ZusammenfassungDie Palliative Sedierung als therapeutische Handlungsoption in anderweitig refraktären Behandlungssituationen wird in der Öffentlichkeit und in Fachkreisen in ihrer klinischen Wertigkeit grundsätzlich akzeptiert und weitgehend positiv konnotiert. Im Widerspruch dazu fallen sowohl die Quantität der empirischen Forschung als auch die Intensität der ethischen und klinischen Diskussion ins Auge, mit der konzeptuelle als auch durchführungsbezogene Aspekte der Palliativen Sedierung beschrieben und kontrovers erörtert werden. Anstatt eines distinkten Behandlungskonzeptes stellt sich hier eher ein komplexes Spektrum verschiedener Vorgehensweisen dar. Die folgende Übersichtsarbeit fasst (...) anhand der aktuellen Literatur zusammen, welche Aspekte im Kontext der Palliativen Sedierung als problematisch bewertet werden. (shrink)

Since Tversky argued that similarity judgments violate the three metric axioms, asymmetrical similarity judgments have been particularly challenging for standard, geometric models of similarity, such as multidimensional scaling. According to Tversky, asymmetrical similarity judgments are driven by differences in salience or extent of knowledge. However, the notion of salience has been difficult to operationalize, especially for perceptual stimuli for which there are no apparent differences in extent of knowledge. To investigate similarity judgments between perceptual stimuli, across three experiments, we collected (...) data where individuals would rate the similarity of a pair of temporally separated color patches. We identified several violations of symmetry in the empirical results, which the conventional multidimensional scaling model cannot readily capture. Pothos et al. proposed a quantum geometric model of similarity to account for Tversky's findings. In the present work, we extended this model to a more general framework that can be fit to similarity judgments. We fitted several variants of quantum and multidimensional scaling models to the behavioral data and concluded in favor of the quantum approach. Without further modifications of the model, the best-fit quantum model additionally predicted violations of the triangle inequality that we observed in the same data. Overall, by offering a different form of geometric representation, the quantum geometric framework of similarity provides a viable alternative to multidimensional scaling for modeling similarity judgments, while still allowing a convenient, spatial illustration of similarity. (shrink)

O lidský svět -- Samomluvy a rozhovory -- Malé řeči sváteční -- Doplňky 1 -- Doplňky 2.

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical (...) issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

At Pliny, Ep. 5. 18 we read that Macer, the recipient of that letter, has a villa which Pliny says must be lovely, because in qua [sc. villa] se composuerat homo felicior, antequam felicissimus fieret. The identity of this homo felicior is undoubtedly of some interest, but the latest commentary on Pliny's Letters has nothing to say on the matter. However, B. Radice in her two translations of the Letters says that the person in question is Nerva, but adds as (...) a second possibility ‘the dictator Sulla’. In this ambivalence she is at one with many of the older commentators on the Letters. Alone among the commentators examined by us, M. Gesner elects to give preference to Sulla over Nerva. We believe Sulla is certainly the owner in question, but since the ambiguity persists in the scholarly tradition, a fresh look should be taken at the problem and the case against Nerva and for Sulla be put more fully than hitherto. In using the phrase homo felicior, antequam felicissimus fieret without actually naming the person, it is clear that Pliny takes it for granted that the individual in question will be immediately recognizable to Macer, the recipient of the letter, by this description. It follows, therefore, that the phrase had become well established as a commonplace, inevitably and unambiguously linked to one person only. All of our evidence suggests that it cannot be applied to Nerva. First of all it is likely that such a phrase would need time to become accepted into the tradition so as to become readily identifiable, whereas Pliny was writing only a relatively short time after Nerva's reign. (shrink)

