A blog from the Centre for Research Ethics & Bioethics (CRB)

Category: Musings (Page 1 of 18)

Columbo in Athens

One of the most timeless TV crime series is probably Columbo. Peter Falk plays an inquisitive police lieutenant who sometimes seems so far beyond ordinary time reckoning that he can make Los Angeles resemble ancient Athens, where an equally inquisitive philosopher cared just as little about his appearance.

I hope you have seen a few Columbo episodes. I also take the liberty of opening this post by revealing why I want to write about him. Because he not only exposes the murderers but at the same time frees them from living entangled in their own brilliant plans. You might remember the unusual disposition of the episodes, that we immediately learn who the perpetrator is. The murderers in the series are distinguished not only by their high social and economic status, but also by their high intelligence (and their overconfidence in it). Before the murder takes place, we get to follow how ingeniously the killer plans the deed. The purpose is to give the appearance of having a watertight alibi, to avoid leaving unintended clues at the murder scene, and to leave those clues that clearly point to someone else. Everything is perfectly thought out: BANG! In the next act, Columbo enters the scene of the murder in his worn coat and with a cigar that has usually gone out. In one episode he arrives with a boiled egg in his pocket which he cracks against the murder weapon when he has not had time to eat breakfast.

The murder was just the prelude. Now the episode begins for real, the interaction between the absent-minded Columbo and the shrewd murderer who planned everything in detail and now feels invincible. Especially considering that the police lieutenant leading the investigation is clearly just a confused poor thing constantly fumbling for his notepad and pencil and asking irrelevant questions. I have soon dealt with this fellow, the killer thinks.

Columbo often immediately knows who the murderer is. He can reveal this in a final conversation with the murderer where both can unexpectedly find each other and speak openly, almost like old friends. Soon even the murderer begins to understand that Columbo knows, even though the lieutenant’s absent-minded demeanor at first made this unlikely. Usually, however, the murderer’s confidence is not shaken by knowing that Columbo knows, for everything is perfectly thought out: Columbo “knows” without being able to prove anything! Columbo spends many sleepless nights wondering about the murderer’s alibi and motive, or about seemingly irrelevant details at the murder scene: the “loose ends” that Columbo often talks about, without the murderer understanding why. They seem too trivial to touch the ingenious plan! The murderer almost seems to enjoy watching Columbo rack his brain with immaterial details that cannot possibly prove what both already “know.” Little does the killer know that Columbo’s uncertainty will soon bear fruit.

Finally, Columbo manages to tie up the loose ends that the murderer did not see the point of (they looked so plain compared to the elegant plan). When Columbo reveals how the alibi was only apparent, how the all-too-obvious clues were deliberately placed at the murder scene, and the murderer’s cheap selfish motive, the murderer expects to be arrested by Columbo. “No, others will come and arrest you later,” says Columbo, who suddenly seems uninterested in the whole matter. Columbo seems to have only wanted to expose the illusory reality the killer created to mislead everyone. The murderer is the one who walks into the trap first. To make everything look real, the murderer must live strictly according to the insidious plan from the very first act. Maybe that is why the murderer often seems to breathe a sigh of relief in the final act. Columbo not only exposes the criminal, but also frees the criminal mind from constantly living trapped in its own calculations.

In the conversation at the end, the otherwise active killer seems numbed by Columbo, calm and without a winning smile. Even the murderer is for the first time happily absent-minded.

How does Columbo manage to uncover the insidious plan? We like to think that Columbo succeeds in exposing the murderer because Columbo is even smarter. If Columbo switched sides and planned crimes, no one could expose him! He would be a super-intelligence that could satisfy every wish, like the genie in the lamp. Sometimes even the murderer seems to think along these lines and offers Columbo employment and a brilliant career. With Columbo as accomplice, the murderer would be invincible. But Columbo does not seem to care more about his future than about his appearance: “No, never, I couldn’t do that.” He loves his work, he explains, but hardly gives the impression of being a police lieutenant, but is sometimes mistaken for a vagrant who is kindly asked to remove himself from the scene of the murder. Nuns can offer him food and clothes. Is Columbo the one actually creating the false appearance? Is he the one with the most cunning plan? Is his absent-mindedness just a form of ironic pretense to lure the murderer into the trap?

