This article is based on a qualitative longitudinal study that followed the subjective experiences of both people living with dementia and their family members during the early stages of the illness. The purpose of this article is to describe and reflect on the ethical and methodological issues that occurred during data collection. The article focuses on the situation of the person with dementia and the family member and the role of the researcher when conducting the research interviews. Based on the (...) results of this study, conducting research interviews with people with dementia and their family members poses several ethical and methodological challenges that must be addressed. In doing so, ethically sound dementia-specific research methods will be actively developed enhancing our understanding of living with dementia and providing new insights into the care of people with dementia and their family members. (shrink)

This study investigated Finnish nurses’ experiences and views on end-of-life decision making and compared them with physicians’ views. For this purpose, a questionnaire was sent to 800 nurses, of which 51% responded. Most of the nurses had a positive attitude towards and respect for living wills, more often than physicians. Most also believed that a will had an effect on decision making. Almost all of the nurses considered it their responsibility to talk to physicians about respecting living wills. Do-not-resuscitate (DNR) (...) orders were often interpreted to imply partial or complete palliative (symptom-orientated) care, which may cause confusion. Half of the nurses reported that a DNR decision was discussed always or often with a patient who was able to communicate; physicians were more positive in this respect. Surprisingly, many nurses (44%) stated that active treatment continued too long. Two-thirds thought that their opinions were taken into account sufficiently, even though only half believed that, in general, they had some impact. (shrink)

Post–World War II developments concerning citizenship and access as one of the dimensions of citizenship are examined through the prism of noncitizenship and rights, using the drafting of the asylum paragraph of the 1949 Grundgesetz of the Federal Republic of Germany as a specific case study. The aim of this article is to look into the creation of the right to asylum in West Germany, to examine its political history by exploring its development and by searching for its conceptual, political, (...) and rhetorical origins. The article investigates the birth of the unique conceptualization of asylum in the debates of the Parliamentary Council, the constitutional and quasi-parliamentary assembly responsible for the writing of the postwar Basic Law, and examines the political choices, motivations, and compromises behind its creation. To connect the matter of asylum to a wider problematic related to noncitizens and rights, the article benefits from the political philosophy of Hannah Arendt, with reference to her writings on human rights and refugees in the immediate post–World War II period. (shrink)

Objectives: This study investigated Finnish physicians’ experiences of decisions concerning living wills and do not resuscitate orders and also their views on the role of patients and family members in these decisions.Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice ; internal medicine ; neurology , and oncology .Results: The response rate was 56%. Most of the respondents had a positive attitude toward , and respect for living wills, and 72% reported situations in which such (...) a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden or only palliative care required . The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed.Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind. (shrink)

Our aim was to study how nurses interpret patient autonomy in end-of-life decision making. This study built on our previous quantitative study, which evaluated the experiences of and views on end-of-life decision making of a representative sample of Finnish nurses taken from the whole country. We performed qualitative interviews with 17 nurses and analysed these using discourse analysis. In their talk, the nurses demonstrated three different discourses, namely, the ‘supporter’, the ‘analyst’ and the ‘practical’ discourses, each of which outlined a (...) certain position for patients and relatives, and a certain identity for the nurses in end-of-life decision making. The nurses’ talk showed notable differences when compared with that of physicians, highlighting the differences that take place in respect of the image of a person’s work, professional culture, professional identification and responsibilities. An important finding was that the nurses often described their participation in end-of-life decision making in terms of indirect influence. (shrink)

