This paper aims at an account of the German “reportive subjunctive”, where the mood signals that the proposition is the object of an utterance report. The report can be explicit in the sentence or in the context, or more or less implicit. We interpret these uses as a more or less local verification or accommodation of a presupposition introduced by the subjunctive, thus accounting for a range of facts and contributing to the theory of presuppositions.

Children with developmental disorders, such as attention-deficit/hyperactivity disorder, are at high risk of school-refusal behavior compared with their peers. One of the most used scales to assess SRB is the school refusal behavior scale – revised. The SRAS-R has demonstrated good psychometric properties when used with the general population of children, but, recently, its validity has been questioned when used with children with developmental disorders. We tested the psychometric properties of the SRAS-R parental reports in 96 children with ADHD. Results (...) showed good model fit and internal consistency for the original four-factor structure. Three of the factors were strongly correlated, suggesting that SRB among children with ADHD is caused by several factors. (shrink)

Understanding the spread of national public policies to increase the percentage of women on boards is often presented using different types of institutional theory logic. However, the importance of the political games influencing these decisions has not received the same attention. In this article, we look beyond the institutional setting by focusing on the role of actors. We explore processes that include who the critical actors that drive and determine these policies are, and what motivates them to push for change. (...) We employ a processual design approach using a longitudinal country-comparative case study exploring the case of Norway, England, Germany and Italy. We map the political games, both inside and outside legislative areas, including the micro-politics among various actors and groups of actors in the selected countries. Data are collected through participation observations, interviews and text analyses. The study contributes by filling important gaps in the literature by embedding the discussion about women on boards in politicking and national public policies and by introducing dynamic perspectives. Finally, by using a processual design approach, we capture the reality of the women on board debates at different points of time and in different actor and motivational contexts. The study has consequences for how policy-makers and businesses may follow up and act, based on the debates. (shrink)

In this article I propose that a postphenomenological approach to science and technology can open new analytical understandings of how material artifacts, embodiment and social agency co-produce learned perceptions of objects. In particle physics, physicists work in huge groups of scientists from many cultural backgrounds. Communication to some extent depends on material hermeneutics of flowcharts, models and other visual presentations. As it appears in an examination of physicists’ scrutiny of visual renderings of different parts of a detector, perceptions vary in (...) relation to social and bodily experiences. Vision in physics has seemingly allowed an objective perception at a convenient distance of the body. This article challenges this view and proposes that the variations can be analysed as cultural at two echelons with the help of a postphenomenological approach combined with cultural psychological theory of artifacts. A third echelon presumably constitutes the phenomenological limit to culture in science. Even this last resort of subjectivity can be embraced by a postphenomenological approach. The process of culturalization in physics can be defined as a process of situating knowledge in a body whose continuous learning of micro-and macro perceptions makes scientific renderings unstable. Taken together postphenomenology, following the distinctions between body one and body two, and combined with cultural psychological learning theory, enables new insight into what constitutes culture in science. (shrink)

The aim of this study was to explore and reflect upon mental health nursing and first-episode psychosis. Seven multidisciplinary focus group interviews were conducted, and data analysis was influenced by a grounded theory approach. The core category was found to be a process named ‘working behind the scenes’. It is presented along with three subcategories: ‘keeping the patient in mind’, ‘invisible care’ and ‘invisible network contact’. Findings are illuminated with the ethical principles of respect for autonomy and paternalism. Nursing care (...) is dynamic, and clinical work moves along continuums between autonomy and paternalism and between ethical reflective and non-reflective practice. ‘Working behind the scenes’ is considered to be in a paternalistic area, containing an ethical reflection. Treating and caring for individuals experiencing first-episode psychosis demands an ethical awareness and great vigilance by nurses. The study is a contribution to reflection upon everyday nursing practice, and the conclusion concerns the importance of making invisible work visible. (shrink)

ABSTRACT This essay shows how certain limit-points of Lacan's psychoanalytic discourse in his 1955–56 seminar on The Psychoses tangentially brush up against Maurice Blanchot's writing on the neuter, as presented in The Space of Literature from 1955. The effort is to strike up a conversation between Lacan's “clinical discourse” and Blanchot's “critical writing” on the topics of language, writing, authority, and madness. In this regard, the essay approaches an infinite point of approximation between the procedure of psychosis and the procedure (...) of literary writing by questioning whether, at some point in these different ways of proceeding, they may share a certain experience of language. Namely, this is an experience of a language that, as stated by both Jacques Lacan and Maurice Blanchot, “speaks all by itself” and does so incessantly and with a certain furious neutrality. (shrink)

