Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

This volume provides a thorough investigation of the theological views of the Twelversh ite Ibn Ab Jumh r al-Ah s (d. after 906/1501) who combined traditional Mu tazilite thought with the philosophical tradition of Ibn S n, with the Illuminationist tradition and with speculative mysticism.

As everyone knows, physicists have proved that free will doesn’t exist. That’s because we are made of tiny particles which follow strict laws, and human behavior is really just a consequence of these particles’ laws. At least that’s what I used to think. But some years ago I stumbled over a gap in this argument. In this essay I want to tell you what made me rethink and why you should rethink, too.

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)

I argue that, in experiencing a recalcitrant emotion, one does not violate a rational requirement of any sort. Rational requirements, as the expression has come to be used, are requirements of coherence. Accordingly, my argument is that there is nothing incoherent in any way about experiencing a recalcitrant emotion. One becomes incoherent only if one allows the emotion to influence one's reasoning and/or action, in which case one violates the ‘consistency principle’ and/or the ‘enkratic principle’. From the standpoint of rationality, (...) it would even be counterproductive to put subjects under the obligation that their emotional experiences and their evaluative judgements must always fit together. When we nevertheless intuitively sense that the subject is irrational in experiencing a recalcitrant emotion this is in cases in which the emotion challenges the subject's agential identity. However, emotions can, but need not, challenge one's agential identity, and, furthermore, perceptions can do so as well. In any case, challenges of this kind do not involve the violation of a rational requirement. (shrink)

Almost all contemporary philosophers on the subject agree that emotions play an indispensable role in the justification (as opposed to the mere causation) of other mental states and actions. However, how this role is to be understood is still an open question. At the core of the debate is the phenomenon of conflict without contradiction: why is it that an emotion need not be revised in the light of better judgment and knowledge? Conflict without contradiction has been explained either by (...) difference in content between emotion and judgment, or by a difference in the respective attitude towards content. I argue that conflict without contradiction is due to both differences, where difference in content is prior to difference in attitude. (shrink)

Long before Jacques Derrida undertook a critique of phonocentrism as a form of ethnocentrism, a few teachers of deaf pupils rose to the challenge of working on a sign language independent of the structures of speech. For Derrida, this critique encompassed a reappraisal of Western limitations, while reflecting upon the boundaries and linearity of alphabetical versus ideographic writing. What I explore in this article is how the development of a pedagogy for deaf pupils went hand in hand with an examination (...) of language itself, including the dominance of alphabetical language, and led thinkers to question its role in the development of thought. The context of the development of a writing proper to sign language was one of the ferments in which this critique took shape, making writing practice the threshold of a critical investigation into the expressive qualities specific to sign language. My aim here is to sketch out the epistemological challenges and stakes of some of these conflicting approaches between the 1760s and the 1850s. This article analyzes some of the most radical linguistic conceptualizations about the potential of sign language to recreate the relationship between users and their language. I consider how teachers’ positionings led them to conceptualize sign language in distinct ways, ranging from a temporary, intermediary tool to an autonomous language with a writing of its own. After considering de Michel de l’Épée’s methodical signs and how far removed they are from the conception of a language of its own, as well as a discussion of them by deaf writer Pierre Desloges, I will investigate how Roch-Ambroise Bébian’s and Joseph Piroux’s conceptions of a writing specific to sign language led each of them to position it as a complete and independent language. (shrink)

Si indagano le ragioni letterarie che motivarono l’interesse di Leopardi per due opere di Francesco Maria Zanotti : i tre dialoghi Della forza de’ corpi che chiamano viva , scritti "per ingannare il tempo", e la satira antilockiana Della forza attrattiva delle idee . L’analisi viene incentrata sulle strategie paratestuali, retoriche e poetiche sfruttate abbondantemente da Zanotti in questi testi che tutti e due esulano dalla comunicazione scientifica canonica. La presa in considerazione di questi procedimenti risulta indispensabile per capire meglio (...) il messaggio filosofico di Zanotti, nonché per circoscrivere l’influsso degli scritti zanottiani sull’opera di Leopardi. (shrink)

L’historienne, l’une des fondatrices de la revue d’histoire des femmes Memoria, a publié des essais sur la Révolution française, l’histoire sociale de l’État pontifical et l’histoire du travail. Sa dernière recherche nous conduit à nouveau dans l’Etat pontifical pour observer une institution qui va jouer un grand rôle dans le destin de centaines de femmes, les « Conservatoires de la vertu », nés au XVIe siècle pour accueillir les petites filles orphelines ou abandonnées afin de protéger leur...

