Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training (...) program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy. (shrink)

This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The (...) two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings. (shrink)

A so called “weak value” of an observable in quantum mechanics (QM) may be obtained in a weak measurement + post-selection procedure on the QM system under study. Applied to number operators, it has been invoked in revisiting some QM paradoxes (e.g., the so called Three-Box Paradox and Hardy’s Paradox). This requires the weak value to be interpreted as a bona fide property of the system considered, a par with entities like operator mean values and eigenvalues. I question such an (...) interpretation; it has no support in the basic axioms of quantum mechanics and it leads to unreasonable results in concrete situations. (shrink)

In recent years, several formalisms for program construction have appeared. One such formalism is the type theory developed by Per Martin-L f. Well suited as a theory for program construction, it makes possible the expression of both specifications and programs within the same formalism. Furthermore, the proof rules can be used to derive a correct program from a specification as well as to verify that a given program has a certain property. This book contains a thorough introduction to type theory, (...) with information on polymorphic sets, subsets, monomorphic sets, and a full set of helpful examples. (shrink)

Harm-reduction approaches are used to reduce the burden of risky human behaviour without necessarily aiming to stop the behaviour. We discuss what an introduction of harm reduction for doping in sports would mean in parallel with a relaxation of the antidoping rule. We analyse what is ethically at stake in the following five levels: (1) What would it mean for the athlete (the self)? (2) How would it impact other athletes (the other)? (3) How would it affect the phenomenon of (...) sport as a game and its fair play basis (the play)? (4) What would be the consequences for the spectator and the role of sports in society (the display)? and (5) What would it mean for what some consider as essential to being human (humanity)? For each level, we present arguments for and against doping and then discuss what a harm-reduction approach, within a dynamic regime of a partially relaxed antidoping rule, could imply. We find that a harm-reduction approach is morally defensible and potentially provides a viable escape out of the impasse resulting from the impossibility of attaining the eradication of doping. The following question remains to be answered: Would a more relaxed position, when combined with harm-reduction measures, indeed have less negative consequences for society than today9s all-out antidoping efforts that aim for abstinence? We provide an outline of an alternative policy, allowing a cautious step-wise change to answer this question and then discuss the ethical aspects of such a policy change. (shrink)

Se trata de un articulo que me lo he bajado de la página de Mplus. En realidad es un DRAFT en lugar de un artículo (no lo puedo citar). Explica cómo realizar análisis Bayesianos y cuándo es conveniente utilizarlos. Es una técnica que se emplea al par del Bootstrapping (aunque su base sea diferente). Pero es interesante porque está disponible en análisis multinivel y puede ser útil cuando los parámetros no son normales y o la muestra es pequeña (el ejemplo (...) multinivel que muestra tiene sólamente 10 clusters a nivel between). (shrink)

Quantum mechanical weak values of projection operators have been used to answer which-way questions, e.g. to trace which arms in a multiple Mach–Zehnder setup a particle may have traversed from a given initial to a prescribed final state. I show that this procedure might lead to logical inconsistencies in the sense that different methods used to answer composite questions, like “Has the particle traversed the way X or the way Y?”, may result in different answers depending on which methods are (...) used to find the answer. I illustrate the problem by considering some examples: the “quantum pigeonhole” framework of Aharonov et al., the three-box problem, and Hardy’s paradox. To prepare the ground for my main conclusion on the incompatibility in certain cases of weak values and logic, I study the corresponding situation for strong/projective measurements. In this case, no logical inconsistencies occur provided one is always careful in specifying exactly to which ensemble or sample space one refers. My results cast doubts on the utility of quantum weak values in treating cases like the examples mentioned. (shrink)

This anthology focuses on “practical” forms and expressions of knowledge, like thinking through artistic media or by crafting things out of materials. The ten chapters follow and review various tracks in conceptions of contemporary knowledge, exploring human knowledge and experience from the perspective of human activities or practices, professional, artistic, domestic, or whatever. A guiding idea is that human knowledge seldom, perhaps never, fits into the traditional dualism between thinking and doing. -/- The chapters are written by philosophers and musicians (...) – some with a double experience as artists and theoreticians. The themes are philosophical, but above all, they touch on questions that are essential for how we understand ourselves as thinking and playing bodies, indeed as parts of nature. The book does not propose one single “theory of knowledge” but steps towards a more diverse and open attitude to the meaning of knowledge. -/- We hope that the texts will be of interest and useful in both disciplinebased and professional education: in philosophy, art schools, tea cher education, and in other programmes where tacit and practical knowledge are essential for the (future) practitioners. It is possible to independently read, and profit from, most of the chapters. (shrink)

Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training (...) program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy. (shrink)

One of the claims sometimes advanced in favour of anti-doping is that allowing doping would lead to a uniform increase in performance in comparison to no doping. The idea is that if all athletes wo...

