X‐linked agammaglobulinemia is a heritable immunodeficiency disease caused by a differentiation abnormality, resulting in the virtual absence of B Iymphocytes and plasma cells. The affected gene encodes a cytoplasmic protein tyrosine kinase, Bruton's agammaglobulinemia tyrosine kinase, designated Btk. Btk and the other family members, Tec, Itk and Bmx, contain five regions, four of which are common structural and functional modules that are found in other signaling proteins. Mutations affect all domains of the gene, but amino acid substitutions seem to be (...) confined to certain regions. More than 150 unique mutations have been identified and are collected in a mutation database, BTKbase. Here we discuss the three‐dimensional structural implications of such mutations and their putative functional role. Of special interest are mutations affecting the pleckstrin homology domain, as Btk is the only disease‐associated protein so far reported to carry mutations in this particular module. (shrink)

Cytoplasmic protein-tyrosine kinases (PTKs) are enzymes involved in transducing a vast number of signals in metazoans. The importance of the Tec family of kinases was immediately recognized when, in 1993, mutations in the gene encoding Bruton's tyrosine kinase (Btk) were reported to cause the human disease X-linked agammaglobulinemia (XLA).(1,2) Since then, additional kinases belonging to this family have been isolated, and the availability of full genome sequences allows identification of all members in selected species enabling phylogenetic considerations. Tec kinases are (...) endowed with Pleckstrin homology (PH) and Tec homology (TH) domains and are involved in diverse biological processes related to the control of survival and differentiation fate. Membrane translocation resulting in the activation of Tec kinases with subsequent Ca2+ release seems to be a general feature. However, nuclear translocation may also be of importance. The purpose of this essay is to characterize members of the Tec family and discuss their involvement in signaling. The three-dimensional structure, expression pattern and evolutionary aspects will also be considered. BioEssays 23:436–446, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Mentalization-based family therapy and family rehabilitation represent a rich variety of approaches for assisting families with difficult interaction patterns. On the other hand, adventure therapy methods have been successfully used with families to offer them empowering experiences of succeeding together against difficult odds and to improve communication between family members. Further, the health promoting qualities of spending time outdoors are now well established and recognized. The Nordic approach to mentalization-based family rehabilitation combines adventure, outdoor, and systemic therapy. We provide three (...) examples of nature-based family rehabilitation practices that are delivered as brief, multi-family psychological interventions taking place in nearby nature and aiming to support sustainable, systemic change. The current contribution is a description of clinical practice, not a systematic review or a formal evaluation. We propose that recontextualizing mentalization-based family rehabilitation to the outdoors can not only provide added health benefits, but also strengthen intra-familial attuned interaction and emotional connectedness. The outdoor adventure provides the families with embodied, multisensory experiences of verbal and, especially, non-verbal interaction that can be usefully examined through the lens of theory of mentalization. The concreteness of adventure experiences is particularly beneficial for families that have difficulties in verbal communication and/or utilizing executive functions, perhaps due to neuropsychiatric traits, intellectual disabilities, or learning difficulties. Furthermore, outdoor adventure can support the participants’ connectedness to nature. (shrink)

BackgroundDebates around euthanasia and physician-assisted suicide are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there (...) have been changes in these attitudes over three decades.MethodsA questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013.ResultsThe proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020. The number of physicians, who expressed no opinion for or against euthanasia decreased from 19 to 5% during the same period. The proportion of physicians having no opinion of whether a physician should be punished for assisting in a suicide decreased from 20 to 10%.ConclusionsThis study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Background Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal. Methods A survey including statements concerning euthanasia and (...) PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. Results Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. Conclusions Finnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal. (shrink)