Columbo probably benefits from his disarming simplicity and absent-minded demeanor. But although we sometimes see him setting traps for the killer, we never see him disguise himself as a vagrant. When his wife has given him a nicer coat, he seems genuinely bothered by it, as if he were dressed up. Is Columbo’s confusion sincere after all? Is it the confusion he loves about his work? Is it perhaps the confusion that eventually reveals the murderer’s watertight plan?

Columbo’s colleagues are not confused. They follow the rules of the game and soon have exactly the conviction the murderer planned for them according to the manual: the murderer has no motive, has a watertight alibi, and cannot be tied to the scene of the murder. Technical evidence, on the contrary, clearly points in a different direction. If the colleagues were leading the investigation, the murderer would have already been removed from the list of suspects. This is how a colleague complains when he feels that Columbo is slowing down the investigation by not following the plan of the criminal mastermind:

Sergeant Hoffman: Now what do you think Lieutenant, do you really think that Deschler didn’t shoot Galesko in the leg?

Columbo: I’ll tell you something, Sergeant, I don’t know what to think.

The injured Galesko is in fact the murderer. He shot himself in the leg after killing Deschler, to make the killing look like self-defense against “his wife’s kidnapper.” Galseko has already murdered his wife, having staged the kidnapping and planted the clues that point to Deschler. Why did Galesko murder his wife? Because he felt she was obscuring his bright future. The murderers in the TV series not only plan their deeds, but also their lives. Without ideas of bright futures, they would lack motive to plan murder.

Neither the killer nor the colleague suffers from uncertainty, they both sleep well. Only Columbo is awake: “I don’t know what to think.” Therefore, he tries to tie up loose ends. Like the philosopher Socrates in ancient Athens, Columbo knows that he does not know. Therefore, he torments the murderer (and the colleagues) with vexing questions that do not belong to the game, but rather revolve around it. Now you probably want to direct Columbo’s most famous line at me: “Oh, just one more thing!” For did I not say that Columbo immediately knows who the murderer is? Yes, I did. Columbo already “knows” who the murderer is. How? Does he know it through his superior intelligence that reveals the whole case in a flash? No, but because the murderer does not react like someone who does not know. When informed of the murder, the killer reacts strangely: like someone who already knows. Lack of confusion is the hallmark of the murderer.

When Columbo reveals the tangle of thoughts that already in the first act ensnared the murderer, the perpetrator goes to prison without complaint. Handcuffs are redundant when the self-made ones are finally unlocked. Columbo has calmed the criminal mind. The culprit is free from the murder plan that would secure the future plan. Suddenly everything is real, just real.

Just one more thing: Merry Christmas and do not plan too much!

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

The dialogue between Hoffman and Columbo is from the episode Negative Reaction (1974). Columbo’s response to the career offer is from The Bye-Bye Sky-High I.Q. Murder Case (1977).

The image is AI-generated in Microsoft Designer by Ashkan Atry.

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Thinking about thinking

AI is the answer! But what is the question?

Many projects are underway in Sweden regarding AI systems in healthcare. The testing of AI solutions is in full swing. But many systems do not seem to be implemented and used. Why? Often it is a matter of poor preparatory work. Without a carefully considered strategy and clear goals, we risk scaling up AI systems that cannot cope with the complexity of healthcare.

The atmosphere around many AI ​​ventures can almost be a little religious. You must not be negative or ask critical questions. Then you are quickly branded as a cynic who slows down development and does not understand the signs of the times. You almost have to blind yourself to potential pitfalls and speak and act like a true believer. Many justify the eager testing of AI by saying that we must dare to try and then see which solutions turn out to be successful. It is fascinating how willingly we apply AI to all sorts of tasks. But are we doing it the right way, or do we risk rushing on without giving ourselves time to think?

There are indeed economical and practical challenges in healthcare. It is not only about a lack of financial resources, but also about a lack of personnel and specialists. Before we can allow technologies like AI to become part of our everyday lives, we need to ask ourselves some important questions: What problems are we trying to solve? How do our solutions affect the people involved? We may also need to clarify whether the purpose of the AI ​​system is to almost take over an entire work task or rather to facilitate our work in certain well-defined respects. The development of AI products should also pay extra attention to socially created categories of ethnicity and gender to avoid reinforcing existing inequalities through biased data selection. Ethically well-considered AI implementations probably lead to better clinical outcomes and more efficient care. It is easy to make hasty decisions that soon turn out to be wrong: accuracy should always be a priority. It is better to think right and slow than fast and wrong. Clinical studies should be conducted even on seemingly not so advanced AI products. In radiology, this tradition is well established, but it is not as common in primary care. If a way of working is to be changed with the help of AI, one should evaluate what effects it can have.

