This article reports a follow-up study of Norwegian nursing students entitled ‘The helping motive -an important goal for choosing nursing education’. It presents and discusses a significant ambiguity within the altruistic helping motive of 301 nursing students in the light of classical and modern virtue ethics. A quantitative longitudinal survey design was used to study socialization and building professional identity. The follow-up study began after respondents had completed more than two-and-a-half years of the three-year educational programme. Data were collected using (...) a questionnaire with closed questions, supplemented by 18 semi-structured, in-depth, audiotaped interviews. A motive such as ‘desire for human contact/to help others’ appeared to be highly significant. The research questions employed were: What motivates nursing students at the end of their studies to help other people? What does helping others mean for nursing students? Factor analysis revealed two factors. Factor 1 can be expressed as an altruism factor and factor 2 can be interpreted as an ‘acknowledgement-from-the-patient factor’ that in fact indicates an ambiguity within the helping motive itself. Findings from the interviews also reveal ambiguous helping motives. On one hand the students want to be altruistic and on the other they wish to receive positive feedback from patients when giving help. The findings indicate that this positive feedback is essential to the students in order for them to provide altruistic care. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...) tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...) variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (shrink)

The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral dou...

The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified is related to professionals’ normative attitudes regarding the use of coercion. This paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions. Descriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as (...) offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’. Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security. This study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion. (shrink)

Ethics in business and economics is often attacked for being too superficial. By elaborating the conclusions of two such critics of business ethics and welfare economics respectively, this article will draw the attention to the ethics behind these apparently well-intended, but not always convincing constructions, by help of the fundamental ethics of Emmanuel Levinas. To Levinas, responsibility is more basic than language, and thus also more basic than all social constructions. Co-operation relations in organizations, markets and value networks are generated (...) from personal relations and personal responsibilities. It is not sufficient to integrate ethics in an impersonal, rational system, neither in business organizations nor in the world economy. Ethics has its source not in rationality, but in the personal. (shrink)

Goethe's objections to Newton's theory of light and colours are better than often acknowledged. You can accept the most important elements of these objections without disagreeing with Newton about light and colours. As I will argue, Goethe exposed a crucial weakness of Newton's methodological self-assessment. Newton believed that with the help of his prism experiments, he could prove that sunlight was composed of variously coloured rays of light. Goethe showed that this step from observation to theory is more problematic than (...) Newton wanted to admit. By insisting that the step to theory is not forced upon us by the phenomena, Goethe revealed our own free, creative contribution to theory construction. And Goethe's insight is surprisingly significant, because he correctly claimed that all of the results of Newton's prism experiments fit a theoretical alternative equally well. If this is correct, then by suggesting an alternative to a well-established physical theory, Goethe developed the problem of underdete... (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including business ethics, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including ‘business ethics’, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

The book is an introductory exposition of the development of the physical and astronomical notions of the universe. It covers the period from Greek antiquity to the Copernican revolution and the Renaissance, half of the text being devoted to medieval science within both the Aristotelian and the Archimedean traditions. The book is intended for a general audience interested in intellectual and scientific developments, but should also be useful as a guide to further studies. Thus it has an extensive bibliography classifying (...) much of the secondary literature on the subject, and also a sixty page 'dictionary' of all the scientists and philosophers mentioned in the text. This contains references to printed editions of the sources and to a selection of books and periodicals. (shrink)

Theory of illness causation is an important issue in all biomedical sciences, and solid etiological explanations are needed in order to develop therapeutic approaches in medicine and preventive interventions in public health. Until now, the literature about the theoretical underpinnings of illness causation research has been scarce and fragmented, and lacking a convenient summary. This interdisciplinary book provides a convenient and accessible distillation of the current status of research into this developing field, and adds a personal flavor to the discussion (...) by proposing the etiological stance as a comprehensive approach to identify modifiable causes of illness. (shrink)

Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in (...) 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems. (shrink)

In this essay, I argue that Ted Poston's theory of explanatory coherentism is well-suited as a tool for causal explanation in the health sciences, particularly in epidemiology. Coherence has not only played a role in epidemiology for more than half a century as one of Hill's viewpoints, it can also provide background theory for the development of explanatory systems by integrating epidemiologic evidence with a diversity of other error-independent data. I propose that computational formalization of Hill's viewpoints in an explanatory (...) coherentist framework would provide an excellent starting point for a formal epistemological (knowledge-theoretical) project designed to improve causal explanation in the health sciences. As an example, I briefly introduce Paul Thagard's ECHO system and offer my responses to possible objections to my proposal. (shrink)

In this article the authors focus on the emergence, or disappearance, of notions of responsibility in social dynamic processes. Hence, the starting point in this article is concrete behavior within organisational settings. This article presents a systematic overview of mechanisms related to acting upon a sense of moral responsibility. Some of these mechanisms are based on individual characteristics, others are embedded in the social context wherein responsible behaviour emerges or disappears. In this article, various mechanisms are identified and labelled in (...) order to analyse what types of processes are behind the mechanisms. In this way, the article yields important understandings for the conscious use of these mechanisms to strengthen responsible behavior within organisations. (shrink)