The study of brain changes in response to mindfulness (MF) practice could serve as a way to expand our understanding of key cognitive processes such as consciousness, attention, or executive functions. The aim of this work is to offer an updated review of the studies that have investigated the effects of MF on cognition; specifically, the processes of consciousness, attention, and executive functioning, measured by evoked potentials (EP). The main studies on this topic from 2006 to the present are reviewed (...) and the principal findings are grouped according to the EP measured, mainly N1, N2, and P3. The convergent evidence derived from the updated research allows us to propose a hypothetical model of the existing correlations between the influences of MF on cognitive processes and the associated EP components. However, the methodological limitations found mean that we should take these results with caution and advise a methodological refinement for future research. (shrink)

Stephanie West suggested in a note in this journal , 280) that the presence of an anecdote in Lodovico Guicciardini's sixteenth-century L'Hore di Ricreatione furnishes a parallel for the fable alluded to by Horace, Ep. 1.2.42–3: ‘Rusticus exspectat dum defluat amnis: at ille / labitur et labetur in omne volubilis aevum.’ The parallels, and a third from nineteenth-century Sicily, allow her to imagine a tale, ‘part of Italian traditional lore’, already extant in Horace's time and presumably transmitted in rural regions (...) down to Guicciardini and the Sicilian story-teller. (shrink)

Marshall and colleagues (2024) offer a framework for emergency physicians (EPs) tasked with caring for “resuscitated opioid users”—or patients who have recently overdosed on opioids. This framework...

The article has as point of departure the idea that for Saint Augustine biological life is intimately linked with spiritual life; moreover, biological life itself is nothing but a metaphor of the real life. It is also presented that for Saint Augustine life is ultimately a Christological matter. The basic Augustinian anthropological idea of the human being as mendicus Dei is also developed, starting from the text of 1 Cor 4, 7, and developing the image of the human being as (...) vilicus, as a simple administrator of God’s gifts. On the other hand, the issue of abortion is addressed according to the Augustinian ideas, to highlight that despite the fact that in the time of Saint Augustine a subtle distinction was made between a formed and an unformed embryo, according to the number of days of gestation, following the Aristotelian theories illuminated by the text of Ex 21, 22-23, according to the LXX, Saint Augustine opposes abortion in all cases, considering it a homicide, because whoever will become a person, is already so in the very womb of their mother. Three sources of human dignity according to Saint Augustine are also presented. In the first place, the fact that the human being has been created in the image and likeness of the Triune God. Second, the fact of Christ’s incarnation and redemption, presenting the Augustinian argument that the price of each man is none other than the blood of Christ. A third Augustinian argument is also presented, which is his condition as a son of God through the sacrament of baptism. It also presents the point of view of Saint Augustine on the death penalty, specifically in relation to the circumcelliones and the ep. 133 and the slave traders and ep. 10*. (shrink)

Lvcretivs II. 263 ‘nonne uides etiam patefactos tempore puncto.’ ‘Tempore puncto’ occurs only here in Lucretius and in no other author; but ‘puncto tempore’ is read in II. 456, 1006, IV. 214; ‘puncto in tempore et,’ VI. 230. ‘Temporis puncto’ is found at I. 1109, and ‘temporis in puncto’ at IV. 164, 193. ‘Puncto… diei’ occurs in IV. 201. ‘Punctum’ as a noun corresponds to τομος, for a point has no dimensions; St. August. Ep. 205, 14, ‘atomo temporis, inquit, hoc (...) est in puncto temporis quod diuidi non potest.’ ‘Inquit’ refers to St. Paul I. Ad Corinth. XV. 52, where the N.T. has ν τόμѡ and the present Vulgate ‘in momento.’ And in Ep. 190, 15, St. Austin says ‘summa celeritate atque atomo temporis’; and St. Jerome, Ep. 119, 2, ‘in atomo et in puncto temporis atque momento,’ 5 ‘atomus… punctum temporis est’; J. Cassian, Inst. II. 7, 2, ‘puncto breuissimo’; Lact. Inst. VII. 12 ‘uno temporis puncto.’ ‘Punctum temporis’ or ‘atomus temporis’ means an instant of time that cannot be divided. (shrink)