We must therefore not neglect three things: We must first of all define the need for an AI solution. We must then consider that the AI ​​tool is not trained with biased data. Finally, we need to evaluate the AI ​​solution before implementing it.

With the rapid data collection that apps and digital tools allow today, it is important not to get carried away, but to carefully consider the ethics of designing and implementing AI. Unfortunately, the mantra has become: “If we have data, we should develop an AI.” And that mantra makes anyone who asks “Why?” seem suspicious. But the question must be asked. It does not hinder the development of AI solutions, but contributes to it. Careful ethical considerations improve the quality of the AI ​​product and strengthens the credibility of the implementation.

I therefore want to warn against being seduced by the idea of ​​AI solutions for all sorts of tasks. Before we say AI is the answer, we need to ask ourselves: What is the question? Only if we can define a real issue or challenge can we ensure that the technology becomes a helping hand instead of a burden. We do not want to periodically end up in the situation where we suddenly have to pull the emergency brake, as in a recent major Swedish investment in AI in healthcare, called Millennium. We must not get stuck in the mindset that everything can be done faster and easier with AI. We must also not be driven by the fear of falling behind if we do not immediately introduce AI. Only a carefully considered evaluation of the need and the design of an AI solution can ensure appropriate care that is also effective. To get correct answers quickly, we must first give ourselves time to think.

Written by…

Jennifer Viberg Johansson, who is an Associate Professor in Medical Ethics at the Centre for Research Ethics & Bioethics.

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We challenge habits of thought

Philosophy on a chair

Philosophy is an unusual activity, partly because it can be conducted to such a large extent while sitting still. Philosophers do not need research vessels, laboratories or archives to work on their questions. Just a chair to sit on. Why is it like that?

The answer is that philosophers examine our ways of thinking, and we are never anywhere but where we are. A chair takes us exactly as far as we need: to ourselves. Philosophizing on a chair can of course look self-absorbed. How can we learn anything significant from “thinkers” who neither seem to move nor look around the world? If we happen to see them sitting still in their chairs and thinking, they can undeniably appear to be cut off from the complex world in which the rest of us must live and navigate. Through its focus on human thought, philosophy can seem to ignore our human world and not be of any use to the rest of us.

What we overlook with such an objection to philosophy is that our complex human world already reflects to a large extent our human ways of thinking. To the extent that these ways of thinking are confused, limited, one-sided and unjust, our world will also be confused, limited, one-sided and unjust. When we live and move in this human world, which reflects our ways of thinking, can it not be said that we live somewhat inwardly, without noticing it? We act in a world that reflects ourselves, including the shortcomings in our ways of thinking.

If so, maybe it is not so introverted to sit down and examine these ways of thinking? On the contrary, this seems to enable us to free ourselves and the world from human thought patterns that sometimes limit and distort our perspectives without us realizing it. Of course, research vessels, laboratories and archives also broaden our perspectives on the world. But we already knew that. I just wanted to open our eyes to a more unexpected possibility: that even a chair can take us far, if we practice philosophy on it.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

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We challenge habits of thought

Finding the way when there is none

A difficulty for academic writers is managing the dual role of both knowing and not knowing, of both showing the way and not finding it. There is an expectation that such writers should already have the knowledge they are writing about, that they should know the way they show others right from the start. As readers, we are naturally delighted and grateful to share the authors’ knowledge and insight.

But academic writers usually write because something strikes them as puzzling. They write for the same reason that readers read: because they lack the knowledge and clarity required to find the way through the questions. This lack stimulates them to research and write. The way that did not exist, takes shape when they tackle their questions.

This dual role as a writer often worries students who are writing an essay or dissertation for the first time. They can easily perceive themselves as insufficiently knowledgeable to have the right to tackle the work. Since they lack the expertise that they believe is required of academic writers from the outset, does it not follow that they are not yet mature enough to begin the work? Students are easily paralyzed by the knowledge demands they place on themselves. Therefore, they hide their questions instead of tackling them.

