This study investigated the relationship between supervisor personality and subordinate reports of exposure to bullying and harassment at work. Three research questions were examined: Is there a direct relationship between supervisor personality and reports of workplace bullying? Is there an interaction between supervisor personality and supervisors’ perceived stress as predictors of workplace bullying? Will subordinates who experience bullying at their workplace rate their supervisor’s personality more negatively? The sample consisted of 207 supervisors and employees within 70 Norwegian restaurants. Supervisors low (...) on conscientiousness, high on neuroticism and portraying high levels of exposure to stress were the subject of significantly more reports from subordinates of exposure to workplace bullying. An interaction between agreeableness and stress was found showing that agreeableness is related to bullying under low levels of stress. In addition, subordinates who perceived their supervisor as being low on agreeableness and high on introversion reported significantly more workplace bullying, supporting a negative halo effect hypothesis. (shrink)

Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, (...) conflict, and ‘outsiders’ are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well‐known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. (shrink)

To Kant, the French revolution's central events were the transfer of sovereignty to the people in 1789 and the trial and execution of the monarch in 1792-1793. Through a contextual study, this Element argues that while both events manifested the principle of popular sovereignty, the first did so in lawful ways, whereas the latter was a perversion of the principle. Kant was convinced that historical examples can help us understand political philosophy, and this Element seeks to show this in practice.

Reidar Thomte's Kierkegaard's Philosophy of Religion is an excellent read for students beginning their study of one of the greats of nineteenth and twentieth century philosophy. Thomte directly appropriates Kierkegaard's insightful language and discussion of the theological and philosophical issues that stimulated him, all of which are still alive and well today. This approach has the happy result that readers seeking an introduction do not have to be led through technical debates in order to approach Kierkegaard's thought. Thomte is (...) a master of incisive summary; his presentations of crucial distinctions are level-headed and to the point. Kierkegaard's categories such as the stages on life's way (the aesthetic, the ethical, Religiousness A, and Religiousness B), the individual, subjectivity, the Paradox, the varieties of love, faith and knowledge, etc., are provocative and illuminating. Not only is this book a good a starter, it is also a comprehensive review of the principal issues in Kierkegaard's philosophy of religion. (by Robert L. Perkins, Editor, International Kierkegaard Commentary). (shrink)

Like the French revolutionaries, Kant defended individual rights and a republican constitution. That he nonetheless rejected a right of revolution has puzzled scholars. In this article I give an overview of Kant’s rejection of a right of revolution, compare it to the German intellectual context, and use it to explain Kant’s view of the events in France. In Kant’s nuanced account of the revolution’s two central phases, he refined a distinction between legitimate political transition and lawless popular rebellion.

This paper argues that, although no resistance or revolution is permitted in the Kantian state, very tyrannical regimes must not be obeyed because they do not qualify as states. The essay shows how a state ceases to be a state, argues that persons have a moral responsibility to judge about it and defends the compatibility of this with Kantian authority. The reconstructed Kantian view has implications for how we conceive authority and obligation. It calls for a morally demanding definition of (...) the state and asserts that the primary personal responsibility is not to evaluate the morality of every single law but to evaluate the moral standing of the polity.Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.Kant, the State, and RevolutionVolume 18, Issue 1Reidar Maliks DOI: https://doi.org/10.1017/S1369415412000271Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. Kant, the State, and RevolutionVolume 18, Issue 1Reidar Maliks DOI: https://doi.org/10.1017/S1369415412000271Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. Kant, the State, and RevolutionVolume 18, Issue 1Reidar Maliks DOI: https://doi.org/10.1017/S1369415412000271Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation. (shrink)

This article raises the issue of the extent to which a single nation can develop a “national agricultural policy,” pursuing internal goals in agrarian development, goals that vary significantly from those of other industrialized countries. What are the conflicts arising from such a policy and how do these conflicts interfere with the general agricultural crisis of these countries? The Norwegian case is explored as an example of a blend of social-democratic and center-populist agricultural policies. The decision in 1975 by the (...) Norwegian Parliament to establish the income level of farmers at the same level as workers is seen as an experiment. As agricultural policy, this new departure represented a deviation from the earlier policies of rationalization. The Social Democrats developed their new position as a result of internal and external pressure. A series of reforms financed by the new state incomes from oil production were undertaken, of which income equalization and a farm relief service were the most important. Most Norwegian farmers speak of the reform years as “the good years of escalation.” Equity was reached in 1982, but nevertheless several problems emerged: 1) the escalation of subsidized incomes led to overproduction and decreasing incomes from the market (after 1982), 2) the large budgetary transfers to agriculture caused a legitimation crisis, fueling the constituency of the right-wing Progress Party, 3) the large subsidies to agriculture contributed to the fiscal crisis of the state, 4) the problems mentioned above, contributed to the general crisis of the Norwegian Social Democracy which finds itself with dwindling support. The likely outcome of the present Norwegian farm crisis is the implementation of an agricultural policy that will protect the most vulnerable sector and open the more competitive sector to market forces. (shrink)