Background: In prior reports, we described the design and initial performance of a fully implantable, bi-directional neural interface system for use in deep brain and other neurostimulation applications. Here we provide an update on the chronic, long-term neural sensing performance of the system using traditional 4-contact leads and extend those results to include directional 8-contact leads.Methods: Seven ovine subjects were implanted with deep brain stimulation leads at different nodes within the Circuit of Papez: four with unilateral leads in the anterior (...) nucleus of the thalamus and hippocampus; two with bilateral fornix leads, and one with bilateral hippocampal leads. The leads were connected to either an Activa PC+S® or Percept PC°ledR deep brain stimulation and recording device. Spontaneous local field potentials, evoked potentials, LFP response to stimulation, and electrode impedances were monitored chronically for periods of up to five years in these subjects.Results: The morphology, amplitude, and latencies of chronic hippocampal EPs evoked by thalamic stimulation remained stable over the duration of the study. Similarly, LFPs showed consistent spectral peaks with expected variation in absolute magnitude dependent upon behavioral state and other factors, but no systematic degradation of signal quality over time. Electrode impedances remained within expected ranges with little variation following an initial stabilization period. Coupled neural activity between the two nodes within the Papez circuit could be observed in synchronized recordings up to 5 years post-implant. The magnitude of passive LFP power recorded from directional electrode segments was indicative of the contacts that produced the greatest stimulation-induced changes in LFP power within the Papez network.Conclusion: The implanted device performed as designed, providing the ability to chronically stimulate and record neural activity within this network for up to 5 years of follow-up. (shrink)

The current study investigated the adaptations which occur in visual search behaviour as a function of expertise in rugby union players when completing attacking scenarios. Ten experienced players and ten novice players completed 2 vs. 1 attacking game scenarios. Starting with the ball in hand and wearing a mobile eye tracker throughout, participants were required to score a try against a defender. The scenarios allowed for a pass to their supporting player or trying to run past the defender. No between (...) group differences were found in fixating on the supporting attacking player. However, EP increased the length and frequency looking at the area immediately ahead of the supporting player, particularly when executing a spin pass. NP fixated longer and more frequently at the defender, whilst EP fixated more frequently in the space the supporting player would run into in Switch and Dummy Switch scenarios. More successful passes were completed and tries scored by EP compared to NP. Differences in visual search behaviour between experienced and NP suggest that the experts extract information from areas directly related to guiding the motor action; the space immediately ahead of the support player to pass the ball in. Contrastingly, novices use a more allocentric perspective where the actions from the defender are used to guide their motor actions. (shrink)

BackgroundKinarm Standard Tests is a suite of upper limb tasks to assess sensory, motor, and cognitive functions, which produces granular performance data that reflect spatial and temporal aspects of behavior. We have previously used principal component analysis to reduce the dimensionality of multivariate data using the Kinarm End-Point Lab. Here, we performed PCA using data from the Kinarm Exoskeleton Lab, and determined agreement of PCA results across EP and EXO platforms in healthy participants. We additionally examined whether further dimensionality reduction (...) was possible by using PCA across behavioral tasks.MethodsHealthy participants were assessed using the Kinarm EXO and EP. Four behavioral tasks were performed that quantified arm sensory and motor function, including position sense [Arm Position Matching ] and three motor tasks [Visually Guided Reaching, Object Hit, and Object Hit and Avoid ]. The number of components to include per task was determined from scree plots and parallel analysis, and rotation type was decided on a per-task basis. To assess agreement, we compared principal components across platforms using distance correlation. We additionally considered inter-task interactions in EXO data by performing PCA across all six behavioral assessments.ResultsBy applying PCA on a per task basis to data collected using the EXO, the number of behavioral parameters were substantially reduced by 58–75% while accounting for 76–87% of the variance. These results compared well to the EP analysis, and we found good-to-excellent agreement values between PCs from the EXO and those from the EP. Finally, we were able to reduce the dimensionality of the EXO data across tasks down to 16 components out of a total of 76 behavioral parameters, which represents a reduction of 79% while accounting for 73% of the total variance.ConclusionPCA of Kinarm robotic assessment appears to capture similar relationships between kinematic features in healthy individuals and is agnostic to the robotic platform used for collection. Further work is needed to investigate the use of PCA-based data reduction for the characterization of neurological deficits in clinical populations. (shrink)

