Göran Hermerén

The purpose of the present paper is: (1) to outline a conceptual framework useful for the analysis of ethical issues raised by goal-directed activities, (2) to apply this framework to nanoscale research, (3) identify some of the main challenges in the evaluation of such research, and (4) exemplify what is needed for a positive answer to the question “How can nanoscale research improve the quality of life?” A basic idea of the paper is that nanoscale research can improve the conditions and quality of life of large groups in society, provided that: (a) this research is directed at certain generally accepted goals, (b) at least some of the opportunities are exploited for the good of mankind, (c) the key obstacles on the road are eliminated, reduced or circumvented, and (d) this is done in ethically acceptable ways.

The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized

The achievement of optimal therapeutic results presupposes the use of appropriate treatment combined with maximal utilization of placebo effects. These aims may sometimes be difficult to satisfy in randomized clinical trials (RCTs). The question thus arises whether there is a conflict between the goals of therapy and those of experimental research; and if so, to what extent, and how is it handled in practice by clinicians and researchers. Various ethical problems have been discussed in several reports connected with RCTs. But we have found no discussion concerning the conflict between obtaining informed consent and promoting optimal placebo effects. Information about RCTs can be given in various ways. Sometimes appropriate information about RCTs to patients involves non-optimal utilization of placebo effects. This gives rise to ethical and methodological problems, which are discussed in this article.

This is a systematic study of the conceptual framework used by critics and scholars in their discussions of influence in art and literature. Göran Hermerén explores the key questions raised in scholarly debate on the topic: What is meant by "influence"? What methods can be used to settle disagreements about influence? What reasons could be used to support or reject statements about artistic and literary influence? The book is based on descriptive analyses in which the author has tried to make explicit what is said or implied in a number of quotations from scholarly writings on art and literature. Throughout, the emphasis is on clarifying the assumptions on which the use of the concept of influence is based, thus describing the limitations and merits of this kind of comparative research for critics and scholars. Originally published in 1975. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

In this study, 10 hematologists and 10 lung oncologists were interviewed regarding the information they provide to patients in four situations of uncertainty: determining the treatment that is in the patient’s best interest; recurrence or progression of the patient’s disease; determining when to withdraw life-prolonging treatment; discussing death, addressing questions such as whether the patient will die from the disease, and when. The primary finding is that delivery of information to patients with low survival rates can be improved by more and better disclosure by physicians at an earlier stage. The crucial point for physicians is to ascertain the wishes of patients, to learn what to reveal about what patients should expect, short term and long term, as death approaches.

In this article I focus on some of Joseph Margolis's contributions to medical ethics. I first discuss some of Margolis's normative and metaphysical views on death and abortion, particularly in his early work Negativities, as well as some of his metaphysical assumptions. Then these views and assumptions are related to his theory of persons and, by implication, his theory of culture, set forth in a number of later works. In the course of the discussion, I call attention to some controversial issues of today, such as embryonic stem cell research and the creation of embryos for the sole purpose of research, and ask for Margolis's views on them, given his earlier contributions and assumptions. Finally, I comment on his relativism and his program for research in aesthetics and ethics.

After a brief sketch of the historical background, the current political situation in Sweden is outlined. Since 1985 the National Council on Medical Ethics has played an important role in the biopolitical debate in Sweden, and its activities and influence are described. Religious teachings are often combined with moral precepts. But what makes a statement religious is not easy to say, especially in societies where religious concerns have been intertwined with humanitarian common sense morality for a long time. Summing up, it can be said that the debate in Sweden on biopolitical issues has not shown many signs of the influence of religious arguments, though some religious actors are active in this debate.

in Undetermined Table d’Hôte Ingar Brinck: Investigating the development of creativity: The Sahlin hypothesis 7 Linus Broström: Known unknowns and proto-second-personal address in photographic art 25 Johan Brännmark: Critical moral thinking without moral theory 33 Martin Edman: Vad är ett missförhållande? 43 Pascal Engel: Rambling on the value of truth 51 Peter Gärdenfors: Ambiguity in decision making and the fear of being fooled 75 Göran Hermerén: NIPT: Ethical aspects 89 Mats Johansson: Roboethics: What problems should be addressed and why? 103 Johan Laserna: Ambivalenta bilder 113 Anna-Sofia Maurin: Metaphysical explanation 161 Kevin Mulligan: Is preference primitive? 169 John D. Norton: How does your garden grow? 181 Johannes Persson & Annika Wallin: The distinction between internal and external validity 187 Johanna Seibt: Becoming our selves 197 Paul Slovic, Robin Gregory, David Frank, and Daniel Vastfjall: Confronting the collapse of humanitarian values in foreignpolicy decision making 209 Peter Sylwan: Det eviga livet 215 Claudine Tiercelin: Chance, love and logic: Ramsey and Peirce on norms, rationality and the conduct of life 221 Epilog 257 Frank Ramsey.