It always comes as a surprise, that the way actually takes shape as soon as we ask for it. Who dares to believe that? Research is a dynamic interplay with our questions: with ignorance and lack of clarity. An academic writer is not primarily someone who knows a lot and who therefore can show others the way, but someone who dares and is even stimulated by this duality of both knowing and not knowing, of both finding and not finding the way.

If we have something important to learn from the exploratory writers, it is perhaps that living knowledge cannot be separated as pure knowledge and nothing but knowledge. Knowledge always interacts with its opposite. Therefore, essay writing students already have the most important asset to be able to write in an exploratory way, namely the questions they are wondering about. Do not hide the questions, but let them take center stage. Let the text revolve around what you do not know. Knowledge without contact with ignorance is dead.  It solves no one’s problem, it answers no one’s question, it removes no one’s confusion. So let the questions sprout in the soil of the text, and the way will soon take shape.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

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Thinking about authorship

Objects that behave humanly

Many forms of artificial intelligence could be considered objects that behave humanly. However, it does not take much for us humans to personify non-living objects. We get angry at the car that does not start or the weather that does not let us have a picnic, as if they were against us. Children spontaneously personify simple toys and can describe the relationship between geometric shapes as, “the small circle is trying to escape from the big triangle.”

We are increasingly encountering artificial intelligence designed to give a human impression, for example in the form of chatbots for customer service when shopping online. Such AI can even be equipped with personal traits, a persona that becomes an important part of the customer experience. The chatbot can suggest even more products for you and effectively generate additional sales based on the data collected about you. No wonder the interest in developing human-like AI is huge. Part of it has to do with user-friendliness, of course, but at the same time, an AI that you find personally attractive will grab your attention. You might even like the chatbot or feel it would be impolite to turn it off. During the time that the chatbot has your attention, you are exposed to increasingly customized advertising and receive more and more package offers.

You can read about this and much more in an article about human relationships with AI designed to give a human impression: Human/AI relationships: challenges, downsides, and impacts on human/human relationships. The authors discuss a large number of examples of such AI, ranging from the chatbots above to care robots and AI that offers psychotherapy, or AI that people chat with to combat loneliness. The opportunities are great, but so are the challenges and possible drawbacks, which the article highlights.

Perhaps particularly interesting is the insight into how effectively AI can create confusion by exposing us to objects equipped with human response patterns. Our natural tendency to anthropomorphize non-human things meets high-tech efforts to produce objects that are engineered to behave humanly. Here it is no longer about imaginatively projecting social relations onto non-human objects, as in the geometric example above. In interaction with AI objects, we react to subtle social cues that the objects are equipped with. We may even feel a moral responsibility for such AI and grieve when companies terminate or modify it.

The authors urge caution so that we do not overinterpret AI objects as persons. At the same time, they warn of the risk that, by avoiding empathic responses, we become less sensitive to real people in need. Truly confusing!

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Zimmerman, A., Janhonen, J. & Beer, E. Human/AI relationships: challenges, downsides, and impacts on human/human relationships. AI Ethics (2023). https://doi.org/10.1007/s43681-023-00348-8

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We recommend readings

The doubtful beginnings of philosophy

Philosophy begins with doubt, this has been emphasized by many philosophers. But what does it mean to doubt? To harbor suspicions? To criticize accepted beliefs? In that case, doubt is based on thinking we know better. We believe that we have good reason to doubt.

Is that doubting? Thinking that you know? It sounds paradoxical, but it is probably the most common form of doubt. We doubt, and think we can easily explain why. But this is hardly the doubt of philosophy. For in that case philosophy would not begin with doubt, but with belief or knowledge. If a philosopher doubts, and easily motivates the doubt, the philosopher will soon doubt her own motive for doubting. To doubt, as a philosopher doubts, is to doubt one’s own thought. It is to admit: I don’t know.

Perhaps I have already quoted Socrates’ famous self-description too many times, but there is a treasure buried in these simple words:

“when I don’t know things, I don’t think that I do either.”

The oracle at Delphi had said of Socrates that he was the wisest of all. Since Socrates did not consider himself more knowledgeable than others, he found the statement puzzling. What could the oracle mean? The self-description above was Socrates’ solution to the riddle. If I am wiser than others, he thought, then my wisdom cannot consist in knowing more than others, because I do not. But I have a peculiar trait, and that is that when I do not know, I do not think I know either. Everyone I question here in Athens, on the other hand, seems to have the default attitude that they know, even when I can demonstrate that they do not. Whatever I ask them, they think they know the answer! I am not like that. If I do not know, I do not react as if I knew either. Perhaps this was what the oracle meant by my superior wisdom?