Background Shared responsibility is an essential part of family-centred care and it characterizes the relationship between parents and healthcare professionals. Despite this, little is known about their shared responsibility for decision-making in neonatal intensive care units. Aim The aim of this scoping review was to identify previous studies on the subject and to summarize the knowledge that has been published so far. Method The review was conducted using electronic searches in the CINAHL, PubMed, Scopus and PsycINFO databases and manual searches (...) of the reference lists of the selected papers. The searches were limited to peer-reviewed papers that had been published in English from 2010 to September 2021. The data were selected based on inclusion and exclusion criteria and the findings were inductively summarized. We identified eight papers that met the inclusion criteria. Ethical considerations: The scoping review was conducted according to good scientific practice by respecting authorship and reporting the study processes accurately, honestly and transparently. Results The results showed that shared responsibility for decision-making was based on the parents’ intentions, but the degree to which they were willing to take responsibility varied. The facilitating and inhibiting factors for shared responsibility for decision-making were related to the communication between parents and professionals. The impact was related to the parents’ emotions. Conclusion It is essential that parents and professionals negotiate how both parties will contribute to their shared responsibility for decision-making. This will enable them to reach a mutual understanding of what is in the infants’ best interests and to mitigate the emotional burden of decisions in neonatal intensive care units. More research is needed to clarify the concept of shared responsibility for decision-making in this intensive care context. (shrink)

Purpose The purpose of this paper is to present a systematic literature review of empirical studies into online platforms for political participation. The objective was to diagnose the relationship between different types of digital participatory platforms, the real possibilities of participation generated by those initiatives and the impact of such participation on the decision-making process of governmental representatives. Design/methodology/approach A systematic literature review was conducted using pre-defined terms, expressions and criteria. A total of 434 articles from 1995 to 2015 were (...) gathered from the Web of Science database. And, 32 studies were selected from those articles for meta-synthesis, and the cases investigated were evaluated according to the e-participation ladder model. Findings The results indicated that online political participation worldwide remains timid both in quantity and quality. We have witnessed the growth of a kind of “rhetorical participation” promoted by policy-makers and the rise of a “participatory despotism”, in which only the privileged partake, while the majority remains silent. Practical implications The solutions found to promote increased participation and ensure its effectiveness ranged from shaping the platform design in accordance with citizens’ capacities and interests to a need for profound political–administrative change, which includes the world’s public agencies adopting a more transparent, inclusive and collaborative approach to decision-making. Originality/value This paper proposes a systematic review, mapping the studies on online platforms for political participation, analysing the questions, methods and conclusions found by the authors and evaluating each case study with a participation ladder. (shrink)

Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses’ codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for (...) nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses’ Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses’ codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses’ ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed. (shrink)

Background: Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years. Objectives: The purpose of this meta-synthesis was to determine the (...) various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept. Research design: The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare. Method and findings: Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements. Conclusion: The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships. (shrink)

This edition contains quaestiones 1-5 of book III of the commentary on the Sentences, by Marsilius of Inghen (†1396), the founding rector and first doctor of theology of the University of Heidelberg. These questions are devoted to the Christology, Mariology, and Trinitology, and deal with the issue of the Incarnation of Christ, with quaestiones 1-3 considering it in relation to the individual Persons of the Trinity, and quaestiones 4-5 in relation to the Blessed Virgin Mary. In all questions, Marsilius advocates (...) the _via media_ of sound faith, even above any school traditions. (shrink)

Ethics education and training are especially important in post-socialist countries where an understanding of ethical and responsible leadership is not yet fully developed. In such countries planning for the short term still dominates, and organisations focus their attention mainly on earning profit. In this article we show why the need has emerged to improve the general awareness of ethical issues in Estonia and teach ethical reasoning skills to business and government leaders. We describe the activities we have pursued at our (...) ethics centre, officially founded at Estonian Business School at the end of 2001, and the research we have conducted over the last seven years. (shrink)

This qualitative study explores how business leaders narrate their personal ways of recognizing, reasoning, and resolving moral conflicts and what these stories reveal about their moral identity processes within organizational contexts. Based on interviews with 25 business leaders, 4 moral identity statuses were identified: achievement, moratorium, foreclosure, and diffusion. The moral identity statuses were based on how leaders approached and interpreted moral conflicts and what the influence of the organizational context was in their moral decision-making processes. Some remained steadfast in (...) adhering to their previous value commitments, while others tried to avoid taking any clear moral standpoint. Still others experienced moral conflicts as disequilibrating events that triggered reflective processes and developmental cycles of moral identity change. These moral identity statuses hold implications for facilitating moral identity development among business leaders in the context of work. (shrink)