Business ethics education aims to enable students to become conscious of their own values and develop the capacity to voice such values and make value-consistent decisions. However, a student’s personal values and the capacity to act on them tend to change after graduation. In this study, we discuss how moral learning is different in real work life compared to a business school setting, and we explain why graduates may downplay or abandon their values after graduation. We launch the concept of (...) dynamic moral capacity (DMC), defined as the metacognitive routines for processing moral decision outcomes, motivated by humility goals. We suggest that future courses in business ethics develop DMC to avoid value drift and negative moral learning over time after graduation. Finally, we discuss how DMC can be included in the instructional framework of giving voice to values and thus increase its impact on moral learning after graduation. (shrink)

Drawing on a finance professional’s reflections on his ethical education as an economics undergraduate, Chartered Financial Analyst, and top-tier MBA graduate, this article considers the framing of, and need for philosophy in, ethical training for finance professionals. Role-playing is emphasized as helpful for developing a mature ethical approach, and theory is seen as desirable after the fact, to plan improved future action. The article problematizes an orientation in professional programs that primarily gears the teaching of ethics toward those students perceived (...) to be least ethical. This orientation seems to underlie both the education the financial professional received and current public interest in ‘more ethics’ in professional programming. As an alternative, the article reframes finance students and professionals as ethical actors whose primary dilemma concerns not how to avoid ethical transgressions, but how to better optimize the duty to self in... (shrink)

What is the relation between material hermeneutics, bodies, perception and materials? In this article, I shall argue cultural learning processes tie them together. Three aspects of learning can be identified in cultural learning processes. First, all learning is tied to cultural practices. Second, all learning in cultural practice entangle humans’ ability to recognize a material world conceptually, and finally the boundaries of objects, the object we perceive, are set by shifting material-conceptual entanglements. All these aspects are important for material hermeneutics (...) in a technoculture. Postphenomenology has expanded the connection between hermeneutics and phenomenology by focusing on studies of how perception, bodies, materials, the sensual realm and hermeneutics are entwined when we perceive the world through technologies. Following Don Ihde, hermeneutics expands beyond interpretation of texts in the humanities. We can interpret materials as for instance animal bones to make new sense of the Bible. New technologies have expanded material hermeneutics, when we can ‘look’ into bodies and ‘perceive’ below surfaces. Interpretation via such tools in a technoculture, both limit and extend our hermeneutic horizons in the humanities as well as in the natural sciences. Furthermore, from the perspective of cultural learning processes, material hermeneutics in the human and natural sciences depend on more than mediating instruments. Material hermeneutics also involve the material cultural environments of scientific apparatuses and the scientists’ processes of learning in cultural practice. This changes the focus from relations in postphenomenology to processes of relations. (shrink)

In this text Hasse presents a new, inclusive, posthuman learning theory, designed to keep up with the transformations of human learning resulting from new technological experiences, as well as considering the expanding role of cyborg devices and robots in learning. This ground-breaking book draws on research from across psychology, education, and anthropology to present a truly interdisciplinary examination of the relationship between technology, learning and humanity. Posthumanism questions the self-evident status of human beings by exploring how technology is changing what (...) can be categorised as "human". In this book, the author applies a posthumanist lens to traditional learning theory, challenging conventional understanding of what a human learner is, and considering how technological advances are changing how we think about this question. Throughout the book Hasse uses vignettes of her own research and that of other prominent academics to exemplify what technology can tell us about how we learn and how this can be observed in real-life settings. Posthumanist Learning is essential reading for students and researchers of posthumanism and learning theory from a variety of backgrounds, including psychology, education, anthropology, robotics and philosophy. (shrink)