So, what did Socrates’ wisdom consist in? In beginning with doubt. But must he not have had reason to doubt? Surely, he must have known something, some intuition at least, which gave him reason to doubt! Curiously, Socrates seems to have doubted without good reason. He said that he heard an inner voice urging him to stop and be silent, just as he was about to speak verbosely as if he knew something: Socrates’ demon. But how could an “inner voice” make Socrates wise? Is that not rather a sure sign of madness?

I do not think we should make too much of the fact that Socrates chose to describe the situation in terms of an inner voice. The important thing is that he does not react, when he does not know. Imagine someone who has become clearly aware of her own reflex to get angry. The moment she notices that she is about to get angry, she becomes completely calm instead. The drama is over before it begins. Likewise, Socrates became completely calm the moment he noted his own reflex to start talking as if he knew something. He was clearly aware of his own knowledge reflex.

What is the knowledge reflex? We have already felt its activity in the post. It struck us when we thought we knew that a wise person cannot doubt without reason. It almost drove us mad! If Socrates doubted, he must have had good reason! If an “inner voice” inspired doubt, it would not be wisdom, but a sure sign of madness! This is the knowledge reflex. To suddenly not be able to stop talking, as if we had particularly good reason to assert ourselves. Socrates never reacted that way. In those situations, he noted the knowledge reflex and immediately became perfectly calm.

The value of becoming completely calm just when the knowledge reflex wants to set us in motion is that it makes us free to examine ourselves. If we let the knowledge reflex drive our doubts – “this is highly dubious, because…” – we would not question ourselves, but assert ourselves. We would doubt the way we humans generally doubt, because we think we have reason to doubt. Of course, Socrates does not doubt arbitrarily, like a madman, but the source of his doubt becomes apparent only in retrospect. Philosophy is love for the clarity we lack when philosophizing begins. Without this loving attitude towards what we do not know, our collective human knowledge risks becoming a colossus on clay feet – is it already wobbly?

When the knowledge reflex no longer controls us, but is numbed by philosophical self-doubt, we are free to think independently and clearly. Therefore, philosophy begins with doubt and not with belief or knowledge.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Plato. “The Apology of Socrates.” In The Last Days of Socrates, translated by Christopher Rowe, 32-62. Penguin Books, 2010.

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Thinking about thinking

Time to forget time

A theme in recent blog posts has been our need for time. Patients need time to be listened to; time to ask questions; time to decide whether they want to be included in clinical studies, and time for much more. Healthcare workers need time to understand the patients’ situation; time to find solutions to the individual problems of patients suffering from rheumatoid arthritis, and time for much more. This theme, our need for time, got me thinking about what is so great about time.

It could be tempting to conduct time and motion studies of our need for time. How much time does the patient need to spend with the doctor to feel listened to? How much time does the nurse need to spend with the patient to get the experience of providing good care? The problem with such studies is that they destroy the greatness of time. To give the patient or the nurse the measured time, prescribed by the time study, is to glance at the clock. Would you feel listened to if the person you were talking to had a stopwatch hanging around their neck? Would you be a good listener yourself if you waited for the alarm signal from the stopwatch hanging around your neck?

Time studies do not answer our question of what we need, when we need time. If it was really a certain amount of time we needed, say fifteen minutes, then it should make no difference if a ticking stopwatch hung around the neck. But it makes a difference! The stopwatch steals our time. So, what is so great about time?

I think the answer is well on its way to revealing itself, precisely because we give it time to come at its own pace. What we need when we need time, is to forget time! That is the great thing about having time. That we no longer think about it.

Again, it can be tempting to conduct time studies. How much time does the patient and the doctor need to forget time? Again, time studies ruin the greatness of time. How? They frame everything in time. They force us to think about time, even when the point is to forget it.

Our need for time is not about measured quantities of time, but about the timeless quality of not thinking about time. Thinking about time steals time from us. Since it is not really about time, it does not have to take that long.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

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We challenge habits of thought

Moral stress: what does the COVID-19 pandemic teach us about the concept?