[First published 09/2016; substantive revision 02/2021.] Evaluative terms and concepts are often divided into “thin” and “thick”. We don’t evaluate actions and persons merely as good or bad, or right or wrong, but also as kind, courageous, tactful, selfish, boorish, and cruel. The latter evaluative concepts are "descriptively thick": their application somehow involves both evaluation and a substantial amount of non-evaluative description. This article surveys various attempts to answer four fundamental questions about thick terms and concepts. (1) A “combination question”: (...) how exactly do thick terms and concepts relate evaluation and non-evaluative description? (2) A “location question”: is evaluation somehow inherent to thick terms and concepts, such as perhaps an aspect of their meaning, or merely a feature of their use? (3) A “delineation question”: how do thick terms differ from the thin and from other kinds of evaluative terms? (4) Given answers to these questions, what broader philosophical significance and applications might thick concepts have? (shrink)

This paper offers a general model of substantive moral principles as a kind of hedged moral principles that can (but don't have to) tolerate exceptions. I argue that the kind of principles I defend provide an account of what would make an exception to them permissible. I also argue that these principles are nonetheless robustly explanatory with respect to a variety of moral facts; that they make sense of error, uncertainty, and disagreement concerning moral principles and their implications; and that (...) one can grasp these principles without having to grasp any particular list of their permissibly exceptional instances. I conclude by pointing out various advantages that this model of principles has over several of its rivals. The bottom line is that we should find nothing peculiarly odd or problematic about the idea of exception-tolerating and yet robustly explanatory moral principles. (shrink)

This paper concerns non-causal normative explanations such as ‘This act is wrong because/in virtue of__’. The familiar intuition that normative facts aren't brute or ungrounded but anchored in non- normative facts seems to be in tension with the equally familiar idea that no normative fact can be fully explained in purely non- normative terms. I ask whether the tension could be resolved by treating the explanatory relation in normative explanations as the sort of ‘grounding’ relation that receives extensive discussion in (...) recent metaphysics. I argue that this would help only under controversial assumptions about the nature of normative facts, and perhaps not even then. I won't try to resolve the tension, but draw a distinction between two different sorts of normative explanations which helps to identify constraints on a resolution. One distinctive constraint on normative explanations in particular might be that they should be able to play a role in normative justification. (shrink)

This paper offers a simple response to the Moral Twin Earth (MTE) objection to Naturalist Moral Realism (NMR). NMR typically relies on an externalist metasemantics such as a causal theory of reference. The MTE objection is that such a theory predicts that terms like ‘good’ and ‘right’ have a different reference in certain twin communities where it’s intuitively clear that the twins are talking about the same thing when using ‘good’. I argue that Boyd’s causal regulation theory, the original target (...) of the MTE objection, was never vulnerable to this objection. The theory contains an epistemic constraint on reference which implies that either the property that causally regulates uses of ‘good’ isn’t different for the twin communities or, in scenarios where the reference is different, the communities diverge in ways where it’s not intuitively clear that ‘good’ has the same reference for them. (shrink)

Normative explanations of why things are wrong, good, or unfair are ubiquitous in ordinary practice and normative theory. This paper argues that normative explanation is subject to a justification condition: a correct complete explanation of why a normative fact holds must identify features that would go at least some way towards justifying certain actions or attitudes. I first explain and motivate the condition I propose. I then support it by arguing that it fits well with various theories of normative reasons, (...) makes good sense of certain legitimate moves in ordinary normative explanatory discourse, and helps to make sense of our judgments about explanatory priority in certain cases of normative explanation. This last argument also helps to highlight respects in which normative explanation won’t be worryingly discontinuous with explanations in other domains even though these other explanations aren’t subject to the justification condition. Thus the paper aims not only to do some constructive theorizing about the relatively neglected topic of normative explanation but also to cast light on the broader question of how normative explanation may be similar to and different from explanations in other domains. (shrink)