Deep brain stimulation of the subthalamic nucleus is a clinically effective tool for treating medically refractory Parkinson’s disease, but its neural mechanisms remain debated. Previous work has demonstrated that STN DBS results in evoked potentials in the primary motor cortex, suggesting that modulation of cortical physiology may be involved in its therapeutic effects. Due to technical challenges presented by high-amplitude DBS artifacts, these EPs are often measured in response to low-frequency stimulation, which is generally ineffective at PD symptom management. This (...) study aims to characterize STN-to-cortex EPs seen during clinically relevant high-frequency STN DBS for PD. Intraoperatively, we applied STN DBS to 6 PD patients while recording electrocorticography from an electrode strip over the ipsilateral central sulcus. Using recently published techniques, we removed large stimulation artifacts to enable quantification of STN-to-cortex EPs. Two cortical EPs were observed – one synchronized with DBS onset and persisting during ongoing stimulation, and one immediately following DBS offset, here termed the “start” and the “end” EPs respectively. The start EP is, to our knowledge, the first long-latency cortical EP reported during ongoing high-frequency DBS. The start and end EPs differ in magnitude and latency, and the end, but not the start, EP magnitude has a significant relationship to ongoing high gamma power during the EP. These contrasts may suggest mechanistic or circuit differences in EP production during the two time periods. This represents a potential framework for relating DBS clinical efficacy to the effects of a variety of stimulation parameters on EPs. (shrink)

The article aims at reconstructing ontological, epistemological, and ethical frames of the posthumanist project, while drawing on the philosophies of Karen Barad, Deleuze and Guattari, and Donna Haraway. Only by defining such theoretical premises of the project one may be able to ask about and think a posthumanist collective and posthumanist politics.

Extruded polystyrene (XPS) otherwise known as a thermoplastic polymer has a closed cell structure and is often stronger, with a higher mechanical performance. XPS is a pressed material and is sold in different thicknesses ranging from 2 cm to 10 cm, thus having a weight that varies from 28 to 45 kg/m3 due to the force and pressure exerted on it. In general, XPS material has very low thermal conductivity and is resistant to bending. This material obtains typical values of (...) thermal conductivity between 0.025 and 0.040 W/m∙K., which means that it is ideal for surfaces that have to withstand weight, continuous traffic, etc. It is also resistant to moisture absorption and has a homogeneous density. Other characteristics of the material are good acoustic properties, easy assembly, and high durability over time. It should always be kept in mind that the surface where the thermal insulation will be applied must be leveled, cleaned, and dried. Primer is applied, before placing the thermal insulation on the surface. Then, XPS boards are placed on the surface, adhering to the corresponding mortar. This paper will deal with different cases of application of XPS tiles in the city of Tirana. A closer look at the resistance of this material from the day of application until today will be analyzed. The results during the observations showed high thermal stability of the material and no mold surface. EPS Expanded Polystyrene, otherwise known by the Dow Chemical trademark name STYROFOAM, is a lightweight product made from expanded plastic beads. It was first discovered by Eduard Simon in 1839 in Germany. EPS in its composition has 95% air and only about 5% plastic. This material is used because of its excellent properties, including good thermal insulation, good protective properties, and extremely lightweight. EPS is inert in nature and therefore does not result in any chemical reaction. EPS is durable, strong, and lightweight and can be used as an insulated panel system for facades, walls, roofs, and floors, as floating material in marine construction, and as a lightweight filler in road and railway construction. Different examples from the city of Tirana, of buildings where XPS and EPS materials are applied, are going to be analyzed, drawing conclusions. (shrink)

This article proposes reading τῆς φύσεως τῶν ὄντων instead of τῆς φύσεως τῶν λόγων at [Chio] Ep. 16, 4 and οὔτε πείθεσθαι βραδέως περὶ αὐτῆς instead of οὔτε πείθεσθαι ῥᾳδίως περὶ αὐτῆς at [Chio] Ep. 16, 6.

