Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and (...) female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity. (shrink)

Nursing practice invites nurses to embody caring practices that meet, comfort and empower vulnerable others. Such a practice requires a commitment to meeting and helping the other in ways that liberate and strengthen and avoid imposing the will of the caregiver on the patient. Being good and acting well (phronesis) occur in particular situations. A socially constituted and embodied view of agency, as developed by Merleau‐Ponty, provides an alternative to Cartesian and Kantian views of agency. A socially constituted, embodied view (...) of agency is less mechanistic and less deterministic than Descartes' and Kant's radical separation of mind and body, and more responsive and generative than Kant's vision of moral agency as constituted by autonomous choice makers who are uninfluenced by emotion. The role of emotion in perception and judgement is explored in this paper. Distinctions between techne and phronesis are drawn. The role of emotion in market relationships and procedural ethics drawn for the abstract, general other are strategies for exchange of goods and services, but these same market relationships are dependent on well‐functioning nonmarket relations of noncalculated giving and receiving. (shrink)

According to second‐personal approaches to moral obligation, the distinctive normative features of moral obligation can only be explained in terms of second‐personal relations, i.e. the distinctive way persons relate to each other as persons. But there are important disagreements between different groups of second‐personal approaches. Most notably, they disagree about the nature of second‐personal relations, which has consequences for the nature of the obligations that they purport to explain. This article aims to distinguish these groups from each other, highlight their (...) respective advantages and disadvantages, and thereby indicate avenues for future research. (shrink)

Various claims have been made concerning the role of narrative in grief. In this paper, we emphasize the need for a discerning approach, which acknowledges that narratives of different kinds relate to grief in different ways. We focus specifically on the positive contributions that narrative can make to sustaining, restoring and revising a sense of who one is. We argue that, although it is right to suggest that narratives provide structure and coherence, they also play a complementary role in disrupting (...) established structure and opening up new possibilities. We add that both of these roles point to the importance of interpersonal, social and cultural factors in shaping the trajectory of grief. We conclude by briefly considering the implications for distinguishing between typical and pathological forms of grief. (shrink)

Engaging with the philosophical writings of Iris Murdoch, we submit that there are difficulties associated with providing a good description of morality that are intimately connected with difficulties in understanding other human beings. We suggest three senses in which moral philosophical reflection needs to account for our understanding of others: (1) the failure to understand someone is not merely an intellectual failure, but also engages us morally; (2) the moral question of understanding is not limited to the extent to which (...) we understand a particular person, but also presents itself in how we picture difficulties in understanding people; and (3) “philosophical pictures of morality” fundamentally shape the conceptual framework we use to investigate morality, as well as the analysis of morality we find illuminative and satisfactory. Exploring the implications of these claims, we ask what it means to think of others as the same, or as different, from ourselves. We then consider the ethical significance of finding, or not finding, our feet in our encounters with others, dwelling on how the metaphor of movement reveals one way in which we are never at peace in the exploration of morality. (shrink)

A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may (...) be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter. (shrink)

This paper addresses the nature of sensed-presence experiences that are commonplace among the bereaved and occur cross-culturally. Although these experiences are often labelled ‘‘bereavement hallucinations’’, it is unclear what they consist of. Some seem to involve sensory experiences in one or more modalities, while others involve a non-specificfeelingorsenseof presence. I focus on a puzzle concerning the latter: it is unclear how an experience of someone’s presence could arise without a more specific sensory content. I suggest that at least some of (...) these experiences consist in a dynamic and non-localized experience of significant and salientpossibilities. This can amount to the sense of currentlyrelating toa particular individual and, by implication, a sense of that person’s presence. Where an experience of this kind also includes sensory qualities, they are inessential to the sense of relatedness and perhaps symptomatic of it. (shrink)

This paper considers how both Levinas and Løgstrup seek to explain how love of the neighbour is possible. It focuses on a criticism of Levinas made by Merold Westphal, which follows Kierkegaard in arguing on Lutheran grounds that such love first requires a relation to God as a “middle term,” but that Levinas cannot appeal to this relation to account for neighbour love, as for him the God relation itself arises through love of the neighbour. In response, the paper explores (...) how Løgstrup, while working in a Lutheran tradition, like Levinas also sees neighbour love as arising without any prior God relation, showing how the accounts that each offer of how this is possible serve to complement each other. (shrink)