Background A significant number of women experience childbirth as traumatic. These experiences are often characterised by a loss of control coupled with a perceived lack of support and inadequate communication with health care professionals. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods A longitudinal Grounded Theory Methods (GTM) study involving 9 women was conducted. Over half (...) of the participants had a formal diagnosis of PTSD and/or PND related to the previous birth. Interviews were carried out at 3 timepoints perinatally. These findings are from the first interviews at 12-20 weeks. Results From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analysing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience, and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective caesareans to freebirth. Some women felt well supported by those around them, including health care professionals, partners, friends and family. Others did not, and were anticipating conflict in trying to assert their birth choices. Many early relationships with health care professionals were characterised by fear and mistrust. Discussion Women who have previously experienced a traumatic birth become pregnant again, have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with health care professionals at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control. (shrink)

Feminism is the movement to end women’s oppression. One possible way to understand ‘woman’ in this claim is to take it as a sex term: ‘woman’ picks out human females and being a human female depends on various anatomical features (like genitalia). Historically many feminists have understood ‘woman’ differently: not as a sex term, but as a gender term that depends on social and cultural factors (like social position). In so doing, they distinguished sex (being female or male) from gender (...) (being a woman or a man), although most ordinary language users appear to treat the two interchangeably. More recently this distinction has come under sustained attack and many view it nowadays with (at least some) suspicion. This entry (around 12 000 words in length) outlines and discusses distinctly feminist debates on sex and gender. (shrink)

Italian is a well-known exception to the cross-linguistic generalization according to which `belief' predicates are indicative selectors across languages. We newly propose that languages that select the subjunctive with epistemic predicates allow us to see a systematic polysemy between what we call an expressive-`belief' (featuring only a doxastic dimension) and an inquisitive-`belief' (featuring both a doxastic and an epistemic dimension conveying doxastic certainty (in the assertion) and epistemic uncertainty (in the presupposition)). We offer several previously unseen contrasts proving this distinction (...) and offer a new analysis for mood choice cross-linguistically. We argue that the distinction between expressive and inquisitive attitudes is not an idiosyncrasy of non-factive epistemics. We provide novel data, showing that fictional predicates (dream, imagine) license the subjunctive. We explain the indicative/subjunctive alternation by again appealing to epistemic uncertainty and disentangling expressive from inquisitive-fictional meanings. We thus pave the way for a new typology of attitudes relying on this systematic polysemy and propose new criteria to explain mood distribution cross-linguistically. (shrink)

Reflexiones filosóficas sobre el tiempo en tono lírico.

The singularity of being -- The rewriting of destiny -- The ethics of the act -- The possibility of the impossible -- The jouissance of the signifier -- The dignity of the thing -- The ethics of sublimation -- The sublimity of love -- Conclusion: the other as face.

The article regards children’s literature as a certain cultural tool. This approach enables to reveal various characteristic aspects of the poetics of children’s literature, while relating them to children’s cognitive and cultural development. Focusing on a book series Paula’s Life by Estonian author Aino Pervik, it can be seen how two different ways of understanding — the initial, so-called mythological type of thinking of preschoolers and the emerging conceptual thinking — are combined. The article draws mostly on the concepts of (...) cultural psychology and the authors of Tartu–Moscow school of semiotics, who have elaborated the idea that proper names form one of the central components of mythological consciousness, the latter being comparable to “the language of proper names”. The main attention is drawn on the functioning of names and the topic of naming and categorizing in these texts. (shrink)

Some commentators have condemned Kant’s moral project from a feminist perspective based on Kant’s apparently dim view of women as being innately morally deficient. Here I will argue that although his remarks concerning women are unsettling at first glance, a more detailed and closer examination shows that Kant’s view of women is actually far more complex and less unsettling than that attributed to him by various feminist critics. My argument, then, undercuts the justification for the severe feminist critique of Kant’s (...) moral project. (shrink)