Newly formed concepts can sometimes satisfy such urgent linguistic needs that they immediately seem completely self-evident. Moral stress is probably such a concept. It is not many decades old. Nevertheless, the concept probably appeared from the beginning as an all-too-familiar reality for many healthcare workers.

An interesting aspect of these immediately self-evident concepts is that they effortlessly find their own paths through language, despite our efforts to define the right path. They are simply too striking in living spoken language to be captured in the more rigid written language of definitions. However, the first definition of moral stress was fairly straightforward. This is how Andrew Jameton defined the concept:

“Moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.”

Although the definition is not complicated in the written language, it still prevents the concept from speaking freely, as it wants to. For, do we not spontaneously want to talk about moral stress in other situations as well? For example, in situations where two different actions can be perceived as the right ones, but if we choose one action it excludes the other? Or in situations where something other than “institutional constraints” prevents the right course of action? Perhaps a sudden increase in the number of patients.

Here is a later definition of moral stress, which leaves more open (by Kälvemark, Höglund and Hansson):

“Traditional negative stress symptoms that occur due to situations that involve an ethical dimension where the health care provider feels he/she is not able to preserve all interests at stake.”

This definition allows the concept to speak more freely, in more situations than the first, although it is possibly slightly more complicated in the written language. That is of course no objection. A definition has other functions than the concept being defined, it does not have to be catchy like a song chorus. But if we compare the definitions, we can notice how both express the authors’ ideas about morality, and thus about moral stress. In the first definition, the author has the idea that morality is a matter of conscience and that moral stress occurs when institutional constraints of the profession prevent the practitioner from acting as conscience demands. Roughly. In the second definition, the authors have the idea that morality is rather a kind of balancing of different ethical values and interests and that moral stress arises in situations that prevent the trade-offs from being realized. Roughly.

Why do I dwell on the written and intellectual aspects of the definitions, even though it is hardly an objection to a definition? It has to do with the relationship between our words and our ideas about our words. Successful words find their own paths in language despite our ideas about the path. In other words: despite our definitions. Jameton both coined and defined moral (di)stress, but the concept almost immediately stood, and walked, on its own feet. I simply want to remind you that spoken-language spontaneity can have its own authority, its own grounding in reality, even when it comes to newly formed concepts introduced through definitions.

An important reason why the newly formed concept of moral stress caught on so immediately is probably that it put into words pressing problems for healthcare workers. Issues that needed to be noticed, discussed and dealt with. One way to develop the definition of moral stress can therefore be to listen to how healthcare workers spontaneously use the concept about situations they themselves have experienced.

A study in BMC Medical Ethics does just this. Together with three co-authors, Martina E. Gustavsson investigated how Swedish healthcare workers (assistants, nurses, doctors, etc.) described moral stress during the COVID-19 pandemic. After answering a number of questions, the participants were requested to describe, in a free text response, situations during the pandemic in which they experienced moral stress. These free text answers were conceptually analyzed with the aim of formulating a refined definition of moral stress.

An overarching theme in the free text responses turned out to be: being prevented from providing good care to needy patients. The healthcare workers spoke of a large number of obstacles. They perceived problems that needed to be solved, but felt that they were not taken seriously, that they were inadequate or forced to act outside their areas of expertise. What stood in the way of good care? The participants in the study spoke, among other things, about unusual conditions for decision-making during the pandemic, about tensions in the work team (such as colleagues who did not dare to go to work for fear of being infected), about substandard communication with the organizational management. All this created moral stress.

But they also talked about the pandemic itself as an obstacle. The prioritization of COVID-19 patients meant that other patients received worse care and were exposed to the risk of infection. The work was also hindered by a lack of resources, such as personal protective equipment, while the protective equipment prevented staff from comforting worried patients. The visiting restrictions also forced staff to act as guards against patients’ relatives and isolate infected patients from their children and partners. Finally, the pandemic prevented good end-of-life care. This too was morally stressful.

How can the healthcare workers’ free text responses justify a refined definition of moral stress? Martina E. Gustafsson and co-authors consider the definition above by Kälvemark, Höglund and Hansson as a good definition to start from. But one type of situation that the participants in the study described probably falls outside that definition, namely the situation of not being taken seriously, of feeling inadequate and powerless. The study therefore proposes the following definition, which includes these situations:

“Moral stress is the kind of stress that arises when confronted with a moral challenge, a situation in which it is difficult to resolve a moral problem and in which it is difficult to act, or feeling insufficient when you act, in accordance with your own moral values.”