There seems to be a broad agreement that curiosity is important in education. However, current research often seeks to answer the question of how best to nurture curiosity and fails to ask the normative question of why this should be done. A closer look reveals that the reasons for justifying the importance of curiosity vary, with some theorists pointing to its role in cognitive development as a starting point for learning, and others praising it as an element of democracy and (...) a child’s right to participation. Most of these approaches understand curiosity as an individual urge or desire for knowledge. In contrast, this article will examine a relational understanding of the concept by focussing on social curiosity. Instead of following a cognitive developmentalist, intellectual virtue or emancipatory approach to valuing curiosity, I will employ relational ethical theory. The argument then explores a possible analogy between social curiosity and the concept of sovereign expressions of life, as developed by the Danish philosopher and theologian K.E. Løgstrup. By drawing on his relational ethics, the article aims to expand the theoretical grounds on which curiosity can be normatively legitimised in education. With children spending longer and longer hours in educational, structured and adult-led settings, I conclude with a twofold normative claim: Social curiosity should be a part of all relations in education and its absence should lead to an ethical demand. In addition, an awareness of the actual deeds through which social curiosity is realised is also a topic that must be addressed by educators. (shrink)

Background: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and (...) greater mutual understanding. Going through studies focusing on the experiences of nursing home patients’ relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. Aim: The aim of the study is to investigate relatives of persons with dementia’s experiences with quality care in nursing homes. Method: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological–hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives’ experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. Discussion: The results are discussed considering the concepts of trust, power and asymmetry. Conclusion: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim. (shrink)

Background: Professional nurses provide holistic healthcare to people and deal with patients closely. Furthermore, patients need nurses to do self-care and patients trust them for their treatments. Therefore, trust is extremely important in a professional care relationship and in satisfactory patient outcomes. Objective: The aim of this study was to examine the patients’ views on the trust status toward nurses and the factors important for the development of trust in a nurse–patient relationship. Research design: This research was planned as a (...) descriptive cross-sectional study. Participants and research context: The study was carried out between April and July 2014 at the oncology hospital of a university in Ankara, Turkey. The sample size was calculated by power analysis and was composed of 356 inpatients diagnosed with cancer. For data collection, a questionnaire and the “Trust in Nurses Scale” were used. From the hospital and written informed consent obtained from participating patients: Approval from the University Clinical Research Ethics Committee was obtained. Written approval was obtained from the hospital and consent letter from the patients. Findings: The average score on the scale was 24.5 ± 3.9, meaning that patients had a high level of trust toward nurses in this hospital. The patients who were in the 50–59 age group and men had statistically higher scores compared with other groups. Patients’ answers revealed that themes of “Personal and Professional Characteristics” were important when developing trust, however “Mistreatment, Professional Incapability, and Communication Problem” were important causing mistrust toward the nurses. Conclusion: In this study, the nurses’ professional competencies and interpersonal caring attributes emerged as most important in developing trust. This study paid attention to the values and attitudes that develop patients’ trust toward nurses. Moreover, the findings raise ethical questions about how the patients’ basic rights are to be protected and how their trust level can be heightened. Nurse managers need to assess continuously how trust toward nurses is developed, protected, and maintained in their institutions. (shrink)

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to (...) comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. (shrink)

This essay addresses the other side of the robot ethics debate, taking up and investigating the question “Can and should robots have rights?” The examination of this subject proceeds by way of three steps or movements. We begin by looking at and analyzing the form of the question itself. There is an important philosophical difference between the two modal verbs that organize the inquiry—can and should. This difference has considerable history behind it that influences what is asked about and how. (...) Second, capitalizing on this verbal distinction, it is possible to identify four modalities concerning social robots and the question of rights. The second section will identify and critically assess these four modalities as they have been deployed and developed in the current literature. Finally, we will conclude by proposing another alternative, a way of thinking otherwise that effectively challenges the existing rules of the game and provides for other ways of theorizing moral standing that can scale to the unique challenges and opportunities that are confronted in the face of social robots. (shrink)

Moral obligation, Darwall argues, is irreducibly second personal. So too, McMyler argues, is the reason for belief supplied by testimony and which supports trust. In this paper, I follow Darwall in arguing that the testimony is not second personal ?all the way down?. However, I go on to argue, this shows that trust is not fully second personal, which in turn shows that moral obligation is equally not second personal ?all the way down?

