The voices of telenursing

September 9, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogI believe that many who call a telenurse are wondering which voice they will encounter. Will it be considerate or dismissive? Male or female? Young or old? Sympathetic or unsympathetic?

I guess also the telenurse is wondering which voice he or (usually) she will encounter when answering the call. Will it be self-assertive or self-denying? Male or female? Young or old? Eloquent or stumbling?

This uncertainty is revealing. Telephone counseling has sensitive dimensions that influence how the conversation develops and what it leads to. There is no direct connection between how you feel and the advice you get, for it will also depend on how the voices take shape and come together in conversation. We know this instinctively before the conversation started. Therefore we wonder, perhaps with some dread: what will the other voice be like?

This is a challenge for telenursing. The aim is to make health care more effective, accessible and safe, and there is potential to challenge inequities in health care. Meanwhile, gender, age, ethnicity and socioeconomic status will be expressed in voices that respond to each other largely beyond our conscious control.

Therefore, it is an important research task to study telenursing and raise awareness of what is happening in the conversations. One such study from Uppsala University was recently published:

The study is done by Roya Hakimnia, together with Inger K. Holmström, Marianne Carlsson and Anna T. Höglund. They develop a qualitative analysis of 20 calls to Swedish Healthcare Direct, and identify a number of relevant types of calls. One type of call, for example, is when the telenurse speaks more as a gatekeeper than as a nurse. Another is when gender norms are central and have consequences, as when a man calls reluctantly and doesn’t get the advice he might need. Another type of call is distinctly medical and avoids the life situation of the caller, although it might be what is relevant.

Portions of several conversations are included in the article. One can thus read transcripts of specific calls, and analyses of them, side by side. This I found quite excellent. The analyses help one to see and to think further about what is happening in the conversations, while the conversations help one to see the point of the analyses.

The study is in my opinion a fine example of how qualitative research can highlight sensitive processes that we normally do not survey or control. Sometimes we need to look more closely at the individual cases.

Pär Segerdahl

In dialogue with patients

Plagiarism: what is it and what makes it wrong?

August 25, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogScience is an advanced collective enterprise. Even the most original researcher inevitably builds on the achievements of other researchers. They deserve credit, and transparency facilitates research and makes it possible to scrutinize the original work. The art of giving due credit to other researchers is therefore part and parcel of scientific practice.

It is a well-known fact, however, that this art isn’t always practiced impeccably. Plagiarism is a growing concern in the research community, not least for editors of scientific journals. The causes of plagiarism may vary: ignorance of the techniques of quotation and their importance, momentary forgetfulness, or an intention to cheat and steal others’ work.

When defining plagiarism, it is tempting to focus on the intentional cases that imply dishonesty. However, from the point of view of the significance that giving due credit has in the collective enterprise of science, it is important to resist that temptation.

A recent article in Medicine, Health Care and Philosophy defines plagiarism while avoiding the focus on intentional plagiarism. Gert Helgesson and Stefan Eriksson define plagiarism as:

  • “An instance of someone using someone else’s intellectual product (such as texts, ideas, or results), thereby implying that it is their own.”

Researchers often use others’ intellectual products. It is the latter part of the definition that specifies what makes such a use a case of plagiarism: using someone else’s intellectual product in such a manner that it implies that it is one’s own. This implies that even a well-intended attempt to be honest can be a case of plagiarism. Suppose that a colleague gives you permission to freely use a text he or she created. If you use it in a manner that implies that you created it, you are plagiarizing.

The value of the suggested definition of plagiarism, as I see it, is that it is rigorously adapted to the significance that giving due credit has in science as a collective enterprise. The intention to deceive certainly makes plagiarism more reprehensible, but it is not primarily what makes plagiarism a concern in science.

The authors thus highlight that what makes plagiarism wrong in research is above all that it distorts scientific credit.

Pär Segerdahl

We want to be just - the Ethics Blog

Philosophers and their predecessors

August 11, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogPhilosophy is often seen as a tradition. Each significant philosopher studied his significant predecessors, found them faulty in various respects, and embarked to correct them. Aristotle corrected Plato, Descartes corrected the scholastics, and Heidegger corrected the whole history of thought since the pre-Socratics.

Philosophy appears as a long backward movement into the future, driven by close reading of predecessors. Such an image is understandable in a time when philosophy is being eaten up by the study of it. We are like archaeologists of thought, trying to reconstruct philosophy through the traces it left behind in our bookshelves. We thus imagine that philosophers were above all readers of philosophical texts: super-scholars with amazing skills of close reading, enabling them to identify the weak points of their predecessors’ work.

The paradox of this view of philosophy is that the textual residues we study don’t look like scholarly texts. Perhaps because philosophers weren’t moving backwards into the future, meticulously studying earlier texts, but were above all sensitive to the times in which they lived and tried to face the future well. That is how they “read” their predecessors.

Pär Segerdahl

Approaching future issues - the Ethics Blog

Philosophical scholarship defuses new ways of thinking

July 28, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogWhat is called “philosophy” is pursued today mostly by scholars who study philosophical authors and texts, and who learn to produce certain types of comments on philosophical ideas and concepts. Such study is interesting and important, and can be compared with literary scholarship.

A problem that I highlighted in my latest post, however, is a tendency to conflate the scholarly study of philosophy with… philosophy. Today, I want to exemplify three consequences of such conflation.

A first consequence is a taboo against thinking for oneself, like the canonized philosophers of the past, who legitimize the study of philosophy, once did. Only “great” philosophers, whose names can be found as entries in philosophical encyclopedias, can be excused for having philosophized for themselves, and without proper citation methods.