Here, too, one can sense an idea of morality, and thus of moral stress. The authors think of morality as being about solving moral problems, and that moral stress arises when this endeavor encounters challenges, or when one feels inadequate in the attempts to solve the problems. The definition can be considered a refined idea of what moral stress is. It describes more precisely the relevant situations where healthcare workers spontaneously want to talk about moral stress.

Obviously, we can learn a lot about the concept of moral stress from the experience of the COVID-19 pandemic. Read the study here, which contains poignant descriptions of morally stressful situations during the pandemic: “Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic.”

Finally, I would like to mention two general lessons about language, which in my view the study highlights. The first is that we can learn a lot about our concepts through the difficulties of defining them. The study took this “definition resistance” seriously by listening to how healthcare workers spontaneously talk about moral stress. This created friction that helped refine the definition. The second lesson is that we often use words despite our ideas about what the words mean or should mean. Spoken language spontaneity has a natural weight and authority that we easily overlook, but from which we have much to learn – as in this empirical study.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Gustavsson, M.E., von Schreeb, J., Arnberg, F.K. et al. “Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic”. BMC Med Ethics 24, 110 (2023). https://doi.org/10.1186/s12910-023-00993-y

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Minding our language

Two orientations of philosophical thought

There are many philosophical movements and several ways of dividing philosophy. I would like to draw attention to two orientations of philosophical thought that are never usually mentioned, but which I believe characterize philosophical thinking. Although unnamed, the two orientations are so different from each other that they can make philosophers roll their eyes when they run into each other: “What kind of nonsense is this?”

I am not referring to the division between analytic and continental philosophy, which is a known source of rolling eyes. I am referring to a division that rather applies to ourselves as thinking beings: our innermost philosophical disposition, so to speak.

So do not think of famous philosophers or of the philosophical movements they are considered to represent. Now it is just about ourselves. Think about what it is like to discuss a question that is felt to be urgent, for example: “Why has humanity failed to create a peaceful world?” How do we usually react to such questions? I dare say many of us wish we could answer them. This is the nature of a question. A question demands an answer, just as a greeting demands a greeting back. And since the answer to an important question should have the same urgency as the question, it feels very important to answer. This has the consequence that the discussion of the question soon turns into a discussion of several different answers, which compete with each other. Perhaps a few particularly committed participants argue among themselves for and against increasingly complicated answers at a speed that leaves the others behind. It feels humiliating to sit there and not be able to propose a single answer with accompanying arguments that it must be the right answer.

Many of us are probably also familiar with how afterwards, when we have time to think in peace and quiet, we can suddenly see possibilities that never occurred to us during the discussion: “So obvious! Why didn’t I see that?” When we are given time to think for ourselves, we are free from a limitation that governed the discussion. What limitation? The limitation that the question must be answered and the answer defended as the correct answer. Why were we so stimulated to find the answer to the question and defend it against the competitors? Was it a good question that gave rise to all these divergent answers, as if someone had thrown a match into a stockpile of fireworks? Already in its wording, the question blames humanity for not being able to resolve its conflicts. Is this not already a conflict? The question pits us against humanity, and when the answers and arguments start to hail, the debaters are also pitted against each other. The discussion becomes yet another example of our tendency to end up on different sides in conflicts.

If we notice how our noble philosophical discussion about world peace threatens to degenerate into the very strife we debate and we want to seek the answer in a more responsible way, then perhaps we decide to review the answers and arguments that have been piled up. We classify them as positions and schools of thought and practice identifying them to avoid well known fallacies, which are classified with equal philosophical rigor. In the future, this hard work will finally lead us to the definitively correct answer, we think. But the focus is still on the answers and the arguments, rather than on the question that ignited the entire discussion. The discussion continues to exemplify our tendency toward conflict, but now in terms of a rigorous philosophical classification of the various known positions on the issue.

