This paper investigates the possibility of understanding the rudimentary elements of clinical sensitivity by investigating the works of Edmund Husserl and Emmanuel Levinas on sensibility. Husserl's theory of intentionality offers significant reflections on the role of pre-reflective and affective intuition as a condition for intentionality and reflective consciousness. These early works of Husserl, in particular his works on the constitution of phenomenological time and subjective time-consciousness, prove to be an important basis for Levinas’ works on an ethics of alterity and (...) infinite responsibility for the other person. In fact, it is difficult to understand the core of Levinasian ethics, of vulnerability as proximity, of ethical sensitivity as passivity and a suffering for the suffering of another, without understanding the influence from Husserl's work. Crucially, the paper will, on the basis of Levinasian ethics, establish an understanding of sensibility as vulnerability and receptivity that is fundamental also for understanding significant intuitions in clinical nursing. Clinical sensitivity and carefulness in nursing are shaped by the concrete and also bodily expressions of vulnerabilities in a receptivity that is pre-reflective and pre-ontological. (shrink)

This paper discusses the application of the supreme emergency doctrine from just-war theory to non-antagonistic threats. Two versions of the doctrine are considered: Michael Walzer’s communitarian version and Brian Orend’s prudential one. I investigate first whether the doctrines are applicable to non-antagonistic threats, and second whether they are defensible. I argue that a version of Walzer’s doctrine seems to be applicable to non-antagonistic threats, but that it is very doubtful whether the doctrine is defensible. I also argue that Orend’s version (...) of the doctrine is applicable to non-antagonistic threats, but that his account is not defensible, regardless of whether the threats are antagonistic or not. (shrink)

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the (...) wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health. (shrink)

The first part of this paper seeks to clarify how interpersonal relationships are generally rooted in considerations about trust, vulnerability and interpersonal dependence. However, for nurse–patient relationships, and from the point of view of justice and fair rationing, it is essential to investigate their distinct moral nature. Hence, the second part of the paper argues that nurse–patient relationships, as a special kind of interpersonal relationship, raise particular normative issues. I will discuss dilemmas facing nurses and professional care‐givers in general who (...) are torn between their obligations to existing patients and more general and impartial considerations regarding the distribution of nursing care. This discussion concerning the normative claims of immediacy and mercy vs. fairness in health care is a pressing issue for nursing care. The claims that arise from particular relationships in nursing care are typically associated with closeness to a person's vulnerabilities. The pressing issue is how considerations of mercy and protection of individual patients can be safeguarded within today's nursing and health‐care practices in which distributivist considerations are crucial. (shrink)

In this article two problems with the recently developed "practice or virtue approach" to business ethics are discussed. The first problem concerns an alleged harmony between common demands of morality (generally understood) and the internal goods of actual business practice. The claimed harmony is strong in essence since it holds that the role expectations a good manager has to live up to, do in fact coincide with what morality demands. The second problem is related to the first and concerns the (...) alleged relevance of a virtue perspective for business ethics. According to the virtue perspective discussed in this article, moral reasoning should take actual practice, and only actual practice, as a point of departure. In so doing ethics is claimed to become insulated from e.g. putting irrelevant demands on practitioners. Such demands are understood as based on abstract principles alien to the practice in question. The thesis of this article is that neither of the above mentioned two claims are plausible. This is so basically because one needs to turn elsewhere than to actual business practice in order to detect a morally laden notion of managerial goodness. (shrink)

The precautionary principle is frequently invoked in environmental law and policy, and the debate around the principle indicates that there is little agreement on what 'taking precautions' means. The purpose of the present paper is to provide an improved conceptual foundation for this debate in the form of an explication of the concept of precaution. Distinctions between precaution and two related concepts, prevention and pessimism, are briefly discussed. The concept of precaution is analysed in terms of precautionary actions. It is (...) argued that precautionary actions are implicitly assumed to be precautionary with respect to something, and that this assumption should be made explicit. A definition of a precautionary action involving three necessary and jointly sufficient conditions (intentionality, uncertainty and reasonableness) is proposed, and the implications of this analysis for the debate on the precautionary principle are discussed. (shrink)