In this paper, I present a nominalist ethics of intersubjectivity based on the principle of a discourse transcendent reality of the Other within an intersubjective relationship. Through a discussion of the authors Foucault, Sartre, and Hegel, and the film Drive My Car, the article presents a phenomenology of the appearance of one’s own body and of the body of the Other, according, either, to evaluative criteria or to existential criteria not accessible to discursive handling. The argument is nominalist in its (...) denial of a discursive purchase on the Other. It is realist in its exploration of the discourse transcendent reality of the Other. The argument moves between different orders of scale. (shrink)

This article presents a case study from the history of cardiology, namely, the development towards the acceptance of the coronary theory of angina pectoris. I show that the arguments which were considered decisive against the theory were not answered at the time the theory was accepted. I also point out that the experimental and practical success of the theory cannot be used to support the initial choice because, in the subsequent development, the field researchers became preoccupied with new questions and (...) problems. In spite of this, there is a sense in which the field of angina research has progressed, but it remains a challenge to exactly characterise in what sense this is the case. (shrink)

Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include the recognition of (...) uncertain data, the introduction of a third alternative, namely suspension of judgement, and the possibility of modifying the choice of probabilities based on a clinical trial with reference to other available knowledge. I have not, however, shown in detail how this modification is done, but I think the concept is sufficiently promising to be applied to an actual clinical decision problem. (shrink)

The article ‘Understanding Racism’ by Kwame Anthony Appiah is a revised version of The Annual Examen Philosophicum Lecture held on 29 September 2023 at the University of Oslo, with comments by Anna...

An introduction to the political philosophy of Kant, exploring how he developed his views in a context shaped by controversies following the French revolution. It provides new information on his followers and critics as they engaged in high stakes political debates on freedom's relation to the state at this key turning point in history.

This essay raises some questions concerning the method and conceptual structure of Sartre's Being and Nothingness. Three substantially different types of interpretation of this text have been put forward. One of the main issues separating the three interpretative strategies is the relationship that they each establish between Sartre's three fundamental concepts: consciousness, nothingness and freedom—each of which can be seen to play the fundamental role in the argument. It therefore seems crucial for any interpretation of Being and Nothingness to determine (...) the exact relationship between these terms. However, Being and Nothingness presents a hybrid argument that interweaves metaphysical deduction, phenomenological description and moral-existential argument in a way that makes it almost impossible to decide which of the strands of the argument should be seen to dominate the others. It is therefore perhaps equally difficult to ascertain which of its principal concepts has the most central place in the system. One could therefore argue that a reading of Being and Nothingness should aim to account for (rather than dismiss) the hybridity of the argument and then seek to assign relative functions to its different strands. The following remarks are intended as a step in that direction. (shrink)

When Kant in 1793 rejected a right of revolution, he was immediately criticized by a group of radical followers who argued that he had betrayed his own principles of justice. Jakob, Erhard, Fichte, Bergk and Schlegel proceeded to defend a right of resistance and revolution based on what they took to be his true principles. I argue that we must understand Kant's Metaphysics of Morals, which came in 1797, partly as a response to these radical democratic writings. Exploring this forgotten (...) controversy reveals that Kant did not betray his own principles when he denied a right of revolution, because he did not mean that persons have an unconditional duty to obey. This becomes clear when we read the final developments of Kant's thinking on individual liberty and republican government in light of the radical critique. (shrink)

In this issue, Alex London and Kevin Zollman provide an analysis of an influential approach to the ethics of international research, known as the “fair benefits” approach. According to them, the fair benefits approach suffers from a fatal flaw: it is either too vague to be useful, or worse, is internally inconsistent. The fair benefits approach was developed based on a presentation I gave at a workshop organized in Malawi in March 2001 by the National Institutes of Health Clinical Center’s (...) Department of Bioethics. In this presentation, I made what I still think is a valid point, which was accepted by the diverse group of participants and formed the basis of the subsequent publications: One should not .. (shrink)

Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers’ needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these (...) challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices. (shrink)

This book, edited by a team of leading European bioethicists, is in all respects an innovative publication.