L’historienne, l’une des fondatrices de la revue d’histoire des femmes Memoria, a publié des essais sur la Révolution française, l’histoire sociale de l’État pontifical et l’histoire du travail. Sa dernière recherche nous conduit à nouveau dans l’Etat pontifical pour observer une institution qui va jouer un grand rôle dans le destin de centaines de femmes, les « Conservatoires de la vertu », nés au XVIe siècle pour accueillir les petites filles orphelines ou abandonnées afin de protéger leur...

L’historienne, l’une des fondatrices de la revue d’histoire des femmes Memoria, a publié des essais sur la Révolution française, l’histoire sociale de l’État pontifical et l’histoire du travail. Sa dernière recherche nous conduit à nouveau dans l’Etat pontifical pour observer une institution qui va jouer un grand rôle dans le destin de centaines de femmes, les « Conservatoires de la vertu », nés au XVIe siècle pour accueillir les petites filles orphelines ou abandonnées afin de protéger leur...

Nature, a topic central to art history, is concurrently a dominant concept in contemporary art, art theory and its related disciplines such as cultural theory, philosophy, aesthetic theory and environmental studies. The project Naturally Hypernatural questions lines of tradition and predetermined categories that coexist with the topic of nature. Currently, nature in art surpasses the simple depiction of art as a material or object. To clarify and analyze the interrelations between nature and art is the aim of the project Naturally (...) Hypernatural. Concepts of Nature - the first volume of this project - argues that contemporary art is predominantly concerned with concepts of nature regarding the depth of their implications in order to reveal and analyze their internal structure. (shrink)

Due to increasing consumer skepticism towards promotional messages, companies are looking for new ways to communicate with their target audiences in a less obtrusive way than traditional advertising. Sponsored content disseminated on the online portals of newspapers (i. e., online advertorials) is regarded as a promising way to promote products and brands. Regulations require communicators to inform consumers about the commercial nature of this ‘masked’ persuasion attempt by including an explicit sponsorship disclosure (i. e., a ‘Sponsored’ label). This study demonstrates (...) that such an explicit advertising cue may not be enough to alert recipients. Furthermore, this study investigates the effects of promotional messages by means of a 2 (no disclosure vs. disclosure) x 2 (no forewarning vs. forewarning) experiment. Results show that both (i) foregoing instructions aimed at activating consumers’ persuasion knowledge (i. e., an additional forewarning message) and (ii) recipients’ prior media literacy can foster the effect of sponsorship disclosures in triggering situational distrust towards brand-related content, and in turn, increasing consumers’ reactance. (shrink)

I examine some aspects of Mach’s concern for photographs and phonographs. I start with the phonographs, and I examine in particular Mach’s reference to this device in his account of the development of written language. My second point is a comparison between Mach's reference to phonographs and hieroglyphs and some very similar insights in Wittgenstein’s Tractatus. Lastly, I address some aspects of Mach’s interest in photographical techniques, and I try to draw a parallel between Mach’s conception of mental economical pictures (...) and the method of composite portraiture developed by Galton. (shrink)