This article describes how we seem to live in a willed blindness towards the effects that our meat production and consumption have on animals, the environment and the climate. A willed blindness that cannot be explained by either lack of knowledge or scientific uncertainty. The blindness enables us to see ourselves as moral beings although our lack of reaction to the effects of our actions tells another story. The article describes the consequences of intensive meat production and consumption to animal (...) welfare and environmental degradation and discusses different strategies to overcome the willed blindness focusing on the development of either a new moral vision of our obligations or new visions of what a good life is. (shrink)

The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one’s identity, embodiment and position. The author suggests conceiving care as an existential condition of (...) life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education. (shrink)

Let me start with the enigmatic dictum of Blaise Pascal: ‘l'homme passe l'homme’ – ‘man goes beyond himself’; ‘humanity transcends itself’. What does this mean? On one plausible interpretation, Pascal is adverting to that strange restlessness of the human spirit which so many philosophers have pondered on, from Augustine before him, to Kierkegaard and many subsequent writers since. To be human is to recognize that we are, in a certain sense, incomplete beings. We are on a journey to a horizon (...) that always seems to recede from view. Unlike all the other animals, who need nothing further for their thriving and flourishing once the appropriate environmental conditions are provided, human beings, even when all their needs are catered for – physical, biological, social, cultural – and even when they enjoy a maximally secure and enriching environment, still have a certain resistance to resting content with existence defined within a given set of parameters. They still have the restless drive to reach forward to something more. (shrink)

Sartre's conception of bad faith suggests that every desire to be someone in love is self-deceptive in the attempt to define my factual being. Departing from İlham Dilman's discussion of personal identity, I argue that this view on selfhood is inattentive to the kind of personal and moral reflection inherent in asking who I am. There is a temptation in love to deceive myself and you by renouncing responsibility. Yet the concept also embodies demands that allow me to continuously shape (...) myself into a loving subject by scrutinising my responses and by asking whether they are expressive of love or not. (shrink)

Enactive cognitive science combines questions in epistemology, ontology, and ethics by conceiving of bodies as open-ended and mutually transforming through activity. While enaction is not a theory of ethics, it can contribute to its foundations. We present a schematization of enactive ideas that underlie traditional distinctions between Being, Knowing, and Doing. Ethics in this scheme begins in the relation between knowing and becoming. Critical of dichotomous thinking, we approach the questions of alterity and ethical reality. Alterity is relevant to the (...) enactive approach, but not in the radical sense of transcendental arguments. We propose difference, instead, as a more generative concept. Following Simondon, we see norms and values manifest in webs of past and future acts together with their potentialities for becoming. We propose a transindividual concept of moral attunement that includes ethical know-how and consciousness raising. Through generative difference and attunement to configurations of becoming, enaction underpins an ethics of participation linking virtue ethics and ethics of care. (shrink)

Since the publication of Annette Baier’s agenda-setting article entitled ‘Trust and Antitrust’, trust has become an increasingly popular topic, not only in moral philosophy and epistemology but als...

Research on collaborative professionalism may be enriched by inquiries into the lived experiences of teachers. The question of what collaboration is like for teachers has not been taken up widely in the literature. The meaning of collaboration as a coming together of individuals who share, design, and co-create for purposes that are aligned with generative possibilities of producing something new, of understanding something in a novel way, and to combine perspectives, personalities, experiences and expertise, represents a new area for research. (...) This paper presents a phenomenological analysis of teachers’ lived experiences of collaboration. To ask these questions requires an orientation to the lived experience of teacher collaboration. For the purposes of this paper, two themes – collaboration and a creative imaginary, and collaboration and relationality – are described as unique structures of human experience. This research supports the conclusion that research in the field of collaborative professionalism and teacher collaboration may be significantly deepened by inquiries into concrete lived experiences of teacher collaboration. (shrink)