The increasing need for innovative research driven by rapid global changes gives doctoral supervisors of early-stage researchers a significant role in facilitating the ethical conduct of qualitative research. In the context of European Commission funding, the demands of research ethics and integrity place a tremendous responsibility on the supervisors of early-stage researchers involved in cross-national projects. This document study seeks to illuminate the role of the supervisors in facilitating research ethics in these projects. Specifically, we describe and discuss the supervisor (...) role associated with five approaches to doctoral supervision of qualitative research, namely those described as ‘Functional’, ‘Enculturation’, ‘Critical thinking’, ‘Emancipation’ and ‘Developing a quality relationship’. The main challenges for supervisors of cross-national research projects are the cultural and linguistic mobilisation of ethical principles in qualitative research processes and the management of the future use of open data. The results from this study have implications for planning and conducting cross-national studies within research involving human participants. These results can guide supervisors in the codification and mobilisation of ethical qualitative research in practice. (shrink)

Will robots ever be able to learn like humans? To answer that question, one first needs to ask: what is learning? Hubert and Stuart Dreyfus had a point when they claimed that computers and robots would never be able to learn like humans because human learning, after an initial phase of rule-based learning, is uncertain, context sensitive and intuitive under contract F49620-C-0063 with the University of California) Berkeley, February 1980.. Washington, DC: Storming Media. https://www.stormingmedia.us/15/1554/A155480.html. Accessed 10 Oct 2017, 1980). I (...) would add that learning also builds on prior learning, and that from the outset, human learning is a socio-cultural materially grounded collective epistemology. This posthuman acknowledgement shifts the focus from the individual learner to learning within collective phenomena. Dreyfus and Dreyfus do not seem to emphasise the essentially social and cultural nature of the human condition. Learning theory, new materialism and postphenomenology have emphasised in different ways the materially based socio-cultural nature of human learning. They thereby point towards a ‘posthuman’ learning that is far from the machine-like or enhanced creature envisioned by singularists. Until robots are essentially social and ground their epistemologies in socio-cultural materiality, I suggest that human-like AI is not possible. (shrink)

Robots are simultaneously real machines and technical images that challenge our sense of self. I discuss the movie Ex Machina by director Alex Garland. The robot Ava, played by Alicia Vikander, is a rare portrait of what could be interpreted as a feminist robot. Though she apparently is created as the dream of the ‘perfect woman’, sexy and beautiful, she also develops and urges to free herself from the slavery of her creator, Nathan Bateman. She is a robot created along (...) the perfect dimensions as a Vitruvian robot but is also a creature which could be interpreted as a human being. However, the point I want to raise is not whether Ava’s reaction to robot slavery is justified or not but how her portrait raises questions about the blurred lines between reality and fiction when we discuss our robotic future. A real version of Ava would not last long in a human world because she is basically a solipsist, who does not really care about humans. She cannot co-create the line humans walk along. The robots created as ‘perfect women’ today are very far from the ideal image of Ava. They are sexist, primitively normative and clearly ‘wax-doll machines’. So though Ava’s dimensions are perfect she, like the Vitruvian Man, remains a fiction. In real life, however, we may have to deal with an increasing solipsism stemming from people engaging with machines like sex robots. In this case, it is human and not robotic solipsism we need to worry about. (shrink)

For quite some time, cognitive science has offered philosophy an opportunity to address central problems with an arsenal of relevant theories and empirical data. However, even among those naturalistically inclined, it has been hard to find a universally accepted way to do so. In this article, we offer a case study of how cognitive-science input can elucidate an epistemological issue that has caused extensive debate. We explore Jason Stanley’s idea of the practical grasp of a propositional truth and present naturalistic (...) arguments against his reductive approach to knowledge. We argue that a plausible interpretation of cognitive-science input concerning knowledge—even if one accepts that knowledge how is partly propositional—must involve an element of knowing how to act correctly upon the proposition; and this element of knowing how to act correctly cannot itself be propositional. (shrink)

This paper contributes to an on-going exchange in political theory on the normative legitimacy of expert bodies. It focuses on epistemic worries about the expertisation of politics, and uses the Nordic system of advisory commissions as an empirical case. Epistemic concerns are often underplayed by those who defend an increasing role of experts in policy-making, while those who have epistemic worries often tend to overstate them and debunk expertise. We present ten epistemic worries, of which some are of an epistemological (...) nature, while others are related to failures and biases. These worries must not be overstated, but no doubt point to real problems which have to be handled through the design of expert bodies and institutions of science advice. We introduce three groups of mechanisms that are likely to contribute to remedying the problems of expertise and discuss what they imply for the design of a system of public advisory commissions. (shrink)

