake and the German visionary philosopher Jacob Boehme. It argues that the relationship between Blake and Boehme was a meeting of like minds that transcended place and time, that each regarded himself as part of a community of vision, and aspiration, and believed that any predominant form ofthought and understanding was only partial.

This article is my contribution to an author-meets-critics session on Daniel Dennett’s Freedom Evolves (Viking, 2003) at the 2004 meetings of the American Philosophical Association – Pacific Division. Dennett criticizes a view I defend in Autonomous Agents (Oxford University Press, 1995) about the importance of agents’ histories for autonomy, freedom, and moral responsibility and defends a competing view. Our disagreement on this issue is the major focus of this article. Additional topics are manipulation, avoidance, and avoidability.

An examination of the relationship between philosophical and economic thought in the nineteenth century, Economy and Self explores how the free enterprise theory of Classical Economy influenced and was in turn influenced by the philosophical notion of alienation common in the writings of the age.