This article considers the foundation of nursing as a moral practice. Its basic claim is that all nursing knowledge and action reside on a moral foundation. The clinical gaze meets vulnerability in the patient’s human condition. To see a patient’s wound is to see his or her hurt and discomfort; it is a concerned observation. To see the factual and pathophysiological is at the same time to see the ethical: the moral realities of suffering, pain and discomfort. A nurse’s emotional (...) sensitivities are central to understanding a patient’s experiences of illness. Emotions reveal value and ascribe moral importance to certain situations; they are addressed centrally by vulnerability and the moral realities of illness. Hence, the essence of nursing knowledge and nursing performance cannot be understood merely as ontology (i.e. as being-with-the-other). Nursing is basically being-for-the-other; it is responsibility; it is ethics. (shrink)

Anthropocentrism—the idea that humans are the most important beings there are—comes in many guises. One version of anthropocentrism states that only humans have full moral status. Those who argue for such a position (beyond merely assuming it) usually refer to some trait that confers moral status and that only humans have. Suggestions include linguistic ability, self-awareness or rationality. However, regardless of what trait one picks it will not track the line between Homo sapiens and other species. You will always be (...) able to find some non-human animal that possesses the trait to a greater degree than some human does— even potentially. Koplin and Wilkinson1 adopt a broadly sentientist position: moral status is conferred by some mental or cognitive function. They discuss two sources of moral uncertainty related to this. In cases of moral uncertainty of the first type, it is uncertain whether Property X confers (full) moral status. In cases of uncertainty of the second type, we assume it to be true that moral status is conferred by X, but it is uncertain whether a particular entity (such as a pig) possesses the property. There are reasons to believe …. (shrink)

ABSTRACT I contend that Miranda Fricker’s ambitious new pluralist account of forgiveness is too inclusive and counts as forgiveness practices that are psychologically and normatively quite different. I raise three worries: First, her account of proleptic Gifted Forgiveness as temporally displaced Moral Justice Forgiveness seems to allow for Preemptive Forgiveness. Second, proleptic Gifted Forgiveness seems to resemble communicative blame more than forgiveness. Finally, an alternative account of forgiveness—explained in terms of reasons to forswear blame—seems capable of meeting Fricker’s desiderata for (...) an adequate theory (e.g., giftedness, pluralism, ambivalence, and genealogy), while avoiding the inclusivity worry. (shrink)

The discussion about theories of health has recently had an important new input through the work of Sridhar Venkatapuram. He proposes a combination of Lennart Nordenfelt's holistic theory of health and Martha Nussbaum's version of the capability approach. The aim of the present article is to discuss and evaluate this proposal. The article starts with a discussion of Nordenfelt's theory and evaluates Venkatapuram’ critique of it, that is, of its relativism, both regarding goals and environment, and of the subjectivist theory (...) of happiness used. Then the article explains why Nordenfelt's idea of a reasonable environment is not a problem for the theory, and it critiques Venkatapuram's own incorporation of the environment into the concept of health, suggesting that this makes the concept too wide. It contends, moreover, that Venkatapuram's alternative theory retains a problem inherent in Nordenfelt's theory, namely, that health is conceived of as a second-order ability. It is argued that health should, instead, be defined as first-order abilities. This means that health cannot be seen as a capability, and also that health cannot be seen as a meta-capability of the kind envisioned by Venkatapuram. It is, furthermore, argued that the theory lacks one crucial aspect of health, namely, subjective wellbeing. Finally, the article tries to illustrate how health, in the suggested alternative sense, as first-order abilities, fits into Nussbaum's capability theory, since health as an ‘actuality’ is part of all the ‘combined capabilities’ suggested by Nussbaum. (shrink)