In recent times, many Callimachean epigrams have been discussed in terms of their connection to contemporary inscribed epigrams. However, in the case of Ep. 1 Pf. influences of inscribed epigrams have not yet been detected. This article argues that similarities to various types of metrical inscriptions (especially funerary inscriptions and sign-posts) do exist and that the epigram could be read as a fictional sign-post with philosophical and possibly metapoetic overtones.

Edward P Thompson’s disapproval of Methodism (which was his own background) is well known, especially in The Making of the English Working Class. There he describes it as religious terrorism with a destructive moral machinery and all too reactionary. However, through a close reading of the sections on Methodism, this article reveals an ambivalence within Thompson’s own text. Again and again, he notes in passing that radicals emerged from the Methodist ranks, so much so that the Methodist Conference worked hard (...) to deal with the problem. It would seem that Thompson has stumbled across a political tension within theology, one that he was to explore in much greater detail in his study of Blake. (shrink)

sola scripturarum ars est, quam sibi omnes passim uindicent: ‘scribimus indocti doctique poemata passim’ [Hor. Epist. 2.1.117]. hanc garrula anus, hanc delirus senex, hanc soloecista uerbosus, hanc uniuersi praesumunt, lacerant, docent, antequam discant. alii adducto supercilio grandia uerba trutinantes inter mulierculas de sacris litteris philosophantur, alii discunt—pro pudor!—a feminis, quod uiros doceant, et, ne parum hoc sit, quadam facilitate uerborum, immo audacia disserunt aliis, quod ipsi non intellegunt. taceo de meis similibus, qui si forte ad scripturas sanctas post saeculares litteras (...) uenerint et sermone conposito aurem populi mulserint, quicquid dixerint, hoc legem dei putant nec scire dignantur, quid prophetae, quid apostoli senserint, sed ad sensum suum incongrua aptant testimonia, quasi grande sit et non uitiosissimum dicendi genus deprauare sententias et ad uoluntatem suam scripturam trahere repugnantem. quasi non legerimus Homerocentonas et Vergiliocentonas ac non sic etiam Maronem sine Christo possimus dicere Christianum, quia scripserit: ‘iam redit et uirgo, redeunt Saturnia regna, iam noua progenies caelo demittitur alto’ [Verg. Ecl. 4.6–7], et patrem loquentem ad filium: ‘nate, meae uires, mea magna potentia solus’ [Verg. Aen. 1.664], et post uerba saluatoris in cruce: ‘talia perstabat memorans fixusque manebat’ [Verg. Aen. 2.650]. puerilia sunt haec et circulatorum ludo similia, docere, quod ignores, immo, et cum stomacho loquar, nec hoc quidem scire, quod nescias. (shrink)

Δωρίχα, ὀστέα μὲν σὰ πάλαι †κοιμήσατο δεσμῶνχαίτης† ἥ τε μύρων ἔκπνοος ἀμπεχόνη,ᾗ ποτε τὸν χαρίεντα περιστέλλουσα Χάραξονσύγχρους ὀρθρινῶν ἥψαο κισσυβίων·Σαπφῷαι δὲ μένουσι φίλης ἔτι καὶ μενέουσιν 5ᾠδῆς αἱ λευκαὶ φθεγγόμεναι σελίδες.οὔνομα σὸν μακαριστόν, ὃ Ναύκρατις ὧδε φυλάξειἔστ’ ἂν ἴῃ Νείλου ναῦς ἐφ’ ἁλὸς πελάγη.

