In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced (...) and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly. (shrink)

Something in the world tears away, jumps out, approaches... A world that approaches is a world that is alive and vivid. This applies not only to the existing natural world, but also to what humans create, which, in form the form of artifacts - from the hand-held ax to linguistic theory - also approaches design in terms of both object and challenge.

The question of what characterizes feelings of being alive is a puzzling and controversial one. Are we dealing with a unique affective phenomenon or can it be integrated into existing classifications of emotions and moods? What might be the natural basis for such feelings? What could be considered their specifically human dimension? These issues are addressed by researchers from various disciplines, including philosophy of mind and emotions, psychology, and history of art. This volume contains original papers on the topic of (...) feelings of being alive by Fiorella Battaglia, Eva-Maria Engelen, Joerg Fingerhut, Thomas Fuchs, Alice Holzhey-Kunz, Matthias Jung, Tanja Klemm, Riccardo Manzotti, Sabine Marienberg, Matthew Ratcliffe, Arbogast Schmitt, Jan Slaby, and Achim Stephan. (shrink)

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before (...) we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively. (shrink)

Doctors occasionally make diagnoses in strangers outside of formal medical settings by using the medical skill of visual inspection, such as noticing signs of melanoma or the symptoms of hyperthyroidism. This may cause considerable moral unease and doubts on the side of the diagnosing physician. Such encounters force physicians to consider whether or not to intervene by introducing themselves to the stranger and offering an unsolicited medical opinion despite the absence of a formal doctor-patient relationship. A small body of literature (...) has addressed the topic of the unsolicited medical opinion, often with a primary focus on practical advice. This article seeks to establish an ethical-theoretical basis for physicians' ethical obligation to offer an unsolicited medical opinion when they make a diagnosis by visual inspection in a stranger outside of the formal medical context. Using a utilitarian approach, it is argued that, if it is in the physicians' power to prevent a possible loss of well-being, without thereby sacrificing anything of equal value, physicians have an ethical obligation to intervene. (shrink)

The human-centered AI approach posits a future in which the work done by humans and machines will become ever more interactive and integrated. This article takes human-centered AI one step further. It argues that the integration of human and machine intelligence is achievable only if human organizations—not just individual human workers—are kept “in the loop.” We support this argument with evidence of two case studies in the area of predictive maintenance, by which we show how organizational practices are needed and (...) shape the use of AI/ML. Specifically, organizational processes and outputs such as decision-making workflows, etc. directly influence how AI/ML affects the workplace, and they are crucial for answering our first and second research questions, which address the pre-conditions for keeping humans in the loop and for supporting continuous and reliable functioning of AI-based socio-technical processes. From the empirical cases, we extrapolate a concept of “keeping the organization in the loop” that integrates four different kinds of loops: AI use, AI customization, AI-supported original tasks, and taking contextual changes into account. The analysis culminates in a systematic framework of keeping the organization in the loop look based on interacting organizational practices. (shrink)

The au pair program in general is still known as a form of cultural exchange program and a good possibility for young women to spend a year abroad, although it has undergone great changes during the last 10 years. This article argues that due to different socio-economic and cultural processes in Western postindustrial societies as well as in the eastern and southern parts of the world the au pair program is becoming a form of domestic work with quite similar working (...) and living conditions to that of live-in migrant domestic workers. This article which is based on two empirical studies on the globalizing au pair business in Eastern and Western Europe as well in the United States looks into the motivations and expectations, the living conditions and interactions between the au pairs and the employer families and contrasts these findings with the discourse of the au pair agencies still advertising au pair as a form of cultural exchange. In doing so the paper can show that it is the still dominant image of au-pair as a cultural exchange program (disarticulating the work aspect) that leaves the young au pair women even more vulnerable to exploitation: ‘big sisters’ are the best domestic servants. This article draws attention to the racialized economization of the private sphere and care work, the inherent traps and exploitative features of this very specific work place. (shrink)

This article presents a series of experiments which were conducted among native speakers of German to determine the influence of different types of German generics on the cognitive inclusion of women. Results indicate that the inclusion of women is higher with ‘non-sexist’ alternatives than with masculine generics, a tendency which was consistent across different studies. The different alternatives, however, showed different effects which also varied depending on the context. These results are discussed with regard to their practical consequences in situations (...) such as nominating women and men for awards or political offices. (shrink)

