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We study the impact of anticipated face-to-face discussions among group members after they have made an anonymous contribution to a public good in an experimental setting. We find that the impact of anticipated discussions depends on how we frame the public good game. When framed in non-evaluative language, anticipated ex post discussions lead to a sharp reduction in contributions to the public good. This effect reversed when evaluative language was used to underscore normative expectations. In contrast, there was no framing in the no-discussion baseline version of our game. We offer an explanation that centres on the idea that the announcement of ex post discussions reinforces both normative and predictive expectations.

“Juridification” is an ambiguous term, both descriptively and normatively. The authors distinguish between five dimensions of “juridification”; constitutive juridification, juridification as law’s expansion and differentiation, as increased conflict solving with reference to law, as increased judicial power and as legal framing. In the first part they clarify the five dimensions. In the second part they discuss the relationship between them, and in a third and concluding part they briefly comment on some of the challenges they are faced with from a normative point of view.

Microbiologic root canal sampling (MRS) has been available to the practising dentist for a full century. During this time its potential benefits and clinical use have almost constantly been argued and disputed. The controversies have not been settled. The overall aim of the present thesis was, therefore, to renew the discussion and to shed new light on the potential, shortcomings and future role of MRS. In the first part, the degree to which MRS was adopted by general practitioners and the reasons for their acceptance or rejection of the methodology were studied. From laboratory records obtained over a period of 25 years, it was calculated that the adoption level among dentists in the Gothenburg region was 3 to 5 percent. Even among adopters MRS was rarely used on a routine basis but in selected cases. Data from a questionnaire survey among the practitioners in that region confirmed these findings. The main reasons for non-adoption seemed to be a perceived low cost benefit ratio and lack of advantage relative to a more standardised treatment strategy. The potential role of MRS in retreatment cases was addressed in the second part of the thesis by studying (i) retrospectively and (ii) prospectively the composition of the microflora that resists treatment. (i) The microbiological status of 100 root-filled teeth with persistent periapical lesions was examined prior to retreatment. Microorganisms were recovered in 68 of these teeth. Facultative anaerobes predominated the isolates. E. faecalis was the most frequently isolated species, showing "heavy" or "very heavy" growth in 25 of 32 positive samples. The sampling of 20 teeth without lesions also showed a high frequency of microbial growth (50%) but the number of cultivable organisms was less. (ii) The potential of intracanal microorganisms to resist maximised intracanal medication was investigated on 50 non-treated teeth, with necrotic and infected pulps. The findings gave no support for an increased overall antimicrobial effect of this combination in comparison with CH alone. These studies have shown that if microorganisms do persist in teeth exposed to treatment in general practice, retreatment cases and teeth receiving intensive antimicrobial treatment they are of similar kinds. Frequent isolates are facultative streptococci, enterococci and lactobacilli. Based on the treatment of 50 infected teeth the diagnostic accuracy of MRS was assessed. Sensitivity and specificity of the test were found to reach 68% and 75%, respectively, when 5% iodine-potassium-iodide was used as a dressing. The data supported the hypotheses that intracanal chemical substances substantially influence test results, and that dressings vary in their potential to induce bias. In a search for alternative methodologies the potential of polymerase chain reaction technology (PCR) was investigated. PCR showed high specificity, and low detection levels (10 cells) for E. faecalis and E. faecium.