Many normative judgments play a practical role in our thought. This paper concerns how their practical role is reflected in language. It is natural to wonder whether the phenomenon is semantic or pragmatic. The standard assumption in moral philosophy is that at least terms which can be used to express “thin” normative concepts – such as 'good', 'right', and 'ought' – are associated with certain practical roles somehow as a matter of meaning. But this view is rarely given explicit defense (...) or even articulation. I’ll consider several versions of the view, and argue that even the most promising among them are problematic. Terms like 'ought' are often used in ways where their customary practical role is absent. Such cases give us a choice: either offer some plausible explanation of why the relevant practical upshots don’t show up in these cases despite featuring in our semantic theory for these expressions, or else don’t build them into that theory. I argue that plausible explanations of the requisite sort aren’t forthcoming in either descriptive semantics or metasemantics for normative language. In closing I briefly consider the prospects for a pragmatic account of the phenomenon and some broader ramifications for metaethics and the philosophy of normativity. (shrink)

Normative naturalism is primarily a metaphysical doctrine: there are normative facts and properties, and these fall into the class of natural facts and properties. Many objections to naturalism rely on additional assumptions about language or thought, but often without adequate consideration of just how normative properties would have to figure in our thought and talk if naturalism were true. In the first part of the paper, I explain why naturalists needn’t think that normative properties can be represented or ascribed in (...) wholly non-normative terms. If so, certain prominent objections to normative naturalism fail. In the second part, I consider the objection that normative properties are “just too different” from (other) natural properties to themselves be natural properties. I argue that naturalists have no distinctive trouble making sense of thought and talk involving forms of “genuine” or “authoritative” normativity which can drive a non-question-begging form of the objection. (shrink)

One prominent strand in contemporary moral particularism concerns the claim of "principle abstinence" that we ought not to rely on moral principles in moral judgment because they fail to provide adequate moral guidance. I argue that moral generalists can vindicate this traditional and important action-guiding role for moral principles. My strategy is to argue, first, that, for any conscientious and morally committed agent, the agent's acceptance of (true) moral principles shapes their responsiveness to (right) moral reasons and, second, that if (...) so, then those principles can contribute non-trivially to some reliable strategy for acting well that is available for use in the agent's practical thinking. My defense of these two claims appeals to an account of moral principles as a kind of hedged principles which I defend elsewhere, but my general line of argument should be acceptable to many other forms of generalism as well. I defend the epistemic significance of hedged principles in moral deliberation, and argue that the need for sensitivity to particulars in moral judgment doesn't supplant principles in moral guidance. I finish by arguing that the generalist model of moral guidance developed here isn't undermined by evidence from cognitive science about how we make moral judgments in actual practice, and that it compares favorably to particularism with respect to its capacity to offer adequate moral guidance. (shrink)

Normative explanations, which specify why things have the normative features they do, are ubiquitous in normative theory and ordinary thought. But there is much less work on normative explanation than on scientific or metaphysical explanation. Skow (2016) argues that a complete answer to the question why some fact Q occurs consists in all of the reasons why Q occurs. This paper explores this theory as a case study of a general theory that promises to offer us a grip on normative (...) explanation which is independent of particular normative theories. I first argue that the theory doesn’t give an adequate account of certain enablers of reasons which are important in normative explanation. I then formulate and reject three responses on behalf of the theory. But I suggest that since theories of this general sort have the right kind of resources to illuminate how normative explanation might be similar to and different from explanations in other domains, they nonetheless merit further exploration by normative theorists. (shrink)

[This paper is available as open access from the publisher.]The conventional wisdom in ethics is that pure moral laws are at least metaphysically necessary. By contrast, Moral Contingentism holds that pure moral laws are metaphysically contingent. This paper raises a normative objection to Moral Contingentism: it is worse equipped than Moral Necessitarianism to account for the normative standing or authority of the pure moral laws to govern the lives of the agents to whom they apply. Since morality is widely taken (...) to have such a standing, failing to account for it would be a significant problem. The objection also shows that the debate about the modal status of moral principles isn’t a debate solely within modal metaphysics, but has implications for topics in moral philosophy. (shrink)