This paper is the Introduction to the Special Issue comprising a selection of papers submitted to the 19th IESE International Symposium on Ethics, Business and Society. The main topic of the Symposium was “Ethical Challenges in Strategic Management.” The paper presents the rationale and context of the Symposium. We begin with a brief historical overview of the evolution of the relationship between ethics and strategy. We propose four pillars that are at the core of a definition of strategy and elaborate (...) on how ethics can contribute to strategy. We present the six papers that make up this selection within the framework of the four aspects introduced in the previous section. We conclude with some proposals for further research that consider the content of the papers. (shrink)

Background:Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves.Purpose:The aim of this study is to illuminate multi-ethnic healthcare providers’ lived experiences of their own working relationship, and its importance to quality care for people with dementia.Research design:The study is part of a greater (...) participatory action research project: ‘Hospice values in the care for persons with dementia’. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation.Participants and research context:Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins.Ethical considerations:The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services.Findings:The results show that good working relationships, characterized by understanding each other’s vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings.Discussion:The results are discussed in the light of Lögstrup’s relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech.Conclusion:The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance. (shrink)

This narrative case study, created from several qualitative sources, portrays a young woman’s life experiences and an eight yearlong therapy process with Norwegian Psychomotor Physiotherapy. It is analyzed retrospectively from an analytical angle, where NPMP theory is expanded with Løgstrup’s phenomenology of sensation and Ricoeur’s narrative philosophy. Understanding Rita’s narrative through this window displayed some foundational phenomena in a singular way, illuminating embodied experiences in inter-subjective relationships in movement, sensation and time entwined. It illustrates how traumatic life experiences may cause (...) pain, suffering and ruptured narratives with fragmented physical and sensuous reactions, chaos and loss of temporal coherence with consequences for a person’s sense of identity. Rita’s narrative also illuminates how intersubjective interaction has healing potentials when there is time and space for trust to emerge and to support new bodily-based experiences. Embodied sensuous experiences in present time may help clarify past and present and support chronology in narration and the sense of identity. With this exemplary case study, we argue that Løgstrup’s and Ricoeur’s thinking may add valuable perspectives to understanding suffering and healing processes in the field of embodied therapies like NPMP. (shrink)

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy. Patients’ experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup’s and Ricoeur’s philosophy, and Mattingly’s and Frank’s narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and cognitive strategies, towards (...) more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one’s own. (shrink)

In this article, we resituate a long-standing duality of (Western) narrative tradition over living story emergence and more linear narrative. Narrative, with its focus on linear beginning, middle and end coherence, retrospection and monologic, is too easily appropriated into managerialist projects. We focus on the web of living stories as a Derridian deconstructive move, which allows us to say something important about their relation to narrative and to develop a storytelling ethics. Our thesis is that resituating the relationship between narrative (...) and living story invites exploration of the plurality of narratives that treat living stories as supplementary. We claim that this deconstructive move allows us to rethink politics and ethics anew. Storytelling ethics opens new spaces for marginalized other(s) voices and creates an awareness of our complicity and responsibility for others. Further, storytelling ethics allows for a more nuanced and varied understanding of business ethics and its inherent exclusionary truth and morality claims and paves the way for a more reflexive ethics. (shrink)

Starting with a decisive scene in Victor Hugo’s novel Les Miserables, the paper searches for a place for trust to reside in the interludes between the situations where it appears in our relations and generously attaches us to each other.

One important aspect of the nurse-patient relationship is nurses’ attitudes towards their patients. Nurses’ attitudes towards people with dementia have been studied from a wide range of approaches, but few authors have focused on the structure of these attitudes. This study aimed to identify a structure in licensed practical nurses’ attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at 11 nursing homes participated in the study. A total of 1 577 assessments of 178 patients were (...) sent out to 181 respondents and 1 237 answers were returned. The semantic differential technique was used. The scale had 57 bipolar pairs of adjectives that estimate an unknown number of dimensions of nurses’ attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions, which related to licensed practical nurses’ opinions of the patients: an ethical and aesthetic dimension; an ability to understand; an ability to experience; and an ability for social interaction. The results of the study indicated that, on the positive to negative attitude continuum, the nurses’ attitudes fell at the positive to neutral end. This is an important finding owing to the personhood perspective, from which it is reasonable to assume that, with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve. (shrink)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports from (...) the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (shrink)