El artículo compara los relatos oníricos de Jerónimo en su carta 22 y de Agustín en conf. 3,19 e Ibíd. 8,29, para destacar que probablemente los dos sueños sucedieron el mismo año, y que ellos ayudaron a ambos Padres de la Iglesia a convertirse, desde el amor a la literatura pagana, al amor de la Sagrada Escritura, la palabra de Dios escrita.

El articulo analiza experiencias de corporeidad de mujeres excombatientes de las FARC-EP, a partir de una investigación sociocrítica, fenomenológica y feminista, que implementó estrategias dialógicas, participativas, contextualizadas y problematizadoras. Los resultados describen los órdenes discursivos insurgentes en torno a la igualdad, los procesos de socialización que moldean cuerpos militantes y a la vez los controlan desde lo normativo; frente a estos últimos se vislumbran prácticas de fuga que evidencian las tensiones entre el orden insurgente y el de la vida civil. (...) Se concluye que el grupo armado moldea una subjetividad que combina elementos de las construcciones de género del contexto campesino de origen y referentes ideológicos y prácticos del contexto bélico que se esfuerza por configurar cuerpos fuertes y disciplinados. (shrink)

Por años, se consideró a las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo como la principal y más grande insurgencia armada, enemigo número uno del Estado. Así mismo, desde 2012 se adelantó un proceso de diálogo y negociación política entre el gobierno colombiano y dichas fuerzas, que tuvo como resultado poner fin a la confrontación militar de más de seis décadas y habilitar un camino de reformas y apertura democrática para esta organización. Son muchos los factores que explican que la (...) posibilidad real del cese definitivo al fuego entre el establecimiento y las farc-ep haya sido exitosa. Sin embargo, la derrota estratégica de la primera guerrilla colombiana es la menos explorada y de escasos resultados en el subcampo del análisis político. Que la guerrilla de las farc-ep haya ingresado a un proceso de reincorporación no solo se explica por un desgaste obvio de la guerra, o una ventana de oportunidad a la salida política negociada, sino también porque en el plano político-militar hubo un escenario desfavorable que no se logró superar. El presente artículo es el resultado de un estudio con base en el enfoque de análisis de coyuntura, que reconoce un horizonte relacional y estratégico de la acción político-militar que comprende la identificación de actores, acontecimientos, escenarios, correlación de fuerzas y relación estructura-coyuntura a partir de la revisión bibliográfica de expertos y el Centro de Investigación en Memoria Histórica Militar, adscrito al Ministerio de Defensa. (shrink)

The Gelasian letter, Famuli uestrae pietatis, addressed to Emperor Anastasius I (491-518), is famous for the so-called theory of two powers that has enjoyedconsiderable fortune and has received continual attention in the history and thought of the Latin West in view of its arguments about the relationshipbetween the Church and secular power. Scholars have been primarily interested in the Wirkungsgeschichte of the letter. Less frequently studied is the letter's specific religious context, characterized by the Acacian schism (484- 519), the dispute (...) between the episcopal sees of Rome and Constantinople. This article seeks to situate this document from the late fifth-century Roman pontifical chancery in its specific historical and ecclesial context, and to provide a commentary on the entire letter. A brief, final chapter offers a synthetic excursus on the immediate reception of the text in the Early Middle Ages before the Gregorian Reform. (shrink)

The aim of this article is to offer a comprehensive analysis of the European Union’s neo-abolitionist approach to prostitution, drawing on the literature that addresses the global rise of neo-abolitionism and using key concepts developed by the gendered approaches to the European Union in order to adapt them to the particular context of the European Union. To do so, the article undertakes a critical frame analysis of the European Union’s violence against women policies, as it is in such policies that (...) prostitution has been most thoroughly addressed, in combination with an analysis of the nature and evolution of the European Union’s gender equality policies more broadly. The article contends that the emergence of prostitution on the gender equality agenda of the European Union and the adoption of an explicit neo-abolitionist approach by the European Parliament can be explained by the coalescence, in the mid 1990s, of three key factors: Sweden’s accession to the European Union and the consequent positioning of Swedish femocrats, keen on exporting Sweden’s neo-abolitionist agenda to the European Union, in central positions of power within European Union institutions; the crystallisation of a robust neo-abolitionist velvet triangle through the creation of strong institutional links between the European Commission, the European Parliament and the European Women’s Lobby, which remained unchallenged; and the gradual development of a hybrid model of gender equality in the European Union which resonates with neo-abolitionist ideals at the same time as neo-abolitionism itself was increasingly associated to gender equality as a fundamental European Union value. (shrink)