A related consequence is a sense of scandalous arrogance when philosophy is carried out as once upon a time. Since only great and already canonized philosophers are allowed to think for themselves, people who tenaciously pursue thinking will appear like pretentious bastards who believe they already have a name in the history of philosophy and, worst of all, claim to be studied!

A third and more serious consequence is that philosophical scholarship, if it is conflated with philosophy, defuses new ways of thinking. New ways of thinking are primarily meant to be adopted, or to provoke people to think better. Learned commentaries on new and original ways of thinking are interesting and important. However, if the scholarly comments are developed as if they brought out the real philosophical content of the proposed thoughts, the new thinking will be reduced to just another occasion to develop the study of philosophy… as if one did the thoughts a favor by bringing them safely home to “the history of philosophy.”

You don’t have to be great, canonized or dead to think. That is fortunate, since thinking is needed right now, in the midst of life. It just appears essentially homeless, or at home wherever it is.

Pär Segerdahl

We transgress disciplinary borders - the Ethics Blog

Doing philosophy and studying philosophy

July 14, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogLiterary scholars don’t claim that they became novelists or poets because they studied such authors and such literature. They know what they became: they became scholars who learned to produce certain kinds of commentaries on literary works. The distinction between the works they produce and the works they study is salient and most often impossible to overlook.

Things are not that obvious in what is called philosophy. Typically, people who study philosophical authors, texts, ideas and concepts and who receive a doctor’s degree in philosophy will call themselves philosophers.

They could also, and in most cases more appropriately, be called philosophical scholars who learned to produce certain types of commentaries on philosophical authors, texts, ideas and concepts.

Has philosophy been eaten up by the study of it? There seems to be a belief that philosophy exists in the scholarly format of commentaries on philosophical authors, texts, ideas and concepts, and that philosophy thrives and develops through the development of such comments.

A problem with this learned “façade conception” of philosophy is that the great canonized thinkers, who legitimize the study of philosophy, never produced that kind of scholarly literature when they philosophized.

An even greater problem is that if you try to philosophize and think for yourself today, as they did, the work you produce will be deemed “unphilosophical” or “lacking philosophically interesting thoughts,” because it isn’t written in the scholarly format of a commentary on canonized authors, texts, ideas and concepts.

Thank God literature isn’t that easily eaten up by the study of it. No one would call a novel “unliterary” because it wasn’t produced according to the canons of literary scholarship.

Pär Segerdahl

The Ethics Blog - Thinking about thinking

Nurses’ experiences of do not resuscitate orders

June 18, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogWhen a critically ill patient has such a poor prognosis that resuscitation would be of no use, doctors can write a so-called do not resuscitate order. The decision means that if the heart stops beating, the medical team should not, as otherwise, perform coronary pulmonary rescue.

The decision is made by the physician on the basis of a medical assessment. But the decision affects the patient, the relatives, and the nurses who care for the patient and family.

Mona Pettersson at CRB is writing her thesis on the decision not to resuscitate. In a study recently published in Nursing Ethics, she interviewed 15 nurses about their experiences of do not resuscitate orders at Swedish hematology and oncology departments.

The nurses describe problems that may arise. The nurses have daily close contact with patients and notice when they are no longer responding to treatment. The nurses can then expect a do not resuscitate order, which may not always come. The decision may be taken by the doctor on the spot, when a resuscitation attempt already started. Sometimes decisions are unclear or contradictory: decisions are taken while continuing to give the patient full treatment. And if the patient and family are not informed about the decision, or the nurse is not present when the information is given, it becomes difficult for the nurse to care for the patient and family – for example, to answer questions afterwards.

Mona Pettersson concludes that nurses need clear, well-documented orders. Patients and families need to be informed and involved in the decisions, and nurses should be present when the information is provided. Finally, regular ethical discussions between nurses and doctors are needed, to understand each other and the different perspectives on do not resuscitate orders. Here you find a link to the article:

Co-authors are Mariann Hedström and Anna Höglund.

Before I finish this post, I want to mention a recently made compilation of our research on nursing ethics:

There you will find our publications with abstracts and links to the publications that are available online.

Pär Segerdahl

We have a clinical perspective :

Our publications on biobanks and registries

June 11, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogBiomedical research does not always require research subjects who are prepared to experimentally try new treatments or diets. Increasingly, research on health and disease is carried out on stored biological samples and personal data in different registries.

Handling human biological material and personal data raises unique ethical issues. People who volunteer as participants in such research are unlikely to be harmed by experimental treatments, but their samples and data are stored for a long time. Samples and data can also be shared by several groups, and be used in different research projects.

One can therefore speak of unique ethical challenges in biobank and registry research. At the Centre for Research Ethics and Bioethics, we have long been working to clarify these challenges and discuss ways to deal with them responsibly. Our work has resulted in numerous publications, often together with biomedical researchers and in international collaborations.

In May 2014, we published an updated compilation of these publications:

The above link will take you to the online version, which also contains further links to the articles that are available online. A printed report can be ordered from

The report contains abstracts of all the publications. What is new is that we now arranged the publications thematically:

  1. Ethical frameworks and policy
  2. Regulatory aspects
  3. Informed consent
  4. Ethical review
  5. Integrity concerns
  6. Trust
  7. Genetic testing
  8. Incidental findings
  9. Commercialization
  10. Public and patient perceptions
  11. Rare diseases
  12. Children & biobanks & genetics

We hope you take a look at the report and find something that interests you!

Pär Segerdahl

Part of international collaborations - the Ethics Blog


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