The difference between the two orientations concerns where we place our emphasis: on the question or on the answer? Either we feel the question propels us, like a starting shot that makes us run for the answer at the finish line. The answer may be in terms of the human mind, the structure of society, our evolutionary history and much more. Or we feel the question paralyzes us, like an electric shock that numbs us so that we have to sit down at the starting line and examine the question. What already happened in the question? Am I not also humanity? Who am I to ask the question? Does not the question make a false distinction between me and humanity, similar to those made in all conflicts? Is that why I cannot discuss the question without becoming an example of the problem myself?

Consider the two philosophical orientations side by side. One of them experiences the question as a stimulating starting signal and runs for the answer. The other experiences the question as a numbing electric shock and remains seated at the starting line. It cannot surprise us that these two philosophical dispositions have difficulty understanding each other. If you emphasize the answer and run for it, stopping at the question seems not only irresponsible, but also unsportsmanlike and inhibiting. Is it forbidden to seek the right answer to urgent questions? If, on the other hand, you emphasize the question and stay seated at the starting line, it seems rash to run for the answer, even when the race follows a rigorously ordered pattern. Did not the starting shot go off too early so that the race should be declared invalid, even though it otherwise went according to the strict rules of the art?

When we consider the two orientations side by side, we can note another difference. Emphasizing the answer directs our attention to the subject of the question: “humanity throughout history.” Emphasizing the question directs our attention to the subject who asks it: to myself. Again, it can hardly surprise us that the two orientations have difficulty understanding each other. Both may seem to be avoiding the subject!

Here one might want to object that even this distinction between two philosophical orientations places people on different sides of a conflict. But maybe we can recognize ourselves in both tendencies, although we lean more in one direction? Is not philosophical thinking often a dialogue between these tendencies? Do we not become more peaceful when we see the two philosophical dispositions side by side? Perhaps we understand each other better when we see the possibility of emphasizing both the question and the answer. We suddenly realize why we sound so different when we philosophize, despite the fact that we are all thinking beings, and we no longer need to exclaim: “What kind of nonsense is this?”

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

This post in Swedish

Thinking about thinking

When ordinary words get scientific uses

A few weeks ago, Josepine Fernow wrote an urgent blog post about science and language. She linked to a research debate about conceptual challenges for neuroscience, challenges that arise when ordinary words get specialized uses in science as technically defined terms.

In the case under debate, the word “sentience” had been imported into the scientific study of the brain. A research group reported that they were able to determine that in vitro neurons from humans and mice have learning abilities and that they exhibit “sentience” in a simulated game world. Of course, it caused quite a stir that some neurons grown in a laboratory could exhibit sentience! But the research team did not mean what attracted attention. They meant something very technical that only a specialist in the field can understand. The surprising thing about the finding was therefore the choice of words.

When the startling choice of words was questioned by other researchers, the research team defended themselves by saying that they defined the term “sentience” strictly scientifically, so that everyone should have understood what they meant, at least the colleagues in the field. Well, not all people are specialists in the relevant field. Thus the discovery – whatever it was that was discovered – raised a stir among people as if it were a discovery of sentience in neurons grown in a laboratory.

The research group’s attitude towards their own technical language is similar to an attitude I encountered long ago in a famous theorist of language, Noam Chomsky. This is what Chomsky said about the scientific study of the nature of language: “every serious approach to the study of language departs from the common-sense usage, replacing it by some technical concept.” Chomsky is of course right that linguistics defines its own technical concepts of language. But one can sense a certain hubris in the statement, because it sounds as if only a linguistic theorist could understand “language” in a way that is worthy of serious attention. This is untenable, because it raises the question what a technical concept of language is. In what sense is a technical concept a concept of language? Is it a technical concept of language in the common sense? Or is it a technical concept of language in the same inaccessible sense? In the latter case, the serious study of language seems to degenerate into a navel-gazing that does not access language.

For a technical concept of language to be a concept of language, our ordinary notions must be taken into account. Otherwise, the technical concept ceases to be a concept of language.

This is perhaps something to consider in neuroscience as well. Namely to the extent that one wants to shed light on phenomena such as consciousness and sentience. Of course, neuroscience will define its own technical concepts of these phenomena, as in the debated case. But if the technical concepts are to function as concepts of consciousness and sentience, then one cannot neglect our ordinary uses of words.

Science is very serious and important. But if the special significance of science goes to our heads, then our attitude risks undermining the great importance of science for humanity. Here you can read the views of three neuroethicists on these important linguistic issues: Conceptual conundrums for neuroscience.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

This post in Swedish

Minding our language

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