This paper addresses a recent suggestion that moral particularists can extend their view to countenance default reasons (at a first stab, reasons that are pro tanto unless undermined) by relying on certain background expectations of normality. I first argue that normality must be understood non-extensionally. Thus if default reasons rest on normality claims, those claims won't bestow upon default reasons any definite degree of extensional generality. Their generality depends rather on the contingent distributional aspects of the world, which no theory (...) of reasons should purport to settle. Appeals to default reasons cannot therefore uniquely support particularism. But this argument also implies that if moral generalism entailed that moral reasons by necessity have invariant valence (in the natural extensional sense), it would be a non-starter. Since generalism is not a non-starter, my argument forces us to rethink the parameters of the generalism-particularism debate. Here I propose to clarify the debate by focusing on its modal rather than extensional aspects. In closing, I outline the sort of generalism that I think is motivated by my discussion, and then articulate some worries this view raises about the theoretical usefulness of the label ‘default reason’. -/- [Note: The outline of moral generalism provided in this paper is superseded by those in "Moral Generalism: Enjoy in Moderation" and "A Theory of Hedged Moral Principles".]. (shrink)

Many philosophers believe that the extensions of evaluative terms and concepts aren’t unified under non-evaluative similarity relations and that this “shapelessness thesis” (ST) has significant metaethical implications regarding non-cognitivism, ethical naturalism, moral particularism, thick concepts and more. ST is typically offered as an explanation of why evaluative classifications appear to “outrun” classifications specifiable in independently intelligible non-evaluative terms. This paper argues that both ST and the outrunning point used to motivate it can be explained on the basis of more general (...) factors that have nothing in particular to do with being evaluative. If so, there is no reason to expect ST to carry the sorts of metaethical implications that get attributed to it. I also show that my main argument is robust across certain complications that are raised by the context-sensitivity of many evaluative terms but have so far been ignored in discussions of ST and related matters. (shrink)

Moral particularism denies that moral reasons present in particular cases depend on any suitable provision of moral principles. If they did, there should be invariable reasons. But reasons are holistic: whether a consideration is a reason may vary with the context. This work responds to particularism with a moderate form of generalism, according to which it is compatible with reasons holism that moral reasons are fundamentally determined by moral principles. The holism of reasons is explained by construing moral principles as (...) hedged: they determine reasons that are invariable, but only given the presence of certain suitable conditions. Both what may function as a reason and what may function as a suitable condition is determined by the given principle's normative basis---the basis on which we attribute to reasons normative force capable of justifying action. Such determinations don't happen fundamentally on a case-by-case basis, but instead set on the holism of reasons the sorts of antecedent constraints that particularism cannot accept. So, although the view rules out standard forms of generalism, it doesn't collapse into particularism. The moderate generalist view of moral metaphysics is argued also to ground better explanations of the relevant sorts of moral facts than its particularist rivals. It is also argued that generalism can regard moral principles as necessary for good moral deliberation without requiring that the deliberator represent them to herself in explicit propositional form. Psychologically, the grasp of moral principles that is required for proper responsiveness to reasons determined by principles may simply structure one's capacity to be responsive to reasons. Finally, on moderate generalism, overall moral verdicts about particular cases are a function of the relative strengths of the reasons present in them. It is argued, from the structure of value and evaluative comparisons, that the relative strengths of reasons are determined not by priority principles that order competing principles but by evaluative comparisons of the alternatives for which the competing principles specify reasons. A plausible moral epistemology is sketched on which the context-sensitivity of such comparisons doesn't make them too weak to justify moral verdicts. (shrink)

Inconsistencies between scientific theories have been studied, by and large, from the perspective of paraconsistent logic. This approach considered the formal properties of theories and the structure of inferences one can legitimately draw from theories. However, inconsistencies can be also analysed from the perspective of modelling practices, in particular how modelling practices may lead scientists to form opinions and attitudes that are different, but not necessarily inconsistent. In such cases, it is preferable to talk about disagreement, rather than inconsistency. Disagreement (...) may originate in, or concern, a number of epistemic, socio-political or psychological factors. In this paper, we offer an account of the ‘loci and reasons’ for disagreement at different stages of the scientific process. We then present a controversial episode in the health sciences: the studies on hypercholesterolemia. The causes and effects of high levels of cholesterol in blood have been long and hotly debated, to the point of deserving the name of ‘cholesterol wars’; the debate, to be sure, isn’t settled yet. In this contribution, we focus on some selected loci and reasons for disagreement that occurred between 1920 and 1994 in the studies on hypercholesterolemia. We hope that our analysis of ‘loci and reasons’ for disagreement may shed light on the cholesterol wars, and possibly on other episodes of scientific disagreement. (shrink)