We are extremely grateful for the insightful and thought-provoking commentaries on our feature article.1 We have distilled four themes emerging from the commentaries, and we would also like to address one misunderstanding of our argument that has appeared. In our article, we explicitly acknowledge that major decisions relevant for climate protection take place at the mesolevels and macrolevels of healthcare, a point raised again in some of the commentaries.2–4 Climate protection is a societal issue, and we thank these authors for (...) the concrete proposals of potential models to guide action. Yet, to us, it still makes sense to reflect simultaneously on the responsibilities that physicians have themselves. Without wanting to put the main responsibility on them, we argue it is important to start thinking about the scope of action that physicians actually have (or not have). As we have argued the need for climate action comes ever more into focus of society, we wanted to explore whether the professional ethics of the medical professionals needs to be amended. Our argument is that this is the case, based on the reasons that climate change has a big health impact while simultaneously the health system has a strong climate impact. Based on the World Medical Association (WMA) Declaration of Geneva the focus on the individual patient is clear, but this and other important codices do also include a public health perspective. The (model) Professional Code for Physicians in Germany, for example, states in its first article that ‘Physicians serve the health of …. (shrink)

ZusammenfassungMit der Vielzahl von Daten aus genetischen Untersuchungsverfahren wächst das Problem von „Zufallsbefunden“, d. h. von zufällig erhobenen Nebenbefunden, die mit der ursprünglichen Fragestellung nicht in Verbindung stehen und dennoch eine Bedeutung für Gesundheit und Reproduktionsverhalten der untersuchten Person selbst oder ihrer Anverwandten haben. In Ermangelung nationaler oder internationaler Richtlinien greifen die Autoren die aktuelle Diskussion um den Umgang mit genetischen Zufallsbefunden in Behandlungs- und Forschungskontext auf. Dabei nehmen sie auf die für Deutschland relevanten rechtlichen und ethischen Rahmenbedingungen Bezug. Nach (...) Gendiagnostikgesetz (GenDG) muss in Deutschland im Rahmen eines Behandlungsvertrages auf die Möglichkeit von Zufallsbefunden hingewiesen werden. Es ist Bestandteil der Aufklärung und Einwilligung, inwieweit Zufallsbefunde mitgeteilt werden, wobei das Recht auf Nichtwissen und der Schutz nicht-einwilligungsfähiger Personen berücksichtigt werden müssen. Im Forschungskontext greift das GenDG nicht, aber auch hier sollte über mögliche Zufallsbefunde aufgeklärt werden, wenngleich eine Rückmeldung nicht zwingend, aber bei Befunden mit hohem klinischen Nutzen ethisch geboten sein kann. Folgende Aspekte sind im Umgang mit Zufallsbefunden zu berücksichtigen: 1) Art und Umfang der Aufklärung und Einwilligung bei einer unüberschaubaren Zahl von möglichen Befunden. 2) Einordnung der klinischen Bedeutung einer genetischen Veränderung im Sinne von gesichertem, wahrscheinlichem, möglichem oder fraglichem/unbekanntem klinischen Nutzen. 3) Prozessierung des Informationsrückflusses für Gegenwart und Zukunft. 4) Ressourcenplanung im Hinblick auf die klinische Validierung, die Erläuterung von Befunden und den Transfer in die klinische Praxis. Im Umgang mit genetischen Zufallsbefunden besteht erheblicher empirisch-ethischer Forschungs- und politischer Regelungsbedarf. Zeitgleich ist es unabdingbar, die Wahrnehmung und das Verständnis der untersuchten Personen sowie die Grundhaltung gegenüber Zufallsbefunden im Rahmen von Studien zu beleuchten und entsprechende Bildungs- und Kommunikationswerkzeuge zu entwickeln. (shrink)

