Meanings of living at home on a ventilator Nine adults were interviewed in order to illuminate the meanings of being dependent on a ventilator and living at home. The data were analysed using a phenomenological‐hermeneutic method inspired by the philosophy of Ricoeur. Five main themes emerged through the analysis: experiencing home as a safe and comfortable space from which to reach out, experiencing the body as being frail, brave and resilient, striving to live in the present, surrendering oneself to and (...) trusting others, and experiencing technology as a burden and a relief to the lived body. Meanings of being home on a ventilator were interpreted as maintaining autonomy and persistence in interaction with the ventilator and other human beings and being able to rise above yourself and your personal boundaries in order to live a good life. These meanings indicate that aesthetic and ethical values impact on the lived body. They are bound up with experiencing a vital force and interdependency, bringing safety and courage into daily life. (shrink)

This article deals with science content “in the making” and in particular the role of the body in producing scientific phenomena. While accounts of scientists’ work have repeatedly demonstrated, how producing phenomena requires immense amounts of time and effort, involving tinkering and manual labor, this is a little empirically studied content in science education. Seeking to shed light on how the body is involved with materiality to produce physics phenomena, and in what terms this is learning physics content, the article (...) first examines how bodily tinkering is a necessary part of knowing physics through reviewing major accounts of science studies and research in science education. Secondly, drawing on phenomenology and pragmatist ideas, the article examines how students’ bodies need to be educated in the transactional process with material and artifacts to produce phenomena in the context of science learning in lower secondary physics education. Demonstrating that embodied phenomena production is an inescapable part of learning scientific inquiry, and that bodies are just as much a part of the subject physics as conceptual knowledge, we suggest that the education of students’ bodies needs to be made an explicit content. This is important not only for making tacit content accessible to all, but also for addressing epistemological understandings of what science and technology is about. (shrink)

New Jersey residents who tested their homes for radon and found more than four picocuries per liter were surveyed about their knowledge, emotions, attitudes, and intentions to take remedial action Respondents proved well informed, but radon levels were not highly correlated with any of the response variables. Overoptimism was more common than overreaction. The results suggest that active guidance is needed to ensure appropriate responses to environmental hazards, like radon, that require individual remediation. Simple information dissemination alone seems inadequate.

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs (...) to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the ‘shape’ of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting. (shrink)

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

La Vita di Filareto il Misericordioso, un testo agiografico di grande interesse storico e letterario, oggetto di riscritture e traduzioni, fu edita per la prima volta nel 1900 da Vasiliev, dal Paris. gr. 1510 (V). Nonostante la maggiore antichità del codice (X secolo), quella di V risultò in seguito una versione secondaria rispetto alla versione edita nel 1934 da Fourmy e Leroy, tratta dai codici Genuensis Urbanus 34 (G) dell'XI secolo e Paris. gr. 1608 (P) del XIV secolo, e riedita (...) ora da Lennart Rydén, recentemente scomparso. Le altre versioni dell'opera sono oggetto di uno studio, di cui è annunciata la pubblicazione, da parte di Jan Olof Rosenqvist. (shrink)

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the carer’s professional (...) role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...) (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...) Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...) are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

I present a dilemma for the market failures approach to business ethics. On an orthodox interpretation, it takes moral requirements for businesses to require them not to profit from market failures to approximate Pareto efficiency. On a moralized interpretation, it also incorporates other considerations. However, the orthodox approach is extensionally inadequate, for it is legitimate to profit from many of the allegedly ruled-out market failures. The moralized approach does better but fails to be sufficiently comprehensive. First, it has not been (...) shown why we ought to adhere to any particular limited subset of norms of and for the market. Second, we have a very general reason to mitigate the moral horror of the world, which indicates that the market failures approach is too arbitrarily restricted. (shrink)