Background: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation. Research objectives: To examine (...) and describe relatives’ experiences of responsibility in the intensive care unit decision-making process. Research design: A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. Participants and research context: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants’ homes, 3–12 months after the patient’s death. Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. Findings: The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians’ intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. Discussion: For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual’s relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. Conclusion: Nurses and physicians should acknowledge and address relatives’ sense of responsibility, include them in regular dialogue and help them separate their responsibility from that of the clinicians. (shrink)

Background: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts. Research objective: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia. Research design: (...) A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential. Findings: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day. Conclusion: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience. (shrink)

This paper seeks to illuminate the nature of empathy by reflecting upon the phenomenology of depression. I propose that depression involves alteration of an aspect of experience that is seldom reflected upon or discussed, thus making it hard to understand. This alteration involves impairment or loss of a capacity for interpersonal relatedness that mutual empathy depends upon. The sufferer thus feels cut off from other people, and may remark on their indifference, hostility or inability to understand. Drawing upon the example (...) of depression, I argue that empathy is not principally a matter of ‘simulating’ another person’s experience. It is better conceived of as a perception-like exploration of others’ experiences that develops progressively through certain styles of interpersonal interaction. (shrink)

BackgroundThis case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention in the literature on prehospital ambulance work.Case presentationThe patient had chest pains that were consistent with serious heart disease, but she wanted to (...) catch her plane and was unwilling to let paramedics assess her heart activity by means of an electrocardiogram (ECG). The paramedics had to decide, there and then, whether the patient’s refusal to submit to an ECG should be respected, or whether they should set the patient’s expressed wishes aside by exercising verbal power and persuasive communication techniques. The paramedics chose to do the latter. It later turned out that the patient was grateful that the paramedics had been very direct, almost brutal, in their communication. When the patient regained her autonomy, she saw clearly that taking time to obtain and monitor an ECG was the best option for her.ConclusionLooking forward in time might be a good professional strategy for deciding whether ethical paternalism in communication is justified. If there is good reason to believe that patients who later regain their autonomy will agree that paternalistic verbal actions were in their best interests, and if acting in accordance with patients’ preferences can have severe negative health consequences for them, then paramedics have good reason to believe that ethical paternalism is justified. (shrink)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of (...) Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

For both Levinas and Løgstrup, the moral encounter is characterized by an asymmetrical prioritization of the other over the self. Some take Løgstrup’s account to be an improvement on Levinas’s, however, insofar as it appears to both foreswear the hyperbole of the latter’s view and ground the ethical claim in the natural conditions of human life. This paper argues, in contrast, that Løgstrup’s own account is equally hyperbolic in its characterization of the self as fundamentally evil, and that his attempt (...) to ground the ethical demand in structures of ‘life’ raises serious difficulties. I will argue that Levinas’s stronger commitment to phenomenology both rules out the problematic metaphysical claims on which Løgstrup’s ontological ethics depends and helps explain the methodological function of Levinas’s own hyperbole. Unlike Løgstrup, Levinas insists that the challenge is not eradicating the claims of the self, but rather resisting its pretention to a global normative priority. In making this case I refute the argument that Levinas, unlike Løgstrup, is committed to a ‘command’ view of morality—whereby it is the other person’s authoritative status that underwrites the moral force of the claim, not the content of the claim itself. But on Levinas’s view, ‘demand’ and ‘command’ accounts merge in his understanding of the face-to-face encounter because responding to the content of the demand—that I treat the other’s claim as reason-giving— just is to see the other person as an authority capable of making legitimate claims on me. (shrink)

In order to articulate an account of erotic love that does not attempt to transcend its personal features, Robert Solomon and Martha Nussbaum lean on the speeches by Aristophanes and Alcibiades in Plato’s Symposium. This leads them to downplay the sense in which love is not only for another person, but also for the good. Drawing on a distinction between relative and absolute senses of speaking about the good, I mediate between two features of love that at first may seem (...) irreconcilable. The first is the sense in which love is deeply personal in character. The second is the sense in which we in love come to articulate ethical demands. With the help of the Diotimian ascent of love that Socrates presents in his speech, I submit that these two can come together in the realization that our personally conditioned responses in love are transformed to accommodate demands that carry an unconditional meaning. (shrink)