The purpose of this paper is to clarify the role of value uncertainty and value instability in decision-making that concerns morally controversial issues. Value uncertainty and value instability are distinguished from moral uncertainty, and several types of value uncertainty and value instability are defined and discussed. The relations between value uncertainty and value instability are explored, and value uncertainty is illustrated with examples drawn from the social sciences, medicine and everyday life. Several types of factor producing value uncertainty and/or value instability are then identified. They are grouped into three categories and discussed under the headings ‘value framing’, ‘ambivalence’ and ‘lack of self-knowledge’. The paper then discusses the role of value uncertainty in decision-making. The concluding remarks summarize what has been achieved and what remains to be done in this area.

It is well known that close relatives of terminally ill patients endure great emotional stress. Many factors, such as existential concerns, contribute to the distress of these relatives. In this study, interviews were conducted to explore experiences concerning life restrictions, emotional distress, and limited support, in a group of close relatives of patients with amyotrophic lateral sclerosis (ALS). The purpose was to identify, illuminate and clarify ethical problems related to these experiences. The results indicate that close relatives of patients with ALS need someone to talk to, as well as more information about the disease and its process. Furthermore, the study illustrates how ethical problems are related to choices and conflicts, and that a process including shared decision making is often an ideal when trying to find a solution to ethical problems.

The purpose of this paper is first to discuss and criticize some general theses about interpretation. The concept of interpretation is shown to be more complex than these general theses indicate. Distinctions are suggested between different types o f interpretations, and an attempt is made to state criteria of interpretation and arguments which can be used to support or criticize proposed interpretations. The relations between the various types of interpretations and the criteria (arguments) are then explored. Can they be combined? How? Can they comie into conflict with each other? How are such conflicts in that case to be solved? It is argued that at least partly different criteria and arguments are used, and ought to be used, when different types of interpretations are proposed, checked, and criticized. Sometimes a particular criterion is given, and ought to be given, different weight when different types of interpretations are considered.

The purpose of this paper is first to discuss and criticize some general theses about interpretation. The concept of interpretation is shown to be more complex than these general theses indicate. Distinctions are suggested between different types o f interpretations, and an attempt is made to state criteria of interpretation and arguments which can be used to support or criticize proposed interpretations. The relations between the various types of interpretations and the criteria (arguments) are then explored. Can they be combined? How? Can they comie into conflict with each other? How are such conflicts in that case to be solved? It is argued that at least partly different criteria and arguments are used, and ought to be used, when different types of interpretations are proposed, checked, and criticized. Sometimes a particular criterion is given, and ought to be given, different weight when different types of interpretations are considered.

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care

Animal models of human diseases are often used in biomedical research in place of human subjects. However, results obtained by animal models may fail to hold true for humans. One way of addressing this problem is to make animal models more similar to humans by placing human tissue into animal models, rendering them chimeric. Since technical and ethical limitations make neurological disorders difficult to study in humans, chimeric models with human neural tissue could help advance our understanding of neuropathophysiology. In this article, we examine whether the introduction of human neural tissue and any consequent cognitive change is relevant to the way we ought to treat chimeras. We argue that changes in cognitive abilities are morally relevant to the extent that they increase the capacities that affect the moral status of any entity, including awareness, autonomy, and sociability. We posit that no being, regardless of species, should be treated in a way that is incommensurate with its moral status. Finally, we propose a framework that can be used to guide ethical assessment of research involving chimeras with advanced cognitive capacities. We advance this framework as a useful tool for bringing relevant considerations to the forefront for those considering the ethical merit of proposed chimeric research. In doing so, we examine concepts relevant to the question of how any entity may be treated, including moral status, dignity, and capacities.