Objective Being involved in serious patient injury is devastating for most doctors. During the last two decades, several efforts have been launched to improve Norwegian doctors’ coping with adverse events and complaints. Methods The method involved survey to a representative sample of 1792 Norwegian doctors in 2012. The questions on adverse events and its effects were previously asked in 2000. Results Response rate was 71%. More doctors reported to have been involved in episodes with serious patient harm in 2012 (35%) (...) than in 2000 (28%), and more of the episodes were reported as required by law. Doctors below age 50 report better support from colleagues, more collegial retrospective discussion on the event and less patient/family blame. In all, 27% of the doctors had been reported to the Norwegian Board of Health Supervision; 79% of these complaints were rejected; 73% of the doctors who had received a reaction from the health authorities found the reaction reasonable, but almost one out of five practiced more testing and referrals after a complaint and 25% claimed that the complaint had made them into a more fearful doctor. Conclusion Our results indicate that adverse events are being met more openly in 2012 than in 2000, and that coping with imperfection and patient complaints is less devastating for new generations of doctors. (shrink)

This article reports a follow-up study of Norwegian nursing students entitled ‘The helping motive -an important goal for choosing nursing education’. It presents and discusses a significant ambiguity within the altruistic helping motive of 301 nursing students in the light of classical and modern virtue ethics. A quantitative longitudinal survey design was used to study socialization and building professional identity. The follow-up study began after respondents had completed more than two-and-a-half years of the three-year educational programme. Data were collected using (...) a questionnaire with closed questions, supplemented by 18 semi-structured, in-depth, audiotaped interviews. A motive such as ‘desire for human contact/to help others’ appeared to be highly significant. The research questions employed were: What motivates nursing students at the end of their studies to help other people? What does helping others mean for nursing students? Factor analysis revealed two factors. Factor 1 can be expressed as an altruism factor and factor 2 can be interpreted as an ‘acknowledgement-from-the-patient factor’ that in fact indicates an ambiguity within the helping motive itself. Findings from the interviews also reveal ambiguous helping motives. On one hand the students want to be altruistic and on the other they wish to receive positive feedback from patients when giving help. The findings indicate that this positive feedback is essential to the students in order for them to provide altruistic care. (shrink)

The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral dou...

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...) variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...) tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

Ethics in business and economics is often attacked for being too superficial. By elaborating the conclusions of two such critics of business ethics and welfare economics respectively, this article will draw the attention to the ethics behind these apparently well-intended, but not always convincing constructions, by help of the fundamental ethics of Emmanuel Levinas. To Levinas, responsibility is more basic than language, and thus also more basic than all social constructions. Co-operation relations in organizations, markets and value networks are generated (...) from personal relations and personal responsibilities. It is not sufficient to integrate ethics in an impersonal, rational system, neither in business organizations nor in the world economy. Ethics has its source not in rationality, but in the personal. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including business ethics, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Although Lorenz Oken is a classic example of Naturphilosophie as applied to biology, his views have been imperfectly understood. He is best viewed as a follower of Schelling who consistently attempted to apply Schelling's ideas to biological data. His version of Naturphilosophie, however, was strongly influenced by older pseudoscience traditions, especially alchemy and numerology as they had been presented by Robert Fludd, whose works were current in Jena and available to him. According to those influences, parts of Oken's philosophical conception (...) were communicable even in a non-idealistic scientific culture, for example in Paris, where Oken met Étienne Geoffroy Saint-Hilaire. Geoffroy however was embedded in a French intellectual tradition, and the correspondence between his views and those of Oken was only superficial. The English anatomist Richard Owen attempted to incorporate the views of Oken and Geoffroy within his own, idiosyncratic system. Although Darwin knew of Oken's ideas, it was Geoffroy who really affected his evolutionary biology, and any influence of Oken must have been attenuated to the point of triviality. (shrink)

In this essay, I argue that Ted Poston's theory of explanatory coherentism is well-suited as a tool for causal explanation in the health sciences, particularly in epidemiology. Coherence has not only played a role in epidemiology for more than half a century as one of Hill's viewpoints, it can also provide background theory for the development of explanatory systems by integrating epidemiologic evidence with a diversity of other error-independent data. I propose that computational formalization of Hill's viewpoints in an explanatory (...) coherentist framework would provide an excellent starting point for a formal epistemological (knowledge-theoretical) project designed to improve causal explanation in the health sciences. As an example, I briefly introduce Paul Thagard's ECHO system and offer my responses to possible objections to my proposal. (shrink)