The purpose of this article is to present a normative theory of the goals of medicine (a theory that tells us in what respects medicine should benefit the patient) that is both comprehensive and unified. A review of the relevant literature suggests that there are at least seven plausible goals that are irreducible to each other, namely to promote functioning, to maintain or restore normal structure and function, to promote quality of life, to save and prolong life, to help the (...) patient to cope well with her condition, to improve the external conditions under which people live, and to promote the growth and development of children. However, it seems that all these goals need to be qualified in different ways, e.g. it does not seem reasonable to improve physiological function or functional ability unless this is expected to have positive effects on quality of life and/or length of life, or to improve the quality of life in any respect, or by any means. These qualifications all suggest that the proposed goals are, as goals, conceptually, and not just causally, related to one another, and that they should therefore not be regarded in isolation. Instead, we should think of the medical enterprise as having a multidimensional goal structure rather than a single goal. In order to depict clearly how the different goals are related to one another, a multidimensional model is constructed. (shrink)

The basic theory of preference relations contains a trivial part reflected by axioms A1 and A2, which say that preference relations are preorders. The next step is to find other axims which carry the theory beyond the level of the trivial. This paper is to a great part a critical survey of such suggested axioms. The results are much in the negative — many proposed axioms imply too strange theorems to be acceptable as axioms in a general theory of preference. (...) This does not exclude, of course, that they may well be reasonable axioms for special calculi of preference. I believe that many axioms which are rejected here may be plausible if their range of application is restricted by conditions which are possible to formulate only in a language richer than that of the propositional calculus, e.g. in one containing modal operators or probabilistic concepts. (shrink)

From good intentions to real life: introducing crisis resolution teams in Norway In Norway, as in most western countries, the adult services for people experiencing mental health problems have gone through major changes over the last decades. A report submitted to the Norwegian Parliament in 1997 summarized several areas of improvement in the provision of mental health‐care to its population, and led to the introduction of a national mental health programme in 1998 for its implementation to be completed by 2008. (...) The most significant recent development in Norway is ‘Crisis Resolution/Home Treatment’ (CRHT) teams that provide an alternative to acute hospital care services. The major aim of this study is to explore an emerging form of community mental health‐care, and present a framework for establishment and examination of CRHT teams applying the user perspectives. An illustration of user experiences in an already established CRHT team provides a background for understanding implications of this form of service in relation to service users’ needs in acute crises. (shrink)

All definitions of mental disorder are backed up by arguments that rely on general criteria (e.g., that a definition should be consistent with ordinary language). These desiderata are rarely explicitly stated, and there has been no systematic discussion of how different definitions should be assessed. To arrive at a well-founded list of desiderata, we need to know the purpose of a definition. I argue that this purpose must be practical; it should, for example, help us determine who is entitled to (...) publicly funded health care. I then propose eight conditions of adequacy that can be used to assess competing definitions (e.g., the ordinary language condition, the coherence condition, and the condition of normative adequacy). These conditions pull in different directions, however, and we must decide which are most important. I also suggest that there is no single definition that can help us deal with all the relevant practical issues. (shrink)

SummaryCertain problems in Quine's philosophy of language are discussed. The first issue is his theory of how an observation sentence is understood. This is part of the more general problem of constructing a theory for how any single cognitive sentence is grasped. Quine's thesis of the inscrutability of reference, according to which it is senseless to ask what the referent of a term is, is our second subject. The content and truth of this thesis is discussed. In this context three (...) rather precise versions of the thesis are presented. The third issue to be treated is the relationship between the inscrutability thesis and theories of observation sentence understanding. The main conclusion of the paper is that the inscrutability thesis can hardly be true. (shrink)

Attributions of what we shall call normative responsibilities play a central role in everyday moral thinking. It is commonly thought, for example, that parents are responsible for the wellbeing of their children, and that this has important normative consequences. Depending on context, it might mean that parents are morally required to bring their children to the doctor, feed them well, attend to their emotional needs, or to see to it that someone else does. Similarly, it is sometimes argued that countries (...) that emit most greenhouse gases are responsible for preventing catastrophic climate change. This responsibility might imply that these countries are morally required to take necessary steps individually and jointly to come to an agreement on and implement a workable plan, and to avoid steps that worsen the situation. More trivially, the grading of your student’s essays might be your responsibility, as might making sure there is wine at tomorrow’s picnic, and you might thus be required to see to it that essays are competently graded and suitable wine brought to the picnic. -/- Though attributions of normative responsibilities are legion, such responsibilities have received surprisingly little philosophical attention compared to its normative relatives, obligations and reasons, and compared to retrospective responsibility. This chapter hopes to improve on this situation by taking on two main tasks. The first, attempted in section 1, is to spell out the general structure of normative responsibility, in particular the relation between normative responsibilities and corresponding obligations and demands. We suggest that normative responsibilities are constituted by normative requirements that the responsible agents care appropriately about how well things go in certain regards, and that obligations generally can be seen as straightforward upshots of requirements to care. -/- The second task, taken on in section 2, is to provide an overview of prominent sources of normative responsibility and its distribution among agents. Why would the children’s wellbeing be the parents’ responsibility? Why not the neighbor’s, or the state’s, or everyone’s? Here we discuss a range of possible sources, including agents’ abilities, costs involved in taking on the responsibility in question, retrospective responsibility for the situation, promises or contracts, and certain social relationships. (shrink)