Awareness that moral beliefs and practices have changed across time threatens our confidence in our current moral beliefs: if past moral beliefs turned out to be wrong, how can we be sure ours aren't likewise mistaken? In this paper, I set up four desiderata for a successful theory of moral progress: it must allow us to judge that progress has occurred, avoid the image of increasing correspondence towards ahistorical truthmakers, allow for revision in belief, and yet not be disobligating. Rorty's (...) pragmatist account of moral progress delivers on the first three, but at the cost of failing to meet the fourth: it drains moral beliefs of their categorical force. I then outline K.E. Løgstrup’s understanding of the relation between the ‘ethical demand’ and changing, socially mediated norms. While Løgstrup does posit an unchanging ground of normativity - the "ethical demand" to act for the sake of the other whose welfare is in our hands – he also thinks that changing social norms are an indispensable part of ethical life. I argue that Løgstrup's discussion of the ‘refraction’ of the ethical demand through changing social norms provides resources for an account of moral progress that fulfils these four desiderata. (shrink)

Introduction: To meet and take care of people with dementia implicate professional and moral challenges for caregivers. Using force happens daily. However, staff also encounter challenges with the management in the units. Managing the caretaking function is also significant in how caretakers experience working in dementia care. Purpose: The purpose of this study is to explore the caregiver’s experiences with ethical challenges in dementia care settings and the significance of professional leadership in this context. Method: The design is qualitative, and (...) data appear through narrative interviews. A total of 23 caretakers participated in the study. The transcribed interviews were subjected to a phenomenological-hermeneutical interpretation. Ethical considerations: The respondents signed an informed consent for participation prior to the interviews. They were assured anonymity and confidentiality in the publication of the data. Ricoeur’s method for interpretation ensures anonymity as the researcher relates to the data as one collective text. The study is part of a larger research project in ethics, in its entirety approved in line with the Helsinki Convention. Results: The findings show that the caretakers experienced inadequacy. Some of them described a negative work atmosphere where they experienced that their leaders did not take them seriously. Because of this, informal negative sub-groups functioned as an exclusive debriefing arena. Some of the informants described the opposite experience where the leaders actively supported them. Discussion: The analyses of the findings are discussed in light of the concepts of trust and mistrust in leadership. Conclusion: There is a correlation between the leadership and the caregivers’ experience of being in difficult situations. (shrink)

Most philosophical discussion of trust focuses on the three-place trust predicate: X trusting Y to φ. This article argues that it is the one-place and two-place predicates – X is trusting, and X trusting Y – that are fundamental.

In this article, we discuss some of the linguistic features of hermeneutic-phenomenological writing and, in so doing, we point to the close connection between lived experience and the ethical-aesthetic traits of writing the experience. Our exploration starts by contemplating texts written by the so-called Utrecht School. We reflect on their orientation as it has been understood, developed, and advocated by Max van Manen. The literary style of the Utrecht orientation is sometimes misunderstood and questioned. This article aims to explicate why (...) and how hermeneutic phenomenology needs an expressive language to "write the lived experience" rather than to simply write "about" the lived experience. Lived experiences are always past experiences that we try to bring into the present, and so the difference between recollections and memories are discussed in connection to writing the experience. We argue that what is being told and not seen is, metaphorically speaking, an event in sound, which can have ethical and aesthetic virtues of truth and beauty. Lived experiences, whether written as anecdotes or as other kinds of experiential accounts, can shine forth through the use of expressive language. But is this kind of language poetry? Can such an account be regarded as poetic writing? If it is poetic writing, exactly how does it differ from academic writing? Our exploration of questions like these leads us to the tentative conclusion that, as hermeneutic phenomenological researchers, we dwell in the borderland between a "poetic attitude" and a utilitarian writing style. (shrink)

This study examines the philosophical question of how it is possible to appreciate music aesthetically as an expressive art form. First it examines a number of general theories that seek to make sense of expressiveness as a characteristic of music that can be considered relevant to our aesthetic appreciation of the latter. These include accounts that focus on resemblances between music and human behaviour or human feelings, on music's powers of emotional arousal, and on various ways in which music may (...) be imaginatively construed by listeners. It argues that none of these are entirely satisfactory. Then it proposes an alternative account, focusing on what is involved when our appreciation of music as an expressive art is informed by our awareness of it as something that is expressively interpreted in performance. It is claimed that this offers the basis for a better understanding of at least some aspects of expressiveness in music and its relevance to aesthetic appreciation. (shrink)