Mit der Vielzahl von Daten aus genetischen Untersuchungsverfahren wächst das Problem von „Zufallsbefunden“, d. h. von zufällig erhobenen Nebenbefunden, die mit der ursprünglichen Fragestellung nicht in Verbindung stehen und dennoch eine Bedeutung für Gesundheit und Reproduktionsverhalten der untersuchten Person selbst oder ihrer Anverwandten haben. In Ermangelung nationaler oder internationaler Richtlinien greifen die Autoren die aktuelle Diskussion um den Umgang mit genetischen Zufallsbefunden in Behandlungs- und Forschungskontext auf. Dabei nehmen sie auf die für Deutschland relevanten rechtlichen und ethischen Rahmenbedingungen Bezug. Nach (...) Gendiagnostikgesetz (GenDG) muss in Deutschland im Rahmen eines Behandlungsvertrages auf die Möglichkeit von Zufallsbefunden hingewiesen werden. Es ist Bestandteil der Aufklärung und Einwilligung, inwieweit Zufallsbefunde mitgeteilt werden, wobei das Recht auf Nichtwissen und der Schutz nicht-einwilligungsfähiger Personen berücksichtigt werden müssen. Im Forschungskontext greift das GenDG nicht, aber auch hier sollte über mögliche Zufallsbefunde aufgeklärt werden, wenngleich eine Rückmeldung nicht zwingend, aber bei Befunden mit hohem klinischen Nutzen ethisch geboten sein kann. Folgende Aspekte sind im Umgang mit Zufallsbefunden zu berücksichtigen: 1) Art und Umfang der Aufklärung und Einwilligung bei einer unüberschaubaren Zahl von möglichen Befunden. 2) Einordnung der klinischen Bedeutung einer genetischen Veränderung im Sinne von gesichertem, wahrscheinlichem, möglichem oder fraglichem/unbekanntem klinischen Nutzen. 3) Prozessierung des Informationsrückflusses für Gegenwart und Zukunft. 4) Ressourcenplanung im Hinblick auf die klinische Validierung, die Erläuterung von Befunden und den Transfer in die klinische Praxis. Im Umgang mit genetischen Zufallsbefunden besteht erheblicher empirisch-ethischer Forschungs- und politischer Regelungsbedarf. Zeitgleich ist es unabdingbar, die Wahrnehmung und das Verständnis der untersuchten Personen sowie die Grundhaltung gegenüber Zufallsbefunden im Rahmen von Studien zu beleuchten und entsprechende Bildungs- und Kommunikationswerkzeuge zu entwickeln. (shrink)

BackgroundPublic involvement activities are promoted as measures for ensuring good governance in challenging fields, such as biomedical research and innovation. Proponents of public involvement activities include individual researchers as well as non-governmental and governmental organizations. However, the concept of ‘public’ in public involvement deserves more attention by researchers because it is not purely theoretical: it has important practical functions in the guidance, evaluation and translation of public involvement activities.DiscussionThis article focuses on collective agency as one property a public as a (...) small group of participants in a public involvement activity could exhibit. It introduces a prominent theoretical approach to collective agents as one specific kind of social entities and demonstrates how this approach can be applied to current practice in public involvement activities. A brief discussion of different types of representation as they are used in the existing literature on this topic is also included because representation and collective agency can be closely related to each other. Suggestions and ideas that are derived from this reasoning include the proposal to use a ‘validity check’ for the generation of collective agents as a regular element of certain types of public involvement activities, the consequences of combining collective agency and representativeness as a further property a public could exhibit, and standards for reporting the content of public involvement activities in scientific publications.SummaryThis article discusses the importance of the concept of ‘public’ in public involvement activities, with a focus on biomedical research and innovation. It introduces various practically relevant ideas that are based on a theoretical analysis of collective agency as an important property a public can possess. (shrink)

Recent philosophical work on children and childhood has revealed many new questions concerning minors’ rights. This special issue of Moral Philosophy and Politics offers new contributions to the topics of paternalism, the nature of the right to parent and children’s voting. It also contains articles about the so far less explored questions of adolescents’ parental rights, minors’ rights against the harms of parental imprisonment, and their right to veto their own parents’ decision to relocate.

Mit seiner Sportwetten-Grundsatzentscheidung vom 28. Marz 2006 hat das Bundesverfassungsgericht die verfassungsrechtlichen Rahmenbedingungen fur das Glucksspielwesen in Deutschland prazisiert und den Gesetzgeber mit dessen Neuregelung beauftragt. Zum 1. Januar 2008 ist ein neues Glucksspielrecht in Deutschland in Kraft getreten. Allein die Ziele der Suchtvermeidung und Suchtbekampfung rechtfertigen Glucksspielmonopole, durch die private Glucksspielanbieter vom deutschen Glucksspielmarkt ausgeschlossen werden. Damit rucken neben okonomischen und rechtlichen Fragengerade auchdie Erkenntnisse der Glucksspielsucht-Forschung in den Mittelpunkt des Interesses. Dem versucht dieses interdisziplinar angelegte Buch Rechnung zu (...) tragen, indem namhafte Wissenschaftler und Praktiker - Okonomen, Juristen, Suchtfachleute - das Glucksspielwesen umfassend analysieren. Die Autoren beziehen Position und verdeutlichen die unterschiedlichen Sichtweisen und Interessenlagen zum Thema. Das Buch gibt dem Leser zugleich eine Idee von der geschichtlichen Dimension und der Bedeutung des Glucksspiels fur den Einzelnen und die Gesellschaft insgesamt.". (shrink)