Background: We define compassion as an enduring disposition that centers upon empathetic concern for another person's suffering and the motivation to act to alleviate it. The contribution of specific candidate genes to the development of dispositional compassion for others is currently unknown. We examine candidate genes in the oxytocin and dopamine signaling pathways.Methods: In a 32-year follow-up of the Young Finns Study, we examined with multiple indicators latent growth curve modeling the molecular genetic underpinnings of dispositional compassion for others across (...) the life span. We selected five single nucleotide polymorphisms whose functions are known in humans: rs2268498, rs3796863, rs1800497, rs4680, and rs1611115. Compassion was measured with Cloninger's Temperament and Character Inventory on three repeated observations spanning 15 years. Differences between gender were tested.Results: We did not find an effect of the five SNPs in oxytocin and dopamine pathway genes on the initial levels of dispositional compassion for others. Individuals who carry one or two copies of the T-allele of DBH rs1611115, however, tend to increase faster in compassion over time than those homozygotes for the C-allele, b = 0.063. This effect was largely driven by male participants, 0.206, and was not significant in female participants when analyzed separately.Conclusions: Men who are known to have, on average, lower compassion than women seem to reduce this difference over time if they carry the T-allele of DBH rs1611115. The direction of the association indicates that dopamine signaling activity rather than overall dopamine levels might drive the development of compassion. (shrink)

Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive (...) phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit. (shrink)

In this article we critique the collectivist approach to collective moral responsibility. According to philosophers of a collectivist persuasion, a central notion of collective moral responsibility is moral responsibility assigned to a collective as a single entity. In our critique, we proceed by way of discussing the accounts and arguments of three prominent representatives of the collectivist approach with respect to collective responsibility: Margaret Gilbert, Russell Hardin, and Philip Pettit. Our aims are mainly critical; however, this should not be taken (...) to imply that we do not ourselves support an alternative account of collective responsibility. We advocate an individualist account of collective responsibility. On this view of collective responsibility as joint responsibility, collective responsibility is ascribed to individuals. Each member of the group is individually morally responsible for the outcome of the joint action, but each is individually responsible jointly with the others. (shrink)

This essay revisits the main themes and arguments put forward in The Comanche Empire: indigenous agency; spatial reorientation in the writing of colonial histories; the composition of the Comanche empire and its impact on the history of North America. It also responds to a number of specific issues raised by the roundtable participants: differences and similarities between indigenous and Euro-colonial power regimes; balancing of culture-specific frameworks with broad-gauge political economic analysis; linkages between indigenous agency and indigenous sovereignty in colonial encounters; (...) the question of periodization in writing Native American and colonial histories. Finally, the essay points to new ways of understanding, conceptualizing, and comparing nonterritorial nomadic empires by introducing the concept of “kinetic empire,” which refers to a flexible imperial organization that revolves around a set of mobile activities and relies on selective nodal control of key resources. (shrink)

The dimensional structure of phenomenal space and its relation to the brain have not been widely focused on in brain and consciousness studies. This paper postulates that focusing on the dimensional structures displayed in the relation between phenomenal space and the brain is necessary for understanding the integration of distributed brain events in binding. A related issue is why items and events of phenomenal space and consciousness as they appear in experience seem to be beyond the reach of natural scientific (...) empirical observation. The proposed solution to these issues is postulated to require a fourth spatial dimension. A transcendence principle of detection (TPD) is introduced, which states that transcendent degrees of freedom of an n+1 dimension are a necessary condition for experiencing or detecting an n-dimensionally extended physical structure as an n-dimensionally extended phenomenal structure. It is postulated that the phenomenal outcome of binding, i.e. the threedimensionally distributed and extended phenomenal structure of human experience, is the expected first-person outcome of threedimensionally distributed neurophysical structures being monitored at the domain of a fourth spatial dimension. (shrink)