This book covers the overlap between informatics, computer science, philosophy of causation, and causal inference in epidemiology and population health research. Key concepts covered include how data are generated and interpreted, and how and why concepts in health informatics and the philosophy of science should be integrated in a systems-thinking approach. Furthermore, a formal epistemology for the health sciences and public health is suggested. -/- Causation in Population Health Informatics and Data Science provides a detailed guide of the latest thinking (...) on causal inference in population health informatics. It is therefore a critical resource for all informaticians and epidemiologists interested in the potential benefits of utilising a systems-based approach to causal inference in health informatics. (shrink)

Models of illness causation play a crucial role in medicine and public health. In their recent paper on this topic, Michael Kelly, Rachel Kelly, and Federica Russo state that the integration of social, biological, and behavioral causes in one and the same etiologic mechanism remains to be clarified. In particular, they think that current models of illness causation do not appreciate "the truly integrated nature of bio-social-behavioral pathogenesis". In brief, Kelly, Kelly, and Russo suggest that two levels of explanation are (...) at work in medicine and public health, biological and social; that integration is difficult because of resistance to including social determinants of disease in both the... (shrink)

Goethe carried out an enormous number of experiments before criticizing Newton's theory of light and colours in the Farbenlehre (1810). He managed to show that Newton's reasoning is based on a rather narrow choice of experiments, in which parameters such as the distance between the prism and the screen are fixed arbitrarily: Newton's famous spectrum (with its green centre) occurs only at a specific distance. Once you reduce the distance, the green centre disappears, and you see the two border spectra (...) instead. Newton can of course explain these border spectra; but things can be explained just as well the other way around: Then you start with a theory based on the two border spectra in order to derive the Newtonian spectrum. Both accounts fit many data (available in Newton and Goethe's days) equally well. Thus by insisting that the step to theory is not forced upon us by "reason and experiments" alone (as Newton would have it), Goethe revealed our own free, creative contribution to theory construction. And surprisingly, his theory of the prismatic colours seems no worse off than Newton's, even taking into account additional criteria of theory choice, such as simplicity or elegance. (shrink)

Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown (...) that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP. (shrink)

Following the concept of internal representations, signal processing in a neuronal system has to be evaluated exclusively on the basis of internal system characteristics. Thus, this approach omits the external observer as a control function for sensory integration. Instead, the configuration of the system and its computational performance are the effects of endogeneous factors. Such self-referential operation is due to a strictly local computation in a network. Thereby, computations follow a set of rules that constitutes the emergent behaviour of the (...) system. Because these rules can be demonstrated to correspond to a "logic" intrinsic to the system, it can be shown that the concept of internal representation provides the basis for neurosemantics. (shrink)

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Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in (...) 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems. (shrink)

In his study on 'schelling's and hegel's verhaltnis zur naturwissenschaft' of 1844 m j schleiden, one of the leading biologists of that time, opposed the speculative idealism. his work marks the change of the german biology to a science that is founded on materialistic assumptions. it gives the essence of a discussion that is not only interesting in a historical perspective but accentuated an ongoing controversy.

Concepts of enlightenment were developed and transmitted to modern times. From that perspective, one has to understand classic and romanticism as a kind of culmination of European enlightenment, thereby describing romanticisms as a European phenomenon. Here, our ideas of freedom, personality and governance, the concept of science, the idea of rationality and, in particular, the disciplinarily defined rationality originated. It is the Kantian perspective, by which we now look on rationality. It is the Hegelian idea of system and coherence, we (...) test our hypothesis with, It is Baumgarten’s aesthetics, and it is the way, Fichte argued about the principle consequences of liberalization in French revolution that came into our discussions about jurisdiction, personal liberty, state and governance. And it is that new idea of an expert system driven rationality that we are accustomed to, in between. This form of rationality originated at the end of the 18th century and has been transferred in its essential methodological characteristics to our time. (shrink)