This paper gives an account of theory structure in the biomedical sciences with particular emphasis on cardiology. Rather than regarding theories as axiomatizable sets of statements (the so-called received view), theories are regarded as answers to questions which are accepted as legitimate and interesting by scientists within a field of investigation at a given time. This account of theory structure is used to distinguish between theories which are quite liable to be revised during the course of scientific investigation, here called (...) theories within the field, and theories which are more securely established, here called theories of the field. These latter theories can also be regarded as patterns of reasoning which are applied again and again to answer the questions of the field. It is argued that the distinction proposed in this paper fits our intuitive understanding of what it means for a theory to be securely established within a field of research. Several examples are given which show the problems of justifying clinical intervention solely on the basis of theories within the field. (shrink)

Empathy is generally regarded as important and positive. However, descriptions of empathy are often inadequate and deceptive. Furthermore, there is a widespread lack of critical attention to such deficiencies. This critical review of the medical discourse of empathy shows that tendencies to evade and misrepresent the understanding subject are common. The understanding subject’s contributions to the empathic process are often neglected or described as something that can and should be avoided or controlled. Furthermore, the intrinsic and closely interwoven relationship between (...) medical understanding and empathy is generally not explored. Instead of challenging objectivistic and instrumental ideals, the medical discourse of empathy tends to accommodate to inadequate ideals of objectivity and instrumentalism. Thus, important aspects of physician’s rationality, understanding, and morality are neglected and important opportunities for reflection, dialogue, and critique are forfeited. Both the critical and constructive parts of this paper are heavily inspired by philosophical hermeneutic insights, e.g. that physician’s empathy is always historically situated and part of a moral commitment. At the end of this paper, an alternative description of empathy - i.e. appropriate understanding of another human being - is outlined to facilitate the inclusion of hermeneutic insights and accentuate the inherent relationship between empathy and morality. (shrink)

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of (...) ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout. (shrink)

This article argues that Kant's republicanism provides a foundation for democratic procedures. The conclusion is reached through an investigation of Critique of the Power of Judgment, which allows us to interpret Kant's notion of the state as a self-determining organic community, and not merely an aggregate of individuals. The article rejects Isaiah Berlin's interpretation of Kant as an authoritarian thinker, and reveals a republican theory centered on liberal freedom expressed within a self-organizing political community.

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should (...) focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)

The main idea of this article is to present various perspectives in order to analyze the recent crisis concerning the agriculture-based rural societies in the developed capitalist communities. In all of these countries there is a production crisis, resulting in too much food. But this is also an ideological crisis, because the consumer thinks that the food is produced at too high a price. And it is a political crisis as well because a major part of the voters think subsidies (...) and trade barriers are too high. The paper argues that beneath the present agricultural and rural policy crisis lies the failure of three great projects of our time: 1) The project of natural science; 2) The project of liberal capitalism; and 3) The project of scientific socialism. The failure of these three projects has to do with the breakdown of the positivist idea of modernization. Modernization theory was partly wrong because it overlooked the persistence of locally based life modes. Those life modes must be understood before a sustainable rural development is found. The article reviews some contemporary social science perspectives that have recently been developed to grasp the fundamental changes of today's rural societies. Based on those perspectives and primarily the life mode perspective, five key elements that are essential to analyze if we want to understand future development are isolated: food production, resources, space, social diversity, and culture. (shrink)

Gilles Deleuze famously expressed distaste for the philosophy of Ludwig Wittgenstein and his followers. The two thinkers are here seen as irreconcilable. The critique of false problems and the refutation of scepticism found in Wittgenstein have no resonance in Deleuze, who was a systematic metaphysical philosopher in the tradition of pre-Kantian rationalism. Pragmatic-sceptical self-limitation of thought's capabilities on the grounds of existing practice flies in the face of aesthetic experience. Moreover Deleuze explicitly upholds modern literature as a locus of philosophical (...) innovation. The comparison between Deleuze and Wittgenstein is pursued in an examination of the questions of ‘rule following’, literary practice and semiotics. Deleuze was hostile to ‘pragmatism’, whereas Wittgenstein and his followers could often be described as pragmatists. (shrink)

This book is about film's encounter with love throughout the medium's history. It is also about the philosophy of love... [it] outlines a new metaphysics and ontology of love as a reciprocal erotic relationship. This study argues that film's special narrative language is particularly well suited to depicting love in this way. It begins with early silent directors, such as Joseph von Sternberg, and concludes with contemporary filmmakers, such as Sophia Coppola; it also compares classical French and American love films (...) of the 1940s with modernist films by Luis Buñuel, François Truffaut, and Wong Kar Wai, amongst many others"--Page [4] of cover. (shrink)