The recent discussion of the concept of mental disorder has focused on what makes a mental disorder a disorder. A question that has received less attention is what makes a mental disorder mental rather than somatic. We examine three views on this issue -- namely, the internal cause view, the symptom view, and the pluralist view -- and assess to what extent these accounts are plausible. Three strategies used to pinpoint the mental in psychiatry are identified, namely negative characterizations, exemplification (...) of paradigmatic mental features, and an appeal to intentional content. We also examine different versions of nihilism. Finally, it is observed that the discussion of what makes a mental disorder mental has largely been unaffected by conceptions of the mental in the philosophy of mind. (shrink)

The aim of this essay is to elaborate on the inner connection between three such diverse entities as lifelong learning, globalization and hermeneutics. After placing lifelong learning in a societal context framed by globalization, my intention is to reflect on the prerequisites for introducing a hermeneutical contribution to the understanding of lifelong learning. First, it is stated that globalization is the most profound horizon today for explaining the current interest we experience in both lifelong learning and hermeneutics. Second, from these (...) links to on globalization, we can also expect to find new links between lifelong learning and hermeneutics. Third, the predominant configuration of lifelong learning according to the logics of globalization and virtues of flexibility is demonstrated, and thereafter criticized mainly from the perspectives of philosophical anthropology. Finally, an alternative configuration of meaning and identity formation in lifelong learning is proposed by utilizing a reformulated theory of interpretation made possible thanks to recent metamorphosis inside the hermeneutical tradition itself. (shrink)

This study was directed towards personality-related, value system and sociodemographic variables of nursing students in a situation of change, using a longitudinal perspective to measure their improvement in principle-based moral judgement (Kohlberg; Rest) as possible predictors of stress. Three subgroups of students were included from the commencement of the first three-year academic nursing programme in 1993. The students came from the colleges of health at Jönköping, Växjö and Kristianstad in the south of Sweden. A principal component factor analysis (varimax) was (...) performed using data obtained from the students in the spring of 1994 (n = 122) and in the spring of 1996 (n = 112). There were 23 variables, of which two were sociodemographic, eight represented self-image, six were self-values, six were interpersonal values, and one was principle-based moral judgement. The analysis of data from students in the first year of a three-year programme demonstrated eight factors that explained 68.8% of the variance. The most important factors were: (1) ascendant decisive disorderly sociability and nonpractical mindedness (18.1% of the variance); (2) original vigour person-related trust (13.3% of the variance); (3) orderly nonvigour achievement (8.9% of the variance) and (4) independent leadership (7.9% of the variance). (The term ‘ascendancy’ refers to self-confidence, and ‘vigour’ denotes responding well to challenges and coping with stress.) The analysis in 1996 demonstrated nine factors, of which the most important were: (1) ascendant original sociability with decisive nonconformist leadership (18.2% of the variance); (2) cautious person-related responsibility (12.6% of the variance); (3) orderly nonvariety achievement (8.4% of the variance); and (4) nonsupportive benevolent conformity (7.2% of the variance). A comparison of the two most prominent factors in 1994 and 1996 showed the process of change to be stronger for 18.2% and weaker for 30% of the variance. Principle-based moral judgement was measured in March 1994 and in May 1996, using the Swedish version of the Defining Issues Test and Index P. The result was that Index P for the students at Jönköping changed significantly (paired samples t-test) between 1994 and 1996 (p = 0.028), but that for the Växjö and Kristianstad students did not. The mean of Index P was 44.3% at Växjö, which was greater than the international average for college students (42.3%); it differed significantly in the spring of 1996 (independent samples t-test), but not in 1994, from the students at Jönköping (p = 0.032) and Kristianstad (p = 0.025). Index P was very heterogeneous for the group of students at Växjö, with the result that the paired samples t-test reached a value close to significance only. (shrink)

It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some specific evaluative (...) standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)

The paper starts with a presentation of the pure happiness theory, i.e. the idea that the quality a person’s life is dependent on one thing only, viz. how happy that person is. To find out whether this type of theory is plausible or not, I examine the standard arguments for and against this theory, including Nozick’s experience machine argument. I then investigate how the theory can be modified in order to avoid the most serious objections. I first examine different types (...) of epistemic modifications of the theory (e.g. the idea that a person’s happiness is more valuable for her if it is based on a correct perception of her own life), and then turn to a number of modifications which all make the value of a person’s happiness depend on whether the evaluative standard on which her happiness is based satisfies certain requirements. In connection with this, I present and defend my own modified version of the happiness theory. (shrink)