Hope beyond certainty is a significant element in contemporary theological discourse after the death of God. This relation between hope and uncertainty is not new. In the nineteenth century, a growing number of intellectuals started to call themselves agnostic, but did not always end up in scepticism and nihilism. On the contrary, new ways to search for meaning and fulfilment in life beyond the traditional answers of institutional religions (i.e. the church) were explored. The Dutch intellectual Allard Pierson (1831–1896) is (...) a good case in point. From a contemporary postsecular perspective and radical theology, this article argues that Pierson’s agnosticism should not be seen as an attitude of indifference, but as opening up the possibility for an eschatological hope beyond certainty. First, the (im)possibility of hope is discussed by debating the views of David Newheiser, Richard Kearney, and John D. Caputo. Second, the article analyses Pierson’s view by focusing upon hermeneutics instead of epistemology, an openness to transcendence, and imagination. The article thereby contributes to the understanding of nineteenth-century religious and secularisation developments as well as to contemporary theological debates on the (im)possibility of faith and hope after the death of God. (shrink)

BackgroundMachine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation theory (...) as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.Main textProfessionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.ConclusionsUsing ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making. (shrink)

Pavarini et al. should be congratulated to their highly valuable contribution shedding light on methodological innovation for bioethics in the digital era. I see a great potential in their a...

Although “rationing” continues to be a dirty word for the public in health policy discourse, Nir Eyal and colleagues handle the concept exactly right in their article in this issue of the Hastings Center Report. They correctly characterize rationing as an ethical requirement, not a moral abomination. They identify the key health policy question as how rationing can best be done, not whether it should be done at all. They make a cogent defense of what they call “rationing through inconvenience” (...) as a justifiable allocational technique. And they wisely call for research on the effectiveness and fairness of this approach and other methods of rationing. I fully agree with their approach to rationing and with their argument that the process they provocatively label “rationing through inconvenience” should not be rejected out of hand. But I believe they have underestimated two ways in which the practical impacts of rationing through inconvenience limit its potential usefulness: the asymmetry of its effect on patients and physicians and the way in which it reduces the capacity of health systems to learn from experience. (shrink)

Cover -- Title -- Copyright -- Dedication -- Contents -- Acknowledgments -- 1 Introduction: Risk and Emotions -- PART I Risk Debates, Stalemates, Values and Emotions -- 2 Emotions and Values in Current Approaches to Decision Making About Risk -- 3 Risk Perception, Intuitions and Values -- PART II Reasonable Risk Emotions -- 4 Risk Emotions: The 'Affect Heuristic', its Biases and Beyond -- 5 The Philosophy of Moral Risk Emotions: Toward a New Paradigm of Risk Emotions -- PART III (...) Emotional Deliberation About Risk -- 6 Reflection on and with Risk Emotions -- 7 Participation with Emotion -- 8 Emotional Deliberation on Technological Risks in Practice -- Epilogue -- References -- Index. (shrink)

BackgroundThe bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other.MethodsBased on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices’ relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and (...) reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice.ResultsFirst, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy. (shrink)

During performative artistic projects in Ambient Art, both space and structures of embodiment are constituted. I illustrate this thesis with examples of performative works in music, theatre and art, in order to analyze the transdisciplinary phenomenon of Ambient Art as a complex structure. My point of departure is a model of lived space in which the bodily enactment in the performative artwork produces place and, vice versa, the place of the artwork determines the active body as an immersive aesthetic experience.

Psychotherapists in mental health institutions as a professional group are part of the medical system, and from this perspective, as representing an occupation that serves the public health interests, as well as those of the individual seeking help. Despite the different existing therapeutic approaches and diverse forms of therapy deriving from these approaches critical theories, however, consider psychotherapy as a profession with a specific jurisdictional claim and own highly specific interests. In contrast to most of the recent discussion around therapy (...) culture, in this article, I argue that sociology and social theory could benefit from an understanding of psychotherapy as a profession with a separate logic and claim for jurisdiction for mental health. Moreover, I present some general trends showing that, regarding psychotherapy, we face a concurrence of a professionalisation, and simultaneously, an already ongoing deprofessionalisation. To develop my argument, I first discuss the perspectives of sociology of the psychotherapy professions. Second, I present the potential lack of professionalism in four dimensions. Third, I discuss possible tendencies of deprofessionalisation. Finally, I conclude by pointing out the importance of theorising the psychotherapy professions for medical sociology. (shrink)