ZusammenfassungKlinische Therapieentscheidungen werden zumeist auf dem Boden einer medizinischen (bzw. ärztlichen) Indikationsstellung und der entsprechenden informierten Zustimmung des Patienten zu der vorgeschlagenen Behandlungsmaßnahme gefällt. Das Recht des Patienten, eine Behandlungsmaßnahme abzulehnen, ist in der juristischen und ethischen Bewertung breit abgesichert. Hingegen ist unklar, welche Rolle ein (positiv geäußerter) Wunsch des Patienten oder gar seiner Angehörigen nach einer bestimmten Behandlung im normativen Entscheidungsprozess spielen sollte, wenn überhaupt. Dieser Beitrag erörtert den Stellenwert des eigenständigen Patientenwunsches aus studienbezogener, klinischer und normativer Sicht. Ein (...) authentisches Fallbeispiel verdeutlicht das Spektrum zugrunde liegender Autonomiekonzepte und das Dilemma divergierender Bewertungsmaßstäbe zwischen Arzt und Patient in der Tumortherapie und Palliativmedizin. Der Beitrag zeigt auf, wie bestehende Konzepte von Autonomie und Indikation genutzt werden können, um einerseits den Behandlungswunsch eines Patienten konkret in den Entscheidungsprozess einzubeziehen, andererseits eine klare Abgrenzung zu einer unreflektierten „wunscherfüllenden Medizin“ aufrecht zu erhalten. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bridge From Analysis to Action:Psychodynamic Analyses of Religion and Michael S. Hogue's American ImmanenceAJ Turner (bio)I. IntroductionThe purpose of this essay is to work constructively with Michael S. Hogue's groundbreaking American Immanence: Democracy for an Uncertain World to demonstrate how psychodynamic analyses of religion are essential theoretical allies in the fight for resilient democracy. The "revolution in mind"1 that psychodynamic approaches contribute, especially in their analyses of religion, (...) both complements and complicates socio-political theory as a whole. In the improvisational spirit of "yes-and," the goal here is not to identify and decry the failures and shortcomings of Hogue's theopolitical vision but rather to inspire the recovery of a sibling discourse—a kind of "rebirth of a forgotten alternative"2—that also draws deeply from the American immanental tradition in order to add psychodynamic depth to Hogue's timely and important analysis. Psychodynamic theories of religion shed light on how symbolic identifications, including and especially ultimate concerns, structure personal and collective experience. By engaging religion and theology sympathetically, constructively, and creatively, theorists such as Rollo May, Gordon Allport, Karen Horney, Erich Fromm, and Ernest Becker departed from the skepticism, reductionism, and dismissal that characterized psychoanalytic analyses of religion in the wake of Freud.3 Each of these figures, and especially Becker whose work will be a focus in this essay, are noteworthy interlocutors for extending Hogue's theopolitical theorizing of resilient democracy, particularly in how they drew unique inspiration from the American immanental tradition [End Page 44] in their social analyses. In this respect, they provide a more robust theorization of the psychosocial conditions of the associational ethos needed to connect Hogue's conception of resilient democracy with forms of agonistic organization and democratic activism. Briefly stated, psychodynamic approaches are a helpful bridge for connecting these proposals to strategies of organization, their impediments, and collective action.In this way, both psychodynamic analyses of religion and Hogue's theopolitical innovation insist that no revolutionary political change is possible, and certainly not of the kind or scale needed to counter our wickedly entangled global crises, without a deep engagement with theological imaginaries. They differ, however, in their theoretical aims. Whereas Hogue compellingly argues for the political upshot of a theology deriving from the American immanental tradition, psychodynamic analysts of religion focus on the function of ultimate concerns in individual and collective life. In other words, American Immanence rests on a methodology of analyzing the philosophical and theological assumptions that have contributed to our climate crises and then presenting clear and compelling articulation of an alternative paradigm meant to open up new ways of being. In contrast psychodynamic analyses leverage conceptual clarity of psychic reality for the fundamentally therapeutic aim of transformation. At their best, both approaches share what could be called an etiological orientation to ontological questions in order to provide liberative alternatives through rational understanding and clarification, but the terrain, and thus the problems they hope to mitigate in their analyses are focused differently. Extending the visual metaphor, they are different lenses highlighting different areas of the same landscape. Furthermore, it must be said that neither are sufficient in themselves, but the psychodynamic theorists of religion to be highlighted in this essay share deeply with Hogue's heading in American Immanence.II. A Problematic AssumptionIn emphasizing and attempting to explain4 the role of non-rational processes in the both individual and social processes of perception and organization of experience, psychodynamic theories confound a widely held and problematic assumption that the triumph of rational analysis is the hallmark for building the society to which we should aspire. Political theory in general, [End Page 45] especially as it has taken its cues from a rationalist legacy about the inherently liberating force of Reason, has been weighted toward an assumption that its task of exposing the mystifications of power would suffice in inspiring more "rational" and therefore necessarily equitable social organization. This speaks to the longstanding socio-political interest in "consciousness raising" tactics, which are often meant to dispel "false consciousness." It even comes across in the emphases of Deweyan pragmatists on education. Psychologists of all stripes point out that this approach... (shrink)