This thesis investigates Responsible Research and Innovation (RRI) and its possible application for assessing assistive technologies. Such assessments aim to produce ethically acceptable solutions as well as enhanced value for the user groups. RRI connects science, innovation, society and citizens in the creation of social goods or the realisation of social values through research and development processes. Although RRI has been an ideal for the governance of science for almost a decade, it remains little studied, in particular in the field of health and assistive technologies. The notion has received support from several European research funding agencies, but is still only in its infancy when it comes to concrete application with and for citizens and society. The goal of this thesis is to investigate how the governance of assistive technologies can become more responsible through assessments. The research process underlying this investigation was itself inspired by RRI. Through extensive literature searches and several engagement activities with potential users, important stakeholders and their representatives, this thesis investigates the performance of socio-ethical assessments of assistive technologies in light of RRI. It draws on earlier research on Technology Assessment (TA) and applied ethics – and the interconnections between these two traditions – to investigate how these traditions might deliver assessment frameworks in line with the normative demands of RRI; and how to relate these traditions to Health Technology Assessments (HTA), the main approach to making policy decisions on new health interventions. By using of a combination of two such frameworks, the Ethical Matrix and the Socratic approach, this thesis suggests that an exploratory approach to RRI can inform assessment strategies and has the potential to enhance responsibility through both process and product selection. In particular, the thesis illustrates that there are lacunas in the municipal innovation process, where value decisions are made, and that structured assessment methodologies could improve the quality of such decisions. The thesis contributes to an understanding of what RRI could entail in practical research through using its methodological and normative positions as points of departure for investigations into the values in assistive technologies. It also introduces a new approach to innovation chains for assistive technologies in municipalities and it explores how to enhance methods in applied ethics through a combination of the Ethical Matrix and the Socratic approach. Avhandlingen undersøker hvordan ansvarlig forskning og innovasjon (Responsible Research and Innovation – RRI) kan anvendes som grunnlag for normative vurderinger av velferdsteknologier. Slike normative vurderinger har som mål å skape løsninger og produkter som etisk sett er mer akseptable og som gir økt verdi for mulige brukergrupper. RRI er en tilnærming til å forstå og påvirke hvordan vitenskap, innovasjon, samfunn og medborgere kan skape samfunnsgoder eller virkeliggjøre samfunnsverdier gjennom forsknings- og utviklingsprosesser. Til tross for at RRI nå har eksistert som et ideal for planlegging og styring av forskning for nærmere et tiår så er tilnærmingen lite utforsket innen helse eller velferdsteknologier. Tilnærmingen har fått oppslutningen fra flere europeiske forskningsråd og finansieringskilder, men er kun i oppstarten hva gjelder faktiske anvendelser sammen med og for borgere innen forskning og utvikling. Gitt at denne avhandlingen springer ut av tenkningen om RRI så er dens overordnede mål å undersøke hvordan styringen og utviklingen av velferdsteknologier kan gjøres mer ansvarlig. Selve forskningsprosessen er også fundert i RRI. Gjennom litteraturstudier og en rekke ulike møter med mulige brukere og andre berørte parter undersøker avhandlingen hva det vil si å gjennomføre sosio-etiske vurderinger i lys av RRI. Ut fra tidligere forskning på Technology Assessment (TA) og anvendt etikk – så vel som skjæringspunktene mellom disse – undersøker avhandlingen hvordan etablerte normative rammeverk fra disse tradisjonene kan bidra til vurderingsformer og –metoder som svarer til de normative kravene i RRI samtidig som de er mulige å kombinere med medisinsk metodevurdering (HTA) som er den sentrale tilnærmingen til å fatte politiske beslutninger om innføringen av nye intervensjoner på helseområdet. Ved å bruke en kombinasjon av to slike rammeverk, etiske matriske og den sokratiske tilnærmingen, viser avhandlingen hvordan en utforskende tilnærming til RRI kan utvikle vurderingsstrategier som har mulighet for å styrke ansvarlighet både i vurderingsprosessene og i valget av teknologiske løsninger. Avhandlingen påpeker at det finnes rom i kommunale innovasjonsprosesser der verdibaserte beslutninger fattes og der mer strukturerte vurderingsprosesser kan øke kvaliteten på utviklingen og valget av teknologiske løsninger. Avhandlingen bidrar til en økt forståelse for hva RRI kan medføre i praktisk forskning og innovasjon ved at den bruker metodiske og normative innsikter fra RRI som utgangspunkt for å undersøke hva verdiene som står på spill ved innføring av velferdsteknologier. Videre åpner avhandlingen opp for nye måter å nærme seg innovasjonskjedene for velferdsteknologier i kommunene, og den utforsker hvordan etisk matrise og den sokratiske tilnærmingen, som er etablerte metoder i anvendt etikk, gjensidig kan berike hverandre.