Wie arbeitet Aristoteles als wissenschaftlicher Autor? Wie nutzt er das Schreiben für seine Argumentation und ihre Darstellung? Dieser Frage geht die vorliegende Monografie für die Schrift De generatione animalium systematisch nach. In ihr entwickelt Aristoteles eine komplexe Theorie, mit der er Fortpflanzungs- und Vererbungsphänomene in der gesamten Tierwelt einschließlich des Menschen erklären möchte. Aristoteles‘ Argumentation ist dicht und wechselt zwischen Beweisführung, Diskursivität und Darstellung. Eine im Rahmen einer Makroplanung insgesamt prozessuale Vorgehensweise schließt die rhetorische Gestaltung einzelner Passagen nicht aus. Insgesamt (...) kann gezeigt werden, wie Aristoteles das Schreiben nutzt, um auf innovative Weise die eigene Theorie zu entwickeln (‚epistemisches Schreiben‘) und gleichzeitig den Weg seiner Forschung zu vermitteln. Mit der detaillierten Analyse der Bücher I-IV, der systematischen Auswertung der Ergebnisse und einem Katalog signifikanter Formulierungen bietet das Buch einen Ausgangspunkt und ein Instrumentarium für die weitere detaillierte Erforschung Aristotelischer Schriften und gleichzeitig einen Beitrag zur Geschichte der Wissenschaftsliteratur. (shrink)

This essay employs insights from embodied approaches to cognition to develop a tighter grasp on the phenomenon of camera mobility. Close readings of two early masterpieces of German cinema investigate how the viewer relates to camera movement on the basis of kinaesthetic empathy and is thereby transported, emotionally gripped or expelled from the storyworld. I argue that the construction of the fictional world is based on this specific viewing attitude, which invites us either to merely observe or, in contrast, to (...) engage with the events on screen. As a consequence, the investigation of camera movement on the basis of embodied cognition helps us both to gain a deeper understanding of how we are drawn into the space defined by camera movement and to open up the possibility of a ‘natural’ history of camera conventions as they were established at this early stage of cinema. (shrink)

The question is why it is that objective safety level and subjective feeling of safety may come apart. Answering this question requires an analysis of the nature of fear in the public sphere since feeling safe means to feel that one avoids the frightening, i.e. the threats or dangers that one perceives in the world. Döring argues that the fact-resistance fear might display in the public sphere is due to the characteristic function that fear fulfills in this sphere. In the (...) public sphere, fear is typically embodied by “fear narratives,” i.e. by real-life structuring stories of local groups which thereby respond to feelings of powerless fear and insecurity. By specifying what the threat is and how to deal with it in the right way, fear narratives reduce felt insecurity. Because of this and by thus enabling a feeling of superiority which may even turn the fear narrative into a narrative of enthusiastic heroism, fear in the public sphere does itself satisfy subjective preferences. This is why objective safety level and subjective feeling of safety may come apart. The question is how we could and should handle this. (shrink)

Where is the church? And what is it? In transposing to Spanish America a question that arose in the bitter confrontations between Catholics and Donatists in Augustine's North Africa, I would like to explain some aspects of the impact of Catholic Christianity, and thus of the Europe that had created it, overseas. Specifically, I will tell the story of Peru, the outlines of which are paralleled, not only throughout the Andes, but also in Brazil, Mexico, and Central America. The works (...) of Augustine, including his writings against the Donatists, were read by Spanish missionaries in America, but it is not merely, nor even primarily, the influence of Augustine that I am tracing here. Rather, what concerns me is to reveal the functioning of a series of tensions and contradictions in the impact of Europe on the world. It is fashionable, of course, to highlight the oppressive and destructive nature of colonial regimes and to stop at that. But this, however justified, along with reference to the all-pervasive power of a dominant culture will not on its own help us understand the ambiguities, tensions, and contradictions that filled the minds of people at the time, and that in one way or another motivated their actions. (shrink)