Previous studies of auditory expectation have focused on the expectedness perceived by listeners retrospectively in response to events. In contrast, this research examines predictive uncertainty —a property of listeners' prospective state of expectation prior to the onset of an event. We examine the information-theoretic concept of Shannon entropy as a model of predictive uncertainty in music cognition. This is motivated by the Statistical Learning Hypothesis, which proposes that schematic expectations reflect probabilistic relationships between sensory events learned implicitly through exposure. Using (...) probability estimates from an unsupervised, variable-order Markov model, 12 melodic contexts high in entropy and 12 melodic contexts low in entropy were selected from two musical repertoires differing in structural complexity (simple and complex). Musicians and non-musicians listened to the stimuli and provided explicit judgments of perceived uncertainty (explicit uncertainty). We also examined an indirect measure of uncertainty computed as the entropy of expectedness distributions obtained using a classical probe-tone paradigm where listeners rated the perceived expectedness of the final note in a melodic sequence (inferred uncertainty). Finally, we simulate listeners' perception of expectedness and uncertainty using computational models of auditory expectation. A detailed model comparison indicates which model parameters maximize fit to the data and how they compare to existing models in the literature. The results show that listeners experience greater uncertainty in high-entropy musical contexts than low-entropy contexts. This effect is particularly apparent for inferred uncertainty and is stronger in musicians than non-musicians. Consistent with the Statistical Learning Hypothesis, the results suggest that increased domain-relevant training is associated with an increasingly accurate cognitive model of probabilistic structure in music. (shrink)

This paper discusses the conditions for legitimate expert arrangements within a democratic order and from a deliberative systems approach. It is argued that standard objections against the political role of experts are flawed or ill-conceived. The problem that confronts us instead is primarily one of truth-sensitive institutional design: Which mechanisms can contribute to ensuring that experts are really experts and that they use their competencies in the right way? The paper outlines a set of such mechanisms. However, the challenge exceeds (...) that of producing epistemically optimal expert deliberations because a deliberative political system must also fulfil the ethical and democratic requirements of respect and inclusion. Yet, epistemic concerns justify expertise arrangements in the first place, and measures taken to make the use of expertise compatible with these requirements have to balance the potential rewards from expertise against potential deliberative costs. In the final part of the paper, the regulatory framework of a best practice expert advice system is tentatively analysed to illustrate the applicability and critical potential of our approach. (shrink)

In this article we refine the design ofcontext shifting experiments, which play a central role in contextualist debates, and we subject a large number of scenarios involving different types of expressions of interest to contextualists, including ‘know’ and color adjectives like ‘green’, to experimental investigation. Our experiment (i) reveals an effect of changing contexts on the evaluation of uses of the sentences that we examine, thereby overturning the absence of results reported in previous experimental studies (so‐callednull results), (ii) uncovers evidence (...) for a ‘truth bias' in favor of positive over negative sentences, and (iii) reveals previously unnoticed distinctions between the strength of the contextual effects displayed by scenarios involving knowledge ascriptions and scenarios concerning color and other miscellaneous scenarios. (shrink)

Epistemic democrats are rightly concerned with the quality of outcomes and judge democratic procedures in terms of their ability to ‘track the truth’. However, their impetus to assess ‘rule by experts’ and ‘rule by the people’ as mutually exclusive has led to a meagre treatment of the role of expert knowledge in democracy. Expertise is often presented as a threat to democracy but is also crucial for enlightened political processes. Contemporary political philosophy has so far paid little attention to our (...) reliance on experts and has not sufficiently addressed the question of how expertise can be used to improve the epistemic quality of democratic decision making. We believe this lack of interest is spurred by a too hasty acceptance of arguments dismissive of the political role of experts. The article examines a series of often-cited epistemic objections and concludes that several of them are overstated or misconceived, yet they all reflect real difficulties that need to be addressed. On this background, we tentatively outline a set of mechanisms that can contribute to alleviating the irreducible problem of epistemic asymmetries and ensuring that experts really are experts and use their expertise in the right way. (shrink)

From the twentieth century into the twenty-first, psychoanalysis and deconstruction have challenged, and continue to challenge, our conceptions of subjectivity and selfhood. This book argues that taking forward this heritage we must retrace the subject and the self as undergoing perpetual auto-deconstruction, through the lens of solitude.