“Whatever matters to human beings, trust is the atmosphere in which it thrives” writes Sissela Bok. Although trust is ubiquitous, understanding trust is a non-trivial challenge. Trust: Analytic and Applied Perspectives addresses critical and analytical issues of trust. It examines trust from a conceptual perspective as well as considers it in practical contexts ranging from the public sphere broadly understood to particular social institutions, such as universities and medical care. Trust: Analytic and Applied Perspectives explores what kind of good trust (...) is, what kind of goods it can protect and how it can bring about goods, and develops subtle distinctions between trust and other virtues, and between trust and other forms of dependence.The pluralism of the volume reflects the diversity of the real world contexts and theoretical perspectives indispensable in the search of a deeper understanding of trust. Without such an understanding of the nature of trust and the good reasons why people might trust one another or the institutions, we are in danger of designing institutions that will reduce trust or even drive it out. Trust: Analytic and Applied Perspectives sheds new light on the intersecting dimensions of our social cooperation, in which trust can be responsibly undertaken. (shrink)

Legislation for dementia care needs to be continually rethought, if the rights of older persons and other persons with dementia are to be addressed properly. We propose a theoretical framework for understanding vulnerability and dependency, which enables us to problematize the currently prevailing legal conception of adults as always able — irrespective of health or age — to act autonomously in their everyday lives. Such an approach gives rise to difficult dilemmas when persons with dementia are forced to make decisions (...) on their own about basic living conditions, such as housing and care, without decision-making support. In Sweden, for example, such matters are frequently left to the person him- or herself to decide, often without any assistance from social workers, and with family members serving as caregivers of last resort.Using vulnerability theory as the framework for our discussion, we argue that policymakers should not apply a group-oriented approach (based on factors like age, legal status, or mental capacity) to persons suffering from dementia. The needs of such individuals are as complex and varied as they themselves are. We discuss our findings from an interdisciplinary (law/social work) research project in which we examine the dilemma that social workers face when they are required, under the terms of the Swedish Social Services Act, to determine whether persons with dementia are to be granted support.We argue further that a cross-disciplinary approach — in which vulnerability theory furnishes the framework — opens up for new ways of understanding and developing social welfare law and practice. This, we believe, can help us better address the rights, interests, and needs of people with dementia, of their families, and of professionals in the social welfare system. Finally, many of the problems faced by ageing societies in general can be understood on the basis of such an approach. (shrink)

In Alzheimer's disease (AD), pathological processes start in the brain long before clinical dementia. Biomarkers reflecting brain alterations may therefore indicate disease at an early stage, enabling early diagnosis. This raises several ethical questions and the potential benefits of early diagnosis must be weighted against possible disadvantages. Currently, there are few strong arguments favouring early diagnosis, due to the lack of disease modifying therapy. Also, available diagnostic methods risk erroneous classifications, with potentially grave consequences. However, a possible benefit of early (...) diagnosis even without disease modifying therapy is that it may enable early decision making when patients still have full decision competence, avoiding problems of hypothetical consents. It may also help identifying patients with cognitive dysfunction secondary to other diseases that may be responsive to treatment already today. (shrink)

This paper is a survey of the supervenience challenge to non-naturalist moral realism. I formulate a version of the challenge, consider the most promising non-naturalist replies to it, and suggest that no fully effective reply has yet been given.