This essay provides a systematic as well as chronological account of Schiller's concepts of freedom and autonomy. Its main thesis is that the duality of Schiller's moral/aesthetic ideal in the Letters on the Aesthetic Education of Man - of beauty and the sublime, of play and the moral law - is a result of his use of conflicting concepts of autonomy. While it is widely accepted that Schiller took over Kant's concept of autonomy, I argue that he simultaneously employed another (...) concept of autonomy, that of the contemporary philosopher Karl Leonhard Reinhold, whose criticism of Kant's concept of free will and alternative formulation of the concept of a neutral will influenced Schiller. (shrink)

Este trabajo trata de ilustrar el paralelismo existente –no obstante ciertas diferencias de enfoque y de conceptualización– entre el pensamiento wittgensteineano de principios de los años 30 y la teoría del conocimiento de C.I. Lewis. El punto de comparación es la noción de experiencia en tanto que trato epistémico con los objetos. Según la lectura sugerida, nuestra vida epistémica se desarrolla –bajo el denominador común de nuestra conciencia de pertinencias conceptuales– como un dinámico juego entre certezas (vitales) y tentativas de (...) conocimiento (racional). Ciertamente, habría que añadir que, debido a su dependencia contextual, estos factores se caracterizan tanto por su provisionalidad como por su naturaleza intercambiable. (shrink)

McCullough et al have taken up an important issue that is highly interesting from a theoretical as well as from a practical standpoint in drawing attention to (in)civility as a matter of professional ethics: As a ‘low intensity deviant behaviour’1 p3 incivility seems to widely escape the scope of professional norms as well as legal regulation and jurisdiction. At the same time, empirical evidence suggests that incivility occurs frequently in healthcare and might have an enormous negative impact on the quality (...) of patient care. Against this background medical ethics should no longer hesitate conducting profound conceptual and empirical research on (in)civility as an ethical issue. The authors’ analysis sheds light on the different dimensions of practical rationality as involved clinical reasoning and behaviour. Whereas I agree with their idea of civility being a ‘professional virtue with cognitive, behavioural and social components’1 p2 I cannot fully support their claim of the cognitive component lasting on a ‘commitment to excellence in scientific and clinical reasoning’ (ibid.). Instead I would like to argue that professionalism comprises both, civility as …. (shrink)

The excavations carried out beside the north rampart of the lower town of Amathus have revealed the existence of a large archaic deposit, most probably originating from a destruction of the palace on the acropolis. This is the first part of a series of articles devoted to the material from this deposit. It deals with the context of its discovery, and considers the circular structure, which requires careful attention, filled by this material.

Ce livre est né de la donation en 1994 aux Archives nationales italiennes (section de la ville d'Orvieto) du fonds photographique d'Elisa Lombardi, « commandante » de l'« Académie féminine nationale d'éducation physique » fondée en 1932 à Orvieto par le régime fasciste. L'Académie formait en trois ans au métier d'enseignante en éducation physique des jeunes filles ayant terminé leurs études secondaires, munies d'un certificat de bonne santé (les lunettes étaient interdites, les trop ma...

Ce livre est né de la donation en 1994 aux Archives nationales italiennes (section de la ville d'Orvieto) du fonds photographique d'Elisa Lombardi, « commandante » de l'« Académie féminine nationale d'éducation physique » fondée en 1932 à Orvieto par le régime fasciste. L'Académie formait en trois ans au métier d'enseignante en éducation physique des jeunes filles ayant terminé leurs études secondaires, munies d'un certificat de bonne santé (les lunettes étaient interdites, les trop ma...