Although Lorenz Oken is a classic example of Naturphilosophie as applied to biology, his views have been imperfectly understood. He is best viewed as a follower of Schelling who consistently attempted to apply Schelling's ideas to biological data. His version of Naturphilosophie, however, was strongly influenced by older pseudoscience traditions, especially alchemy and numerology as they had been presented by Robert Fludd, whose works were current in Jena and available to him. According to those influences, parts of Oken's philosophical conception (...) were communicable even in a non-idealistic scientific culture, for example in Paris, where Oken met Étienne Geoffroy Saint-Hilaire. Geoffroy however was embedded in a French intellectual tradition, and the correspondence between his views and those of Oken was only superficial. The English anatomist Richard Owen attempted to incorporate the views of Oken and Geoffroy within his own, idiosyncratic system. Although Darwin knew of Oken's ideas, it was Geoffroy who really affected his evolutionary biology, and any influence of Oken must have been attenuated to the point of triviality. (shrink)

Two decades after the publication of Clifford and Marcus' volume Writing Culture, this collection provides a fresh and diverse reassessment of the debates that ...

Bradford Hill (1965) highlighted nine aspects of the complex evidential situation a medical researcher faces when determining whether a causal relation exists between a disease and various conditions associated with it. These aspects are widely cited in the literature on epidemiological inference as justifying an inference to a causal claim, but the epistemological basis of the Hill aspects is not understood. We offer an explanatory coherentist interpretation, explicated by Thagard's ECHO model of explanatory coherence. The ECHO model captures the complexity (...) of epidemiological inference and provides a tractable model for inferring disease causation. We apply this model to three cases: the inference of a causal connection between the Zika virus and birth defects, the classic inference that smoking causes cancer, and John Snow’s inference about the cause of cholera. (shrink)

Quine claims that holism (i.e., the Quine-Duhem thesis) prevents us from defining synonymy and analyticity (section 2). In "Word and Object," he dismisses a notion of synonymy which works well even if holism is true. The notion goes back to a proposal from Grice and Strawson and runs thus: R and S are synonymous iff for all sentences T we have that the logical conjunction of R and T is stimulus-synonymous to that of S and T. Whereas Grice and Strawson (...) did not attempt to defend this definition, I try to show that it indeed gives us a satisfactory account of synonymy. Contrary to Quine, the notion is tighter than stimulus-synonymy -- particularly when applied to sentences with less than critical semantic mass (section 3). Now according to Quine, analyticity could be defined in terms of synonymy, if synonymy were to make sense: A sentence is analytic iff synonymous to self-conditionals. This leads us to the following notion of analyticity: S is analytic iff, for all sentences T, the logical conjunction of S and T is stimulus-synonymous to T; an analytic sentence does not change the semantic mass of any theory to which it may be conjoined (section 4). This notion is tighter than Quine's stimulus-analyticity; unlike stimulus-analyticity, it does not apply to those sentences from the very center of our theories which can be assented to come what may, even though they are not synthetic in the intuitive sense (section 5). (shrink)

The intention of the article is to offer stakeholders affected by mergers a criterion from which moral arguments may be generated for the organization of each individual case. The criterion: "Any operation causing legitimate interests to suffer vital infringement should be avoided in a merger process." A vital infringement of these interests is assumed when the merger undermines unique positive opportunities or considerable impairment in the future, impossible to overcome for the person affected without an unacceptable level of difficulty. Therefore, (...) we mainly concentrate on implicit contracts – which should be based on the principle pacta sunt servanda as well. These contracts are mandatory to run an economy that produces increasingly more knowledge-based goods. (shrink)

Models of illness causation play a crucial role in medicine and public health. In their recent paper on this topic, Michael Kelly, Rachel Kelly, and Federica Russo state that the integration of social, biological, and behavioral causes in one and the same etiologic mechanism remains to be clarified. In particular, they think that current models of illness causation do not appreciate "the truly integrated nature of bio-social-behavioral pathogenesis". In brief, Kelly, Kelly, and Russo suggest that two levels of explanation are (...) at work in medicine and public health, biological and social; that integration is difficult because of resistance to including social determinants of disease in both the... (shrink)