ZUSAMMENFASSUNGDie Kirche sieht sich in der Zuständigkeit für die Verwaltung des Transzendenten. Gestützt auf die Genesis erhebt sie aber auch den Erklärungsanspruch für die Entstehung der irdischen Welt. Jedoch weicht sie hier mehr und mehr der naturwissenschaftlichen Konkurrenz. Selbst die Evolutionstheorie wird heute nicht mehr rundweg abgelehnt. Die Neubewertung des Realitäts-begriffs und der Naturgesetze durch die evolutionäre Erkenntnistheorie zeigt jedoch, dass auch der Erklärungsanspruch empirischer Weltbilder überdacht werden muss, was nicht ohne Einfluss auf das Verhältnis zu den religiösen Weltbildern bleibt.Viel (...) gravierender jedoch kann die Tendenz werden, dass sich die Auseinandersetzung zwischen Religion und Wissenschaften immer mehr von den Naturwissenschaften zu den Sozialwissenschaften verlagert. Probleme der physischen Naturbeherrschung sind heute sehr viel weiter gehend gelöst als die Probleme der sozialen Umwelt. Schon heute ist das zentrale Paradigma der Menschheit die Bewältigung sozialer Probleme. Die Beherrschung des Klimas zum Beispiel, von der Sache her ein physisches Problem, wird mehr und mehr zum sozialen Problem. Wollen die Kirchen hier als gestaltende Kraft mithalten, müssen sie sich von der auf die Bibel gestützten Angebotsorientierung fortentwickeln zu der Nachfrageorientierung politischer Parteien und anderer Sozialorganisationen. Das könnte sich zur Bedrohung der theologischen Bedeutung der Kirchen entwickeln. SUMMARYThe church sees itself as the general administrator of the transcendent. But at the same time, based on the genesis, it claims as well the competence to explain the creation of the physical world. Here, however, it recoils more and more from the natural sciences. Even the idea of biological evolution is no longer flatly rejected. However, the reinterpretation of the natural laws and the notion of reality within the framework of the evolutionary epistemology show that the explanatory power of the natural sciences is no longer unquestionable. This, no doubt, has consequences for the relationship of natural and transcendental sciences.Of far more impact, however, can be the trend that the dispute between religion and sciences is shifting from the nature sciences towards the social sciences. Problems we have with our natural environment and to be solved by nature sciences are replaced more and more by problems we have with our social environment and to be solved by the social sciences. Already nowadays the central paradigm of mankind is the solution of social problems. Mastering the climate, for example, though primarily a physical problem becomes more and more a social subject. If the churches want to keep up here they have to shift from the supply orientation as provided by the bible towards the demand orientation presented by political and other social organisations. This could begin to threaten the theological importance of the churches. (shrink)

When it became uncool to speak of beauty with respect to pieces of art, physicists started claiming that their results are beautiful. They say, for example, that a theory's beauty speaks in favour of its truth, and that they strive to perform beautiful experiments. What does that mean? The notion cannot be defined. (It cannot be defined in the arts either). Therefore, I elucidate it with examples of optical experimentation. Desaguliers' white synthesis, for example, is more beautiful than Newton's, and (...) the many colourful syntheses done by Viennese painter Ingo Nussbaumer exemplify even greater beauty. Here are some criteria (which, of course, do not implement a decision procedure concerning beauty in experiments): cleanliness, simplicity, intellectual clarity, symmetry. Similar criteria are relevant to our aesthetical judgements about some pieces of music. So we can assume that our notion of beauty conserning art is related to the one conserning scientific experiments. (shrink)

We use quotation marks when we wish to refer to an expression. We can and do so refer even when this expression is composed of characters that do not occur in our alphabet. That's why Tarski, Quine, and Geach's theories of quotation don't work. The proposals of Davidson, Frege, and C. Washington, however, do not provide a plausible account of quotation either. (Section I). The problem is to construct a Tarskian theory of truth for an object language that contains quotation (...) marks, without appealing to quotation marks in the metalanguage. I propose to supply Tarski's truth definition with one axiom that determines the denotation of all expressions containing quotation marks. According to this axiom, quotation marks create a non-extensional context. Since admitting such contexts does not lead to any difficulties in the recursive truth characterization, we may indeed dispense with extensionalism. (Section II). Finally, I argue that we classify and denote expressions in the very same way that we classify and denote extralinguistic entities. Both tokens and types of written signs can be easily incorporated into the naturalist's worldview. (Section III). (shrink)