The name of Thomas Reid rarely appears in discussions of the history of moral thought. This is a pity, since Reid has a lot of interesting ideas that can contribute to the current discussions in meta-ethics. Reid can be understood as an ethical intuitionist. What makes his account especially interesting is the role affective states play in his intuitionist theory. Reid defends a cognitive theory of moral emotions. According to Reid, there are moral feelings that are the result of a (...) moral judgment made by reason. The judgment and the feeling together constitute what Reid calls sentiments. Reid thinks that affective states (feelings and sentiments) play the role of helping reason to guide and control the egoistic feelings and passions. The affective states are particularly important, in Reid's view, because the motivating force of reason is often defeated by the stronger motivating force of the passions. So without affective states, we would often not be able to do what is morally good or right. In this paper, I will argue that the role of the affective states is still too limited in Reid's approach. He takes affective states to have a merely motivational function, namely, to help reason to control the passions and motivate to action where reason is too weak. Reid thinks that in making moral judgments we do not need to have feelings, feelings are at most a result of a judgment. Instead, I will argue that affective states also play an epistemological role. (shrink)

Direct-to-consumer genetic testing has been available for several years now, with varying degrees of regulation across different countries. Despite a restrictive legal framework it is possible for consumers to order genetic tests from companies located in other countries. However, German laypeople’s awareness and perceptions of DTC GT services is still unexplored. We conducted seven focus groups with German laypeople to explore their perceptions of and attitudes towards commercial genetic testing and its ethical implications. Participants were critical towards DTC GT. Criticism (...) was directed at health-related, predictive testing, while lifestyle tests were accepted and even welcomed to some extent. Participants expressed strong reservations regarding commercial provision of genetic diagnostics and expressed a lack of trust in respective companies. They preferred non-commercial distribution within the public healthcare system. Participants also expressed high expectations of physicians’ abilities to interpret information obtained via DTC GT companies and provide counseling. Legal restrictions on commercial distribution of genetic tests were opposed, with participants arguing that it should be available to consumers. DTC GT companies are not perceived as trustworthy when compared to the public healthcare system and its professional ethical standards and practices. Laypeople rated general consumer autonomy higher than their own concerns, thus recommending against strong legal regulation. We conclude that medicine’s trustworthiness may be negatively affected if commercial provision is not visibly opposed by the medical professions, while DTC GT companies may gain in trustworthiness if they adapt to standards and practices upheld in medicine. (shrink)

Giorgia Pozzi’s feature article1 on the risks of testimonial injustice when using automated prediction drug monitoring programmes (PDMPs) turns the spotlight on a pressing and well-known clinical problem: physicians’ challenges to predict patient behaviour, so that treatment decisions can be made based on this information, despite any fallibility. Currently, as one possible way to improve prognostic assessments of patient behaviour, Machine Learning-driven clinical decision support systems (ML-CDSS) are being developed and deployed. To make her point, Pozzi discusses ML-CDSSs that are (...) supposed to deliver physicians an accurate estimation of the likelihood of narcotic, sedative and stimulant opioid misuse by a given patient (like, e.g., ‘NarxCare’). Regarding cases of deviating assessment between human evaluators and automated systems, the medico-ethical discussion has so far mainly focused on disagreement between clinicians and Machine Learning (ML) algorithms,2 for example in ‘second opinions’ that have been reconstructed as disagreements between physician testimony and ML-CDSS testimony.3 Examples such as those of PDMPs, by contrast, draw attention to situations in which patient testimony potentially contradicts ML-CDSS testimony. Pozzi examines decision-making situations in which ML-CDSS testimony factually overrides the testimony of the person affected. Thus, in the presented case of patient Kathryn, the testimony of her own physical and mental condition was insufficient to overturn the unfavourable outcome for …. (shrink)

Andrew Hantel’s proposal for dealing with cancer drug shortages exemplifies the kind of clinician-led discussion of rationing the U.S. political process requires. I argue that the U.S. will not get a grip on healthcare cost escalation until we set true budgets for healthcare. We will not be able to do that until the public accepts that rationing, done right, is an ethical necessity, not an ethical abomination. Because endorsing rationing is a third rail for politicians, “top down” leadership is currently (...) impossible. As a result, health professionals must lead a “bottom up” educational process. Hantel shows how this can be done. (shrink)

This volume provides a thorough investigation of the theological views of the Twelvershī‘ite Ibn Abī Jumhūr al-Aḥsā’ī who combined traditional Mu‘tazilite thought with the philosophical tradition of Ibn Sīnā, with the Illuminationist tradition and with speculative mysticism.