Constitutivism explains norms in terms of their being constitutive of agency, actions, or certain propositional attitudes. However, the shmagency objection says that if we can be shmagents – like agents, minus the norm-explaining features of agency – we can avoid the norms, so the explanation fails. This paper extends this objection, arguing that constitutivists about practical norms suffer from it despite their recent attempts to solve it. The standard response to the objection is that it is self-defeating for agents to (...) become shmagents. I agree, but the response ignores the possibility of shmagents who consider whether to be agents while already standing outside agency. Another response says that we ought to be agents because agency is, in some sense, normatively valuable, and if so, we can explain norms in terms of this valuable form of agency. But then the norms that our constitutions are supposed to explain are underdetermined because it is unclear how much we ought to care about this value. I conclude that the shmagency objection has yet to be answered. (shrink)

In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What (...) this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)

Realists about corporate agency, according to whom corporate agents may have aims above and beyond those of the individuals who make them up, think that individual agents may switch between participating in individual and corporate agency. My aim is, however, to argue that the inescapability of individual agency spells out a difficulty for this kind of switching – and, therefore, for realism about corporate agency. To do so, I develop Korsgaard’s notion of plight inescapability, which on my take suggests that (...) individual agents are continuously faced with fully exercising their individual agency (absent external limits at the time of its exercise). But then individual agents may not switch to acting as members of corporate agents if the aims of the corporation differ from their own, in the sense that they have different mental state tokens. But as it is possible to participate fully in the action of a corporate entity, this incompatibility between individual and corporate aims suggests that we ought to think of corporate agents as in some sense reducible to individual aims. (shrink)

In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost‐effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and (...) virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost‐effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

Background: Palliative carers constantly face ethical problems. There is lack of organised support for the carers to handle these ethical problems in a consistent way. Within organisational ethics, we find models for moral deliberation and for developing organisational culture; however, they are not combined in a structured way to support carers’ everyday work. Research objective: The aim of this study was to describe ethical problems faced by palliative carers and develop an adapted organisational set of values to support the handling (...) of these problems. Research design: Ethical problems were mapped out using focus groups and content analysis. The organisational culture were developed using normative analysis and focus group methodology within a participatory action research approach. Main participants and research context: A total of 15 registered nurses and 10 assistant nurses at a palliative unit (with 19 patient beds) at a major University Hospital in Sweden. Ethical considerations: The study followed standard ethics guidelines concerning informed consent and confidentiality. Findings: We found six categories of ethical problems (with the main focus on problems relating to the patient’s loved ones) and five categories of organisational obstacles. Based on these findings, we developed a set of values in three levels: a general level, an explanatory level and a level of action strategies. Discussion: The ethical problems found corresponded to problems in other studies with a notable exception, the large focus on patient loved ones. The three-level set of values is a way to handle risks of formulating abstract values not providing guidance in concrete care voiced in other studies. Conclusion: Developing a three-level set of values adapted to the specific ethical problems in a concrete care setting is a first step towards a better handling of ethical problems. (shrink)

In the article Should rare diseases get special treatment? by Monica Q F de Magalhaes,1 it is argued that rarity is not a morally relevant feature to consider in prioritising treatment in healthcare, but severity is. A central conclusion in the article is that severity rather than prevalence should guide different cost-effectiveness thresholds. Hence, I take it, she answers no to the question in her own heading. I agree with all of this—and with most of her other arguments and conclusions (...) in the article—except for the clause ‘rather than prevalence’. For this reason, I find the article misses its’ mark. Let me explain by taking Sweden as an example. Sweden has a legally established ethics framework for priority setting in healthcare since 1997, comprising three principles: human-dignity principle, needs-solidarity principle and cost-effectiveness principle. The implication of these principles in practice is that the higher the severity—the higher the cost-effectiveness threshold acceptable.2 During the last 10 years or so, the highest accepted cost-effectiveness threshold for the most severe conditions have been in the order of €100 000/QALY. Until a few years ago rarity or prevalence was …. (shrink)