It is shown that the method of operationaldefinition of theoretical terms applied inphysics may well support constructivist ideasin cognitive sciences when extended toobservational terms. This leads to unexpectedresults for the notion of reality, inductionand for the problem why mathematics is sosuccessful in physics.A theory of cognitive operators is proposedwhich are implemented somewhere in our brainand which transform certain states of oursensory apparatus into what we call perceptionsin the same sense as measurement devicestransform the interaction with the object intomeasurement results. Then, (...) perceivedregularities, as well as the laws of nature wewould derive from them can be seen asinvariants of the cognitive operators concernedand are by this human specific constructsrather than ontologically independent elements.. So, reality in so far it isrepresented by the laws of nature has no longeran independent ontological status. This isopposed to Campbell's `natural selectionepistemology'. From this it is shown that thereholds an incompleteness theorem for physicallaws similar to Gödels incompletenesstheorem for mathematical axioms, i.e., there isno definitive or object `theory of everything'.This constructivist approaches to cognitionwill allow a coherent and consistent model ofboth cognitive and organic evolution. Whereasthe classical view sees the two evolutionrather dichotomously. (shrink)

The intention of the article is to offer stakeholders affected by mergers a criterion from which moral arguments may be generated for the organization of each individual case. The criterion: "Any operation causing legitimate interests to suffer vital infringement should be avoided in a merger process." A vital infringement of these interests is assumed when the merger undermines unique positive opportunities or considerable impairment in the future, impossible to overcome for the person affected without an unacceptable level of difficulty. Therefore, (...) we mainly concentrate on implicit contracts – which should be based on the principle pacta sunt servanda as well. These contracts are mandatory to run an economy that produces increasingly more knowledge-based goods. (shrink)

In this article the authors focus on the emergence, or disappearance, of notions of responsibility in social dynamic processes. Hence, the starting point in this article is concrete behavior within organisational settings. This article presents a systematic overview of mechanisms related to acting upon a sense of moral responsibility. Some of these mechanisms are based on individual characteristics, others are embedded in the social context wherein responsible behaviour emerges or disappears. In this article, various mechanisms are identified and labelled in (...) order to analyse what types of processes are behind the mechanisms. In this way, the article yields important understandings for the conscious use of these mechanisms to strengthen responsible behavior within organisations. (shrink)

Theory of illness causation is an important issue in all biomedical sciences, and solid etiological explanations are needed in order to develop therapeutic approaches in medicine and preventive interventions in public health. Until now, the literature about the theoretical underpinnings of illness causation research has been scarce and fragmented, and lacking a convenient summary. This interdisciplinary book provides a convenient and accessible distillation of the current status of research into this developing field, and adds a personal flavor to the discussion (...) by proposing the etiological stance as a comprehensive approach to identify modifiable causes of illness. (shrink)

In vielen Debatten werden spezifische Vorstellungen über die Geschichte, Kultur oder Werteordnung ›Europas‹ für die Erklärung oder Legitimierung politischer Verhältnisse und Projekte herangezogen. Die vorliegende Studie prüft die Berechtigung solcher Konstruktionen, indem sie der Frage nachgeht, seit wann und warum überhaupt von ›Europa‹ gesprochen wird. Die Analyse der historischen Semantik des Europabegriffs muss, um identitätspolitisch motivierte Anachronismen zu vermeiden, seine materiellen, kulturellen und diskursiven Konstitutionsbedingungen einbeziehen. ›Europa‹ verliert dadurch seinen transhistorischen Charakter, den es erhält, wenn man ihm im Bestreben, es (...) als politische und kulturelle Entität auszuzeichnen und fungibel zu machen, eine mythische Geschichte und Struktur zuschreibt. Demgegenüber zeigt die kritische Analyse: Als politische und kulturelle ›Idee‹ wie als gelebte und erfahrene ›Wirklichkeit‹ gründet Europa nicht in Antike oder Mittelalter, sondern ist das Produkt der Entstehung der modernen Welt seit der frühen Neuzeit. (shrink)