The gender concept woman is central to feminism but has proven to be notoriously difficult to define. Some feminist philosophers, most notably Sally Haslanger, have recently argued for revisionary analyses of the concept where it is defined pragmatically for feminist political purposes. I argue against such analyses: pragmatically revising woman may not best serve feminist goals and doing so is unnecessary. Instead, focusing on certain intuitive uses of the term ‘woman’ enables feminist philosophers to make sense of it.

Although advance care planning can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis (...) to identify major themes, which included “initiation by patients” and “initiation by healthcare professionals.” In the latter case, seven specific triggers were identified: when the patients’ medical condition changed in terms of symptom relief, when the patients’ medical condition changed in terms of prognostic prediction, when serious events occurred, when a choice of treatment was presented, when the location for end-of-life care was chosen, when the patients’ cognitive function deteriorated, and when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients’ medical condition, whereas nurses focused more on their patients’ desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients’ autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital. (shrink)

The relationship between feminism and metaphysics has historically been strained. Metaphysics has until recently remained dismissive of feminist insights, and many feminist philosophers have been deeply skeptical about any value that metaphysics might have when thinking about advancing gender justice. Nevertheless, feminist philosophers have in recent years increasingly taken up explicitly metaphysical investigations. Such feminist investigations have expanded the scope of metaphysics in holding that metaphysical tools can help advance debates on topics outside of traditional metaphysical inquiry. Moreover, feminist philosophers (...) typically bring new methodological insights to bear on traditional ways of doing philosophy. Feminist metaphysicians have also recently begun interrogating the methods of metaphysics and they have raised questions about what metaphysics as a discipline is in the business of doing. In discussing such methodological issues, Elizabeth Barnes has recently argued that some prevalent conceptions of metaphysics rule out feminist metaphysics from the start and render it impossible. This is bad news for self-proclaimed feminist metaphysicians in suggesting that they are mistaken about the metaphysical status of their work. With this worry in mind, the paper asks: how does feminist metaphysics fare relative to ‘mainstream’ metaphysics? More specifically, it explores how feminist and ‘mainstream’ debates intersect, on what grounds do they come apart, and whether feminist metaphysics qualifies as metaphysics ‘proper’. (shrink)

In 1837 the German-born astronomer F. G. W. Struve published his famous catalogue of double stars. For Struve this was the culmination of 12 years' detailed observation of a class of celestial objects lying exclusively beyond the solar system; for historians of astronomy it poses the problem of explaining why the study of double stars became a significant part of astronomical endeavour, as it did, during the 1820s and 1830s. For, although Struve's interest was extreme, it was shared to a (...) lesser extent by several eminent contemporaries, including John Herschel, Friedrich Bessel, Johann Encke, James South and Félix Savary. Their combined efforts represented an important transition in astronomy: for the first time one of the emphases of the subject moved beyond the solar system to the so-called fixed stars. The question of the emergence of interest in double stars is of historical significance, therefore, as it is related to the problem of the origins of ‘stellar astronomy’. This essay is thus intended to offer an explanation of astronomers' interest in double stars, and to tackle the related question of whether this transition constituted a major break in the history of astronomy. Furthermore it is proposed that answers to these problems may be found by considering the practice of astronomy dominant during the first half of the nineteenth century. Astronomers in this period were overwhelmingly concerned with a refined form of positional astronomy. The problems they chose to solve were by and large related to the difficulties of the accurate reduction of observational data, and the compilation of reliable tables and star charts, which were then used as a background against which the motions of solar system objects were plotted. By assessing individuals' studies of double stars within this context it can be seen firstly that such studies were no more or less than specific examples of a general case, and secondly that the stars themselves were not usually of intrinsic interest. In general it was the positions of the stars on the. (shrink)