During the past decades, research collaboration between researchers from different disciplines has become more frequent. However, there is a need to look into the generic modalities and challenges. The article explores a series of potential obstructions to cross-disciplinary collaboration of methodological and epistemological nature. Furthermore, a number of contextual, inhibiting factors are outlined. As means of overcoming the obstacles, the importance of mutual knowledge, allocation of adequate time and conducive research management is emphasised. New teams may benefit from tutoring by (...) facilitators, who can help to make problem areas explicit and negotiate solutions. Owing to the training background of the author, most of the examples are drawn from the interface between biomedicine/natural science and applied medical anthropology. However, the issues raised basically apply to all sorts of cross-disciplinary research collaboration in various combinations. (shrink)

Existing research on the formation of employee ethical climate perceptions focuses mainly on organization characteristics as antecedents, and although other constructs have been considered, these constructs have typically been studied in isolation. Thus, our understanding of the context in which ethical climate perceptions develop is incomplete. To address this limitation, we build upon the work of Rupp to develop and test a multi-experience model of ethical climate which links aspects of the corporate social responsibility, ethics, justice, and trust literatures and (...) helps to explain how employees’ ethical climate perceptions form. We argue that in forming ethical climate perceptions, employees consider the actions or characteristics of a complex web of actors. Specifically, we propose that employees look outward at how communities are impacted by their organization’s actions, upward to make inferences about the ethicality of leaders in their organizations, and inward at their own propensity to trust others as they form their perceptions. Using a multiple-wave field study conducted at a privately held US corporation, we find substantial evidence in support of our model. (shrink)

This paper examines the systematic connections between Fink and Fichte. For this purpose, three points are emphasized. The text that is mainly referred to is the VI. Cartesian Meditation. The first point concerns the notion of “construction”, which ismethodologically central to the genuine mode of knowledge of transcendental idealism; secondly, a consideration will be given to the extent to which “reflection of reflection” provides crucial insights for the basic position of phenomenological transcendental idealism; and third, in a concluding consideration of (...) the status of transcendental idealism, several points will be made which should allow us to grasp “transcendental idealism” in Kant, Fichte, Husserl, and Fink as precisely as possible. These considerations make it their task to contribute to counteract the indeterminacy of this concept within this entire tradition. (shrink)

The paper reconstructs the “speculative exposition” of the correlative distinction between being and cognition called for by Fink in Husserl’s intentional analytics on the basis of his discussion of Hegel’s Phenomenology of Spirit. In this context, for Fink the chapter “Force and the Understanding, Appearance and the Supersensible World” is key in the Phenomenology asa whole. There, not only the transition fromobject-consciousness to self-consciousness is accomplished but also the question of the basic structure of thinghood in general is raised: From (...) where does being as such and as a whole make itself appear? The paper traces Fink’s reading step by step, which is guided by a radicalisation of “ontological experience” – ontology as an “Er-fahrung (ex-perience)”, which sounds out itself in view of its presuppositions. “Radicalisation”, according to Fink, is the “transition from operative use to the subject”: the living, performative reference itself moves to the abysmal centre of an “inverted world”, which at the same time can be read as an introduction to Fink’s own thinking of a “cosmological difference”. (shrink)

This essay aims to outline in what ways Kierkegaard’s thinking of existence not only brings into view a concept of existence, but, more fundamentally, enables one to locate an opening to questioning anew the relation of thinking and existence. This thinking of existence does not seek to dissolve existence into knowledge but aims at intensifying the question of a thinking grounded not in the conclusion made in “an external relation between a knower and a non-knower” of which non-knowledge is the (...) negative determination of knowledge, but rather of a thinking grounded in existence. (shrink)

In the Letter of Humanism, Heidegger reinterprets the Greek notion of ethos as designating the way in which human beings dwell in the world through a “unifying” language. Through various down strokes in the autobiographical and psychopathological literature on schizophrenia as well as in literary texts and literary criticism, this paper, experimental in its effort, argues that the language productions of schizophrenia and poetry, each in its own way, seem to fall outside this unification of a language in common. Furthermore, (...) it argues that this “falling outside” is related to radical experiences of “alienation” and “otherness,” which call for an alteration of conventional language. However, whereas poetry appears to open new linguistic possibilities, schizophrenia runs the risk of reducing language to the silence of incomprehensible “nonsense.” The paper ends with the suggestion that a poetic employment of language may hold a double potential with regard to the understanding and possible treatment of schizophrenia spectrum disorders. (shrink)