It is undeniable that the form of Seneca'sEpistulae Moraleswe currently read is a work of literature, literature being here defined as a piece of work the author intended to publish. What Seneca claims inEp. 21.3–5 is clear evidence of this:exemplum Epicuri referam. cum Idomeneo scriberet et illum a uita speciosa ad fidelem stabilemque gloriam reuocaret, regiae tunc potentiae ministrum et magna tractantem, ‘si gloria’ inquit ‘tangeris, notiorem te epistulae meae facient quam omnia ista quae colis et propter quae coleris’. […] (...) quod Epicurus amico suo potuit promittere, hoc tibi promitto, Lucili: habebo apud posteros gratiam, possum mecum duratura nomina educere. (shrink)

ZusammenfassungKlinische Therapieentscheidungen werden zumeist auf dem Boden einer medizinischen (bzw. ärztlichen) Indikationsstellung und der entsprechenden informierten Zustimmung des Patienten zu der vorgeschlagenen Behandlungsmaßnahme gefällt. Das Recht des Patienten, eine Behandlungsmaßnahme abzulehnen, ist in der juristischen und ethischen Bewertung breit abgesichert. Hingegen ist unklar, welche Rolle ein (positiv geäußerter) Wunsch des Patienten oder gar seiner Angehörigen nach einer bestimmten Behandlung im normativen Entscheidungsprozess spielen sollte, wenn überhaupt. Dieser Beitrag erörtert den Stellenwert des eigenständigen Patientenwunsches aus studienbezogener, klinischer und normativer Sicht. Ein (...) authentisches Fallbeispiel verdeutlicht das Spektrum zugrunde liegender Autonomiekonzepte und das Dilemma divergierender Bewertungsmaßstäbe zwischen Arzt und Patient in der Tumortherapie und Palliativmedizin. Der Beitrag zeigt auf, wie bestehende Konzepte von Autonomie und Indikation genutzt werden können, um einerseits den Behandlungswunsch eines Patienten konkret in den Entscheidungsprozess einzubeziehen, andererseits eine klare Abgrenzung zu einer unreflektierten „wunscherfüllenden Medizin“ aufrecht zu erhalten. (shrink)