This book provides a clear and concise introduction to the philosophy of Gilles Deleuze. It analyses his key theoretical concepts, such as difference and the body without organs, and covers all the different areas of his thought, including metaphysics, the history of philosophy, psychoanalysis, political theory, the philosophy of the social sciences and aesthetics. As the first book to offer a comprehensive analysis of Deleuze's writings, it reveals both the internal coherence of his philosophy and its development through a series (...) of distinct phases. Reidar Due offers an entirely new interpretation of Deleuze's philosophy, centred around the notion of thought as a capacity to form relations. These relations are embodied in nature, in language and in the unconscious; in art, science and social practice. With this concept of embodied thought, Deleuze challenges our most entrenched beliefs about the self and about signs whether linguistic or social. He develops an original theory of power and social systems and presents a method for understanding any signifying practice, from language and ritual to the unconscious, including cinema, literature and painting. Due analyses the different strands in this theoretical edifice and shows its implications for a wide range of human sciences, from history and psychology to political theory and cultural studies. (shrink)

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.

Democratic theorists are usually dismissive about the idea that citizens act “through” their representatives and often hold persons to exercise true political agency only at intervals in elections. Yet, if we want to understand representative government as a proper form of democracy and not just a periodical selection of elites, continuous popular agency must be a feature of representation. This article explores the Kantian attempt to justify that people can act “through” representatives. I call this the “exercise view” of representation (...) and defend its superiority to the “opportunity view,” which I attribute to Locke. It is superior because it has a robust conception of rationality and collective action, allowing us to understand how representation can mediate public reason. (shrink)

L’article propose une analyse de la gestion politique de la pandémie, élaborant un concept de domination nouvelle qui, du côté de l’Etat comme du côté du citoyen, et des attitudes normatives que l’on attend de lui, aurait été caractérisé par un type de réflexion rationnelle à échelle temporelle brève. L’article analyse les implications temporelles et politiques de ce lien de domination nouveau en comparant la raison d’Etat des gouvernements occidentaux durant la pandémie à des conceptions du pouvoir défini en termes (...) d’idéologie ou de “biopolitique”. Ensuite, il cherche à déterminer la nature du citoyen-sujet qui entre dans cette nouvelle forme de domination par comparaison avec trois formes de subjectivité canoniques : le sujet kantien, l’individu sociologique et la subjectivité contingente et éthique théorisée par Hannah Arendt. Par ce biais, il définit la singularité du citoyen-sujet nouveau par sa réactivité. (shrink)

This article explores the writings of Ludwig Heinrich Jakob and Johann Benjamin Erhard, two young Kantians who produced original defences of resistance and revolution during the 1790's. Comparing these two neglected philosophers reveals a crucial divergence in the liberal theory of revolution between a perspective that emphasises resistance by the individual and another that emphasises revolution by the nation. The article seeks to contribute to a more nuanced view of the political theory of the German Enlightenment, which has often been (...) presented as excessively obedient to authority.The historian Charles Ingrao repeated a common perception when, in an article on enlightened absolutism, he speculated that, ‘the German's greater acceptance of authority both then and now may be rooted in their own distinctive national culture’. This idea of the obedient German has been promoted especially by those who seek cultural explanations for the authoritarian bent of German society in the 20thcentury. But the idea has a longer history. Herder described Germany as the land of obedience, and Kant wrote that, ‘in keeping with their penchant for law and order, they [the Germans] will rather submit to despotic treatment than venture on innovations ’. By ‘wilful reforms of government’ Kant meant revolution. Madame de Staël later observed that Germans ‘join the greatest boldness of thought to the most obedient character’. As Frederick Beiser has shown, this view, which was repeated by Heine and Marx, came to dominate the historiography. (shrink)

ABSTRACTCan there be a legal or a moral right to resist the government? Scholarly interest in the right of resistance has rarely focused on German philosophy, which has often been considered unusually committed to authority. Yet, during the Enlightenment German philosophers regularly attempted to justify not just conscientious refusal but also revolution. This essay explores the two dominant justifications, which were based in Wolffian perfectionism and Kantian relational theory. It argues that we can best understand the complexity of these theories (...) of resistance by exploring their contrasting views on the state’s purpose: providing material and spiritual welfare, or establishing freedom as independence. (shrink)

In recent years, political philosophers have debated whether human rights are a special class of moral rights we all possess simply by virtue of our common humanity and which are universal in time and space, or whether they are essentially modern political constructs defined by the role they play in an international legal-political practice that regulates the relationship between the governments of sovereign states and their citizens. This edited volume sets out to further this debate and move it ahead by (...) rethinking some of its fundamental premises and by applying it to new and challenging domains, such as socio-economic rights, indigenous rights, the rights of immigrants and the human rights responsibilities of corporations. Beyond the philosophy of human rights, the book has a broader relevance by contributing to key themes in the methodology of political philosophy and by addressing urgent issues in contemporary global policy making. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)