This paper examines the existential context of physical and mental health. Hans Georg Gadamer and The World Health Organization’s conceptualizations are discussed, and current medicalized and idealized views on health are critically examined. The existential dimension of health is explored in the light of theories of selfhood consisting of different parts, Irvin Yalom’s approach to “ultimate concerns” and Martin Heidegger’s conceptualization of “existentials.” We often become aware of health as an existential concern during times of illness, and health and illness (...) can co-exist. The paper discusses how existential suffering in Western culture is described, to an increasing degree, as disorders or psychological deficits, and perfectionistic health goals easily can become a problem. We seek to avoid suffering rather than relate to it, with all the tension that may create. The paper argues that suffering is an unavoidable aspect of people’s experience of their lives, and actively relating to suffering must be regarded as a fundamental aspect of health. The need and usefulness of a concept of “existential health” is discussed. (shrink)

It is one of the tasks of the philosophy of mathematics to explain in a Kantian way, how and to what extent, mathematics as we know it, is possible. It should be clear, however, that, as things stand at present, a philosophical theory of mathematics can in this respect, it seems, be little more than a declaration of faith or the lack of it.

This article critically examines two different answers to the ancient question, why be moral. The first suggests that valid reasons refer to a specific relation between human beings and God. Here, being moral means to treat oneself and others with the respect that is the due of God’s closest friend. The second argues that we have good reasons for being moral when being moral makes us happy (realizes Eudaimonia). The investigation offers two results, one critical and the other constructive. The (...) critical shows how and why both theistic accounts of bestowed human dignity and eudaimonistic accounts offer no relevant reasons for being moral. The constructive result builds on an observation; both accounts presuppose the inherent force of the obligation to act morally right. It shows that the reasons for being moral should be explicated as internal to the very meaning of being moral. (shrink)

Combining in-depth analysis with strikingly apt examples of the role that courage plays in the life of human beings, this major contribution to moral philosophy argues that courage is necessary to personal achievement as well as to the common good of a civic community. Bauhn insists that courage is necessary for reinforcing people's understanding of themselves as autonomous agents, which is in turn necessary for countering widespread feelings of alienation and depression. He defines courage as the ability to confront fear, (...) but crucially distinguishes a variety of fears that give rise to different types of courage. (shrink)

The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the (...) paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use. (shrink)

It is argued that existing axiomatic theories of utility do not provide the utility principle or the principle of maximising expected utility with a formal justification. It is also argued that these theories only put mild constraints on a decision-maker in a decision-context. Finally, it is argued that the prospects are not particularly bright for finding formal non-circular arguments for the utility principle that do not rely on the law of large numbers.

Human rights language is often used as a universal benchmark for moral criticism. However, its philosophical basis has been seriously questioned. The purpose of this study is to investigate the contributions of Christian ethics (1) to the reconstruction of a plausible conception of a human right and (2) to the elaboration of a satisfying justification of human rights. Three different Christian ethical models of human rights are set forth and evaluated.

ABSTRACTIn Critical Discourse Studies and in other linguistics oriented scholarly journals we now see more research which draws upon multimodality as part of carrying out analyses of how text...