As moral injury is a still-emerging concept within the area of military mental health, prevalence estimates for moral injury and its precursor, potentially morally injurious events (PMIEs), remain unknown for many of the world’s militaries. The present study sought to estimate the prevalence of PMIEs in the Canadian Armed Forces (CAF), using data collected from CAF personnel deployed to Afghanistan, via logistic regressions controlling for relevant sociodemographic, military, and deployment characteristics. Analyses revealed that over 65% of CAF members reported exposure (...) to at least one event that would be considered a PMIE. The most commonly PMIEs individuals reported included seeing ill or injured women and children they were unable to help (48.4%), being unable to distinguish between combatants and non-combatants (43.6%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement under which they were required to operate (35.4%). These findings provide support for both the presence of exposure to PMIEs in CAF members and the need for formal longitudinal data collection regarding PMIE exposure and moral injury development. (shrink)

Journal of Social Philosophy, EarlyView.

Journal of Social Philosophy, Volume 52, Issue 4, Page 473-490, Winter 2021.

"Dieser Beitrag fasst den aktuellen Stand der rechtlichen Herausforderungen der Blockchain-Technologie kurz und prägnant zusammen. Blockchain stellt, ähnlich dem World Wide Web, eine Art Grundlagentechnologie dar, auf deren Basis neue Plattformen und Geschäftsmodelle geschaffen werden können. Es stellt sich jedoch die Frage, ob das deutsche Rechtssystem grundsätzlich in der Lage ist, die Herausforderungen, die eine solch dezentrale Technologie mit sich bringt, zu bewältigen. Insbesondere hinsichtlich strafbarer Handlungen oder der neuen Datenschutzgrundverordnung. Fraglich ist dabei, wie sich die derzeitigen Negativschlagzeilen (beispielsweise Silk (...) Road) langfristig auf Kryptowährungen und infolgedessen wo- möglich auch auf die Blockchain-Technologie, nicht nur im Hinblick auf die rechtswidrigen Inhalte wie Kinderpornographie, auswirken. This article summarizes the current status of the legal challenges of blockchain technology. Similar to the World Wide Web, Blockchain represents a kind of basic technology on the basis of which new platforms and business models can be created. However, the question arises as to whether the German legal system is fundamentally capable of mastering the challenges posed by such a decentralized technology. In particular with regard to criminal offences or the new Basic Data Protection Ordinance. The question is how the current negative headlines (e. g. Silk Road) will affect crypto currencies in the long term and, as a result, blockchain technology, not only with regard to illegal content such as child pornography. ". (shrink)

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility (...) of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (shrink)

The traditional distinction between basic and applied science has been much criticized in recent decades. The criticism is based on a combination of historical and systematic epistemic argument. The present paper is mostly concerned with the historical aspect. I argue that the critics impose an understanding at odds with the way the distinction was understood by its supporters in debates on science education and science policy in the nineteenth and twentieth centuries. And I show how a distinction that refers to (...) difference on several epistemic and social dimensions makes good sense of representative historical cases. If this argument is tenable it suggests more continuity in the epistemology and politics of science than has been claimed by a new paradigm of science studies and politics during recent decades. (shrink)

Theoretical models for patient-physician communication in clinical practice are frequently described in the literature. Respecting patient autonomy is an ethical problem the physician faces in a medical emergency situation. No theoretical physician-patient model seems to be ideal for solving the communication problem in clinical practice. Theoretical models can at best give guidance to behavior and judgement in emergency situations. In this article the premises of autonomous treatment decisions are discussed. Based on a case-report we discuss different genuine efforts the physician (...) can do to uncover treatment refusal and respect patient autonomy in an emergency situation. Autonomy requires competence and in emergency medicine time does not allow intimate exploration of patient competence and reasons for treatment refusal. We find that the physician must base her decision on a firm theoretical base combined with a practical and realistic view of the patient's situation on a case to case basis. (shrink)