Strategische Kommunikation zielt mit ihren kontingenten Wirklichkeitsbeschreibungen seit jeher auf gesellschaftliche Wahrheitsmodelle. Wie häufig gesellschaftliche Wahrheitsmodelle auf strategische Kommunikationsbemühungen zurückgehen, auf Unwahrhaftigkeit beruhen und damit zumindest zeitweise zu strategischen Wahrheiten werden, zeigen eindrucksvoll zwischenzeitlich geglaubte Wahrheiten, die sich als Lüge entpuppt haben: von Walter Ulbrichts "Niemand hat die Absicht, eine Mauer zu errichten" über Hitlers Tagebücher bis hin zu den Massenvernichtungswaffen im Irak. Die erfolgreichen Kampagnen der Brexiteers und von Donald Trump 2016 haben diesem Thema zu neuer und bislang ungeahnter (...) Aufmerksamkeit verholfen. Während die Themen Desinformation und postfaktische Gesellschaft die Journalismus-, politische Kommunikations- und Medienethikforschung aktuell zu dominieren scheinen, ist das Schweigen der deutschsprachigen und internationalen PR- und Organisationskommunikationsforschung auffällig. Dies ist umso bemerkenswerter, weil die PR-Wissenschaft in der Vergangenheit immer wieder versucht hat, ihren Gegenstand zu schärfen, indem sie sich am Begriff der Propaganda abgearbeitet hat. Daraus müsste eigentlich eine Affinität für das Thema Desinformation resultieren. Aber genau das Gegenteil ist offensichtlich der Fall: Hat sich die PR-Wissenschaft gerade deshalb nicht mit Desinformation beschäftigt, weil sie sich so dezidiert von Propaganda und darin eingeschlossenen desinformierenden und manipulativen Techniken abgrenzen will? Was sind die Gründe hierfür? Glauben wir, bereits alles zum Thema gesagt zu haben? Liegt dies daran, dass sich die PR- und Organisationskommunikationsforschung seit jeher vor allem für Unternehmen und weniger für politische und Non-Profit-Organisationen interessiert? Oder fühlen wir uns hier schlicht und ergreifend nicht zuständig? Es scheint offenkundig höchste Zeit zu sein, sich wieder eingehend mit Fragen der Desinformation aus der Perspektive der strategischen Kommunikationsforschung zu befassen. Die Beiträge des Tagungsbandes fokussieren hierzu auf neue theoretische Perspektiven, normative Bewertungen und empirische Befunde. (shrink)

It is generally assumed that electronic cryptography benefits democracy because it can be instrumental in protecting free speech, which is considered a cornerstone for democracy. The author argues, however, that a close look at some aspects of democratic theory suggests that matters are not really as clear-cut. The fact that encryption can be abused in many ways also poses a threat to democracy. This paradox is examined in detail.

Wenn überhaupt in einem Gebiet Wahrheit und Existenz unabhängig von unseren Erkenntnisfähigkeiten sind, dann in der Metaphysik – etwa bei der Frage, ob es Gott gibt oder eine Seele, die unseren Tod überdauert. Die metaphysica specialis schreit geradezu nach metaphysischem Realismus und dem zugehörigen Wahrheitsbegriff. Von diesem Ausgangspunkt gerät man allerdings schnell in Verlegenheit, wenn man fragt: Nach welchen Kriterien sollen wir uns richten, wenn wir uns über Gott oder Unsterblichkeit ein Urteil bilden wollen? Mit den Mitteln der Naturwissenschaft und (...) deren rationaler Methodologie (in der es um Empirie, Einfachheit, Sparsamkeit usw. geht) kommen wir bei Themen wie Gott oder Unsterblichkeit immer nur bis zum Patt. Genauso steht es bei der Frage, ob wir in unseren Entscheidungen frei sind. Urteilsenthaltung können wir uns nicht erlauben, dafür sind die metaphysischen Fragen zu wichtig; Auslosen kommt auch nicht infrage. Statt erkenntnistheoretisch zu kapitulieren, schlage ich programmatisch vor, die Erkenntnislehre auf weichere Weise weiterzubetreiben. Emotion, Intuition, Moral – das sind einige der zusätzlichen außerrationalen Hilfsmittel, mit deren Hilfe wir weiterkommen können. Ich zeige, dass diese Hilfsmittel respektabler und gewichtiger sind, als kühle, rationale Erkenntnistheoretiker zugeben wollen. Diese Hilfsmittel führen zu guten Postulaten aus Unvernunft (und zwar nicht nur in der Metaphysik). Wie schlimm es für den Realismus ist, dass diese Postulate immer noch falsch sein könnten, diese Frage werde ich im vorliegenden Aufsatz nicht mehr klären. (shrink)

Cosmological narratives like the creation story in the book of Genesis or the modern Big Bang are popularly understood to be descriptions of how the universe was created. However, cosmologies also say a great deal more. Indeed, the majority of cosmologies, ancient and modern, explore not simply how the world was made but how humans relate to their surrounding environment and the often thin line which separates humans from gods and animals. Combining approaches from classical studies, anthropology, and philosophy, this (...) book studies three competing cosmologies of the early Greek world: Hesiod's Theogony; the Orphic Derveni theogony; and Protagoras' creation myth in Plato's eponymous dialogue. Although all three cosmologies are part of a single mythic tradition and feature a number of similar events and characters, Olaf Almqvist argues they offer very different answers to an ongoing debate on what it is to be human. Engaging closely with the ontological turn in anthropology and in particular with the work of Philippe Descola, this book outlines three key sets of ontological assumptions - analogism, pantheism, and naturalism - found in early Greek literature and explores how these competing ontological assumptions result in contrasting attitudes to rituals such as prayer and sacrifice. (shrink)

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in populations, (...) (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage. (shrink)