This thesis studies the conflicting normative claims of partiality and impartiality in nursing care. The principal focus and aim of the study is to establish an argument for permissible partiality in nursing care. Partiality here is understood as giving preference to one patient’s nursing-care needs over those of other patients based on relational proximity to the actual patient. The study assumes that prioritisations in health care give rise to moral dilemmas in clinical nursing care. One such dilemma is how to reconcile qualified concerns for the particular patient with equally important concerns for the maximisation of health-related welfare for all with relevant nursing-care needs. The trend in clinical nursing care is that qualified attention to the nursing-care needs of the individual patient increasingly is constrained because nurses’ ability to accomplish the mandate of the nursing profession is progressively becoming compromised by the demands of cost-efficient health care. This situation amplifies a significant normative imbalance between concerns for relational and individual care and concerns for distributive justice. It also highlights the growing importance of debates about reasonable and legitimate forms of partiality in nursing care. The discussion in this thesis is based on different positions and theories in moral philosophy, and the challenge is how discussions of partiality and impartiality in moral philosophy can have relevance to the professional context of clinical nursing care as well as in nursing ethics in general. This challenge is met through an exploration of how to conceptualise professional roles and ethical responsibility in nursing. It is argued that the role of a nurse should be comprehended as a professional role distinct from other contractual role occupations, thereby influencing the way role morality is understood. Nursing involves role-relative ethical concerns and obligations that combine impartial and the partial views. Nurses are committed to individualised nursing care as one of the most important responsibilities of their profession. Nursing care takes place in nursing projects, in relational proximity to the individual patient. Any aspect of nursing care requires various degrees of time and attention in order to be adequate and tailored to the individual. Therefore, it is argued that nurses, in some situations, are permitted to be partial in order to uphold their professional commitment. Though partiality sometimes might trump impartial concerns of distributive justice, it is also constrained by both principled and context-sensitive assessments of patients’ needs, as well as of the role-relative deontological restriction of minimising harm. Some of the conflicts discussed in this research can be framed as moral dilemmas of a tragic nature, which cannot be solved without some kind of negative consequence. It is proposed that some of these difficult situations could and should be mitigated by institutional and organisational adaptations and decisions at a macro level. Finally, I suggest how a framework for normative nursing ethics could incorporate a notion of permissible partiality, and specify which concerns an ethics of nursing care should entail when balancing partialist and impartialist concerns. Avhandlingen studerer partiskhet og upartiskhet som divergerende normative hensyn i sykepleie. Hovedfokus og hensikt med studien er å etablere et argument for legitim partiskhet i sykepleie. Partiskhet forstås her som å gi forrang til en pasients behov for sykepleie fremfor andre pasienters behov for sykepleie, med utgangspunkt i relasjonell nærhet til den aktuelle pasient. En sentral antakelse for studien er at prioriteringer i helsetjenestene medfører moralske dilemmaer i klinisk sykepleie. Ett slikt dilemma er hvordan hensyn til den enkelte pasient skal kunne forenes med hensyn til likebehandling og maksimering av helserelatert velferd for alle som har relevante behov for sykepleie. I klinisk sykepleie er det en økende tendens at adekvat oppmerksomhet til enkeltpasienters sykepleiebehov begrenses fordi sykepleiernes mulighet til å realisere sykepleiens faglige og etiske mandat stadig kommer i konflikt med kravene om kostnads-effektivitet i helsevesenet generelt, og i pleie og behandling spesielt. Dette indikerer en betydelig normativ ubalanse mellom hensyn til relasjonell og individuell omsorg og hensyn til distributiv rettferdighet. Dette viser også den økende betydningen av diskusjoner om akseptable former for partiskhet i sykepleie. Diskusjonen i denne avhandlingen baserer seg på ulike moralfilosofiske teorier og posisjoner. En utfordring er hvordan slike diskusjoner om partiskhet og upartiskhet kan ha relevans i en profesjonell rollekontekst som klinisk sykepleie, så vel som i sykepleieetikken generelt. Denne utfordringen imøtekommes ved å undersøke hvordan profesjonelle roller og etisk ansvar i sykepleie kan konseptualiseres. Det argumenteres at sykepleierollen bør forstås som en profesjonsrolle ulik andre kontraktuelle rolle på en måte som har betydning for måten rollemoral og rollebaserte forpliktelser forstås. Sykepleie innebærer rolle-relative etiske hensyn som forbinder upartiske og partiske perspektiver. Sykepleieres forpliktelse til å utøve individtilpasset og adekvat sykepleie utgjør en av de viktigste plikter og ansvar i sykepleieprofesjonen. Sykepleie finner sted innenfor rammen av sykepleieprosjekter, i relasjonell nærhet til den enkelte pasienten. Aspektene i sykepleie fordrer ulik grad av tid og oppmerksomhet for å imøtekommes adekvat og individtilpasset. Derfor argumenteres det for at sykepleiere i enkelte situasjoner tillates å være partiske for å opprettholde deres profesjonelle forpliktelse. Likevel, selv om partiskhet enkelte ganger kan trumfe upartiske hensyn til distributive rettferdighet, er partisket begrenset både av prinsipielle og kontekstuelle vurderinger av pasienters behov, så vel som rolle-relative deontologiske restriksjoner for minimalisering av skade. Noen av de dilemmaene som diskuteres kan betegnes som moralske dilemmaer av en tragisk natur, og disse kan ikke løses uten uheldige konsekvenser. Det foreslås at noen slike vanskelige situasjoner kan og bør reduseres ved institusjonelle og organisatorisk tilrettelegging og beslutninger fra helsetjenestens makronivå. Til slutt foreslås hvordan et rammeverk for normativ sykepleieetikk kan inkorporere tillatt partiskhet og hvilke hensyn sykepleieetikken bør inkorporere for å balansere partiske og upartiske hensyn.