This paper treats the problem of which type of units, individuals or whole societies, should be used when explaining societal phenomena. It is argued that factors operating at the individual level in principle form societies, and that societal phenomena therefore should ideally be explained at this level. However, it is also argued that many societal phenomena cannot in practice be analyzed at the individual level in a clear and strict way, but rather must be analyzed holistically, because it is not (...) known how they are related to individual factors due to the complexity of societies. For societies to be described and analyzed in a clear and strict way, they must as a rule be much simplified, and such simplification is often made easier by abandoning the individualistic perspective. If researchers still wish to describe a connection between individual factors and a societal phenomenon, they often must do so in vague terms. There are also other problems with the individualistic perspective that make it difficult to use. However, using the holistic perspective may be risky, as shown by two hypothetical examples. (shrink)

With healthcare systems under pressure from scarcity of resources and ever‐increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We (...) find that the standard justifications for patient representation, such as to achieve patient‐relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants. (shrink)

This five-volume edition of Aristotle's works in Greek is (with the exception of Vol. III) a photomechanical copy of the standard edition of Aristotle's works from 1831-1870. Vols. I And II contain Aristotle's works. VOlume III presents O. GIgon's revision and supplementation of Aristotle's fragments. VOl. IV Presents a selection of the most important sections of Classical commentaries on Aristotle, together with a concordance with the Commentaria in Aristotelem Graeca. VOl. V Contains a copy of H. BOnitz' Index Aristotelicus.

In recent discussions of the Humean Theory of Motivation (HTM), several authors – not to mention other philosophers around the proverbial water cooler – have appealed to the simplicity of the theory to defend it. But the argument from simplicity has rarely been explicated or received much critical attention – until now. I begin by reconstructing the argument and then argue that it suffers from a number of problems. Most importantly, first, I argue that HTM is unlikely to be simpler (...) than even close competing theories, and second, it is unlikely that a plausible version of the theory will be very simple. Moreover, I argue that a convincing case for HTM is likely to have to show that it is more virtuous than defenders have done so far. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being (...) in the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...) deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life. (shrink)

How should we understand the relation between corporate agency, corporate moral agency and corporate moral patienthood? For some time, corporations have been treated as increasingly ontologically and morally sophisticated in the literature. To explore the limits of this treatment, I start off by redeveloping and defending a reductio that historically has been aimed at accounts of corporate agency which entail that corporations count as moral patients. More specifically, I argue that standard agents are due a certain type of moral concern, (...) but corporate agents are not due that type of concern, so they are not agents of, at least, the standard type. Diagnosis: because corporations plausibly lack qualia, they are ‘zombie agents’ that mimic real agents. This explains why they are neither standard agents nor standard moral patients: they are not standard agents because they lack mental states, and because they lack experiences, they are, at best, morally notable rather than morally respectable. However, I then argue that we nevertheless have instrumental reasons to include them in our moral responsibility practices, both because that is what notability involves and bluffingly, and both when it comes to treating them as moral agents and as moral patients. Hence, we may treat corporations as part of our moral responsibility practices to a limited extent anyway. (shrink)

Constitutivist approaches to the normativity of rationality have recently come into vogue. Unlike their moral counterparts, however, they have not been confronted with the shmagency objection. In this paper, I challenge them with two versions of the objection based on recent developments in the debate surrounding the normativity of morality. These are shmagency as modal escapability, which is based on taking sophisticated shmagents to be able to modally escape various norms, and shmagency as underdetermination, which is based on taking constitutive (...) norms that allegedly have independent value to be underdetermined by that value. I consider three different kinds of constitutivist theories of the normativity of rationality: first-person-authority views, single-mental-state views, and systems-of-mental-states views. None of the three are able to deal with either of these shmagency objections. There are sophisticated shmagents who escape all these types of constitutivist principles of rationality, so they are modally escapable, and the value of rationality underdetermines all the views. Upshot: constitutivists about structural rationality ought to worry about shmagency. (shrink)