This paper examines the psychology of existential guilt with Martin Heidegger and Rollo May’s conceptualizations as the point of departure. The concept of existential guilt describes preconditions for responsibility and accountability in life choices and the relationship to the potential given in the life of a human. It might also be used as a starting point to examine an individual’s relationship to the potential offered in their life and life context and, in this way, the hitherto unlived life of an (...) individual. The following questions are discussed in contexts of identity development, perfectionism, and current cultural shifts in conceptualizations of selfhood: How can humans relate to the fact that only limited parts of who they might be can ever be actualized? Moreover, how can they relate to the fundamental ambiguity and “groundlessness” in the contexts of life where choices are made? There are striking parallels between the role of exploration in the Eriksonian approaches to healthy identity development and the ontological groundlessness that stands out as a premise for existential guilt. There are also parallels between identity fore-closure and normative identity styles and “falling” into das Man in the existential framework. Perfectionistic ideals easily become an objectivization – and closure – of possible alternatives and choices. In contemporary theories of constructions of selfhood, the dangers of alienation from the community on the one hand and escape into what might become totalitarian collectivism on the other is pointed out. The contextualization of personal responsibility offered through the concept of existential guilt might address both dangers. It provides a perspective on how personal responsibility is embedded in contexts of human relationships, relationships to nature, and the finitude, freedom, uncertainties, and suffering that is given through human existence. Existential guilt can wake sorrow and regret over opportunities overlooked and lost. However, most of all, it can be seen as a drive toward repair in the relationship toward both oneself and the other. It takes the form of receptivity, an openness to a life not yet lived, and creative use of imagination. (shrink)

Rebecca Brown and Julian Savulescu argue in ‘Responsibility in Healthcare Across Time and Agents’ that if responsibility should play a crucial role in healthcare, then we need a concept of responsibility that reflects that an individual’s behaviour is sometimes, if not routinely, influenced by external factors in various ways. As Brown and Savulescu convincingly show, health-related behaviour in particular is often affected by other agents and typically involves multiple decisions on different occasions. Smoking and a poor diet are but two (...) examples where these factors are salient. Since health-related behaviour is often influenced by others, and often spread out over time, a notion of responsibility that does not take these two factors into account will be inadequate. In this comment to their paper I wish to raise an issue concerning Brown and Savulescu’s characterisation of individual responsibility for health-related behaviour that involves multiple choices by the same agent over a period of time. For simple acts—smoking a cigarette or eating some junk food for example—Brown and Savulescu assume two necessary conditions for responsibility: a ‘control condition’ and a ‘epistemic condition’. These conditions are intended to capture the plausible idea that …. (shrink)

In Mensonge romantique et vérité romanesque, René Girard attempts to explain how desire has been depicted in different European novels. According to Girard, the lesser novelists have retracted to some kind of romantic worldview in their description of human relationships. While the “romantic writer” does not see that desires are mediated by other people’s desires, and instead describes desire as object-related, linear, and devoid of any ongoing mimetic contagion, a number of novelists, are, nonetheless, able to reveal the illusion of (...) romantic desire. In Flaubert’s Madame Bovary, the author tries to peer into the desires that govern Emma Bovary's relentless search for a romantic life.... (shrink)

Within child and adolescent psychiatry, there are a number of potential dilemmas pertaining to diagnosis, treatment, the protection of the child, as well as the child's own developing intelligence and moral judgement. Diagnostic Dilemmas in Child and Adolescent Psychiatry is the first in the IPPP series to explore this highly complex topic.

During the last hundred years medical language has been influenced by scientific and technological progress. As a result uncertainty in medical communication is increasing. This may have serious consequences not only for health care delivery but also for medical science. Disease classification, assessment of the validity of epidemiological investigations and comparison of the results of various investigations are examples of what will become less secure. The purpose of the article is to emphasise a main source of uncertainty — the problem (...) of interpreting definitions. Two issues of interpretation are explored. One concerns the logical status of a statement and the other the function of a statement. It is concluded that the security of medical language can be increased through the elucidation of the logical status and functions of statements making up medical concepts. (shrink)

In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about (...) the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well‐founded. (shrink)

Abolitionism is the view that if no one is responsible, we ought to abandon the reactive attitudes. This paper defends abolitionism against the claim, made by P.F. Strawson and others, that abandoning these attitudes precludes the formation and maintenance of valuable personal relationships. These anti-abolitionists claim that one who abandons the reactive attitudes is unable to take personally others’ attitudes and actions regarding her, and that taking personally is necessary for certain valuable relationships. I dispute both claims and argue that (...) this objection exaggerates the role of the reactive attitudes and underestimates the importance of non-reactive moral emotions. (shrink)