The article examines the role of discourse in organisational sensemaking. By building links between the theorising undertaken within organisational studies and the empirical analysis of multimodal social interaction, it argues for a relational view of sensemaking and investigates how sense is made in and through social interaction in real organisational situations where language use intertwines with embodied actions and the manipulation of artefacts. In particular, the article studies the use of discourse technologies of textual artefacts in sensemaking processes. The data (...) come from training workshops of a Finnish workplace organisation, conducted in order for the employees to delineate the history and future of their organisation with the help of writable papers. The results show how the papers exert agency in the situation by facilitating three specific discursive practices and by enabling and restricting the actions employed in constructing a shared understanding of the organisational reality. (shrink)

A particular tradition in medicine claims that a variety of evidence is helpful in determining whether an observed correlation is causal. In line with this tradition, it has been claimed that establishing a causal claim in medicine requires both probabilistic and mechanistic evidence. This claim has been put forward by Federica Russo and Jon Williamson. As a result, it is sometimes called the Russo–Williamson thesis. In support of this thesis, Russo and Williamson appeal to the practice of the International Agency (...) for Research on Cancer. However, this practice presents some problematic cases for the Russo–Williamson thesis. One response to such cases is to argue in favour of reforming these practices. In this paper, we propose an alternative response according to which such cases are in fact consistent with the Russo–Williamson thesis. This response requires maintaining that there is a role for mechanism-based extrapolation in the practice of the IARC. However, the response works only if this mechanism-based extrapolation is reliable, and some have argued against the reliability of mechanism-based extrapolation. Against this, we provide some reasons for believing that reliable mechanism-based extrapolation is going on in the practice of the IARC. The reasons are provided by appealing to the role of robustness analysis. (shrink)

I first distinguish between different forms of the buck-passing account of value and clarify my target in other respects on buck-passers' behalf. I then raise a number of problems for the different forms of the buck-passing view that I have distinguished.

This paper is a survey of the generalism-particularism debate and related issues concerning the relationship between normative reasons and moral principles.

Francesco Guala has written an important book proposing a new account of social institutions and criticizing existing ones. We focus on Guala’s critique of collective acceptance theories of institutions, widely discussed in the literature of collective intentionality. Guala argues that at least some of the collective acceptance theories commit their proponents to antinaturalist methodology of social science. What is at stake here is what kind of philosophizing is relevant for the social sciences. We argue that a Searlean version of collective (...) acceptance theory can be defended against Guala’s critique and question the sufficiency of Guala’s account of the ontology of the social world. (shrink)

The growth of Sweden’s urban population necessitates new approaches for increasing the sustainability and energy efficiency of multifamily buildings. The development of such approaches will require a holistic and integrated understanding of the factors driving the decision making of both professionals who design buildings and end-users who live in them. This paper, therefore, uses the goal framing theory to determine which aspects of multifamily buildings are considered important by these two groups of actors. An empirical study based on semi-structured interviews (...) with professionals involved in building design and development was conducted to identify goals affecting the choices made during building design and development. In parallel, a questionnaire survey of building end-users was conducted to determine which factors guided their choice of dwelling. It was found that professionals’ design choices were primarily governed by normative goals relating to environmental benefits but were also influenced by the other goals. These included gain goals relating to budgetary constraints and keeping the building’s operational and maintenance costs low. Hedonic goals were also important; some design choices were made with the aim of providing pleasant, comfortable, and convenient living environments, or of giving the buildings a distinct aesthetic or some other special features. By comparing the professionals’ responses to the end-user surveys, it was found that the two groups had similar views concerning gain goals; both considered it important for apartments to be affordable and easy to maintain. However, their views on hedonic and normative goals differed markedly. The professionals sought to strike an optimal balance between different related aspects, whereas end-users placed greater importance on aspects relating to hedonic and gain goals when choosing dwellings. The findings provide a basis for constructive discussions on building design and development, and the scope for creating buildings that encourage end-users to adopt sustainable living practices while also satisfying their needs and preferences. (shrink)

The use of evidence in medicine is something we should continuously seek to improve. This book seeks to develop our understanding of evidence of mechanism in evaluating evidence in medicine, public health, and social care; and also offers tools to help implement improved assessment of evidence of mechanism in practice. In this way, the book offers a bridge between more theoretical and conceptual insights and worries about evidence of mechanism and practical means to fit the results into evidence assessment procedures.