Despite their many similarities, one apparent difference between the ethics of K.E. Løgstrup and Emmanuel Levinas concerns trust: Levinas does not analyse trust as a morally significant phenomenon, whereas Løgstrup makes it a central component of his moral phenomenology. This paper argues that an analysis of Løgstrupian trust nonetheless reveals at least three important commonalities between Levinas and Løgstrup’s moral projects: an understanding of war and ethics as metaphysical opposites; an emphasis on openness to the other as something that transcends (...) the prudential order of norms and laws; and a view of the ethical as that which breaks into and disrupts the order of human instrumental calculation. (shrink)

How can a person forge a stable ethical identity over time? On one view, ethical constancy means reapplying the same moral rules. On a rival view, it means continually adapting to one's ethical context in a way that allows one to be recognized as the same practical agent. Focusing on his thinking about repetition, I show how Kierkegaard offers a critical perspective on both these views. From this perspective, neither view can do justice to our vulnerability to certain kinds of (...) crisis, in which our ethical self-understanding is radically undermined. I further examine his alternative account of ethical constancy, by clarifying Kierkegaard's idea of a ‘second ethics’, as addressed to those who feel ethically powerless and as requiring an ongoing process of self-transformation. (shrink)

In this article, I offer a brief account of some of Kierkegaard’s key concerns about friendship: its “preferential” nature and its being a form of self-love. Kierkegaard’s endorsement of the ancient idea of the friend as “second self” involves a common but misguided assumption: that friendship depends largely upon likeness between friends. This focus obscures a vitally important element, highlighted by the so-called “drawing” view of friendship. Once this is emphasized, we can see a significant aspect - though by no (...) means all - of Kierkegaard’s worry as misplaced. However, the “drawing” view also enables us to begin to see what a “Kierkegaardian” friendship might look like. (shrink)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Nursing, or caring science, is mainly concerned with developing knowledge of what constitutes ideal, good health care for patients as whole persons, and how to achieve this. The aim of this study was to find clinical empirical indications of good ethical care and to investigate the substance of ideal nursing care in praxis. A hermeneutic method was employed in this clinical study, assuming the theoretical perspective of caritative caring and ethics of the understanding of life. The data consisted of two (...) Socratic dialogues: one with nurses and one with nursing students, and interviews with two former patients. The empirical data are first described from a phenomenological approach. Observations of caregivers offering `the little extra' were taken to confirm that patients were `being seen', not from the perspective of an ideal nursing model, but from that of interaction as a fellow human being. The study provides clinical evidence that, as an ontological response to suffering, 'symbolic acts' such as giving the `little extra' may work to bridge gaps in human interaction. The fact that `little things' have the power to preserve dignity and make patients feel they are valued offers hope. Witnessing benevolent acts also paves the way for both patients and caregivers to increase their understanding of life. (shrink)

It has become commonplace to hold the view that virtual surrogates for the things that are good in life are inferior to their actual, authentic counterparts, including virtual education, virtual skill-demanding activities and virtual acts of creativity. Virtual friendship has also been argued to be inferior to traditional, embodied forms of friendship. Coupled with the view that virtual friendships threaten to replace actual ones, the conclusion is often made that we ought to concentrate our efforts on actual friendships rather than (...) settle for virtual replacements. The purpose of this paper is to offer a balanced and empirically grounded analysis of the relative prudential value of actual and virtual friendship. That is, do actual and virtual friendships differ when it comes to enhancing our subjective well-being? In doing so, I will discuss a number of presuppositions that lie behind common criticisms of virtual friendship. This will include, among other considerations, their potential for replacing actual friendship, as well as the possibility for self-disclosure, trust, sharing and dynamic spread of happiness in virtual worlds. The purpose is not to arrive at a firm, normative conclusion, but rather to introduce a number of considerations that we should take into account in our individual deliberations over which role virtual friendships ought to have in our unique life situations. (shrink)

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making (...) in psychiatric practice. (shrink)