Following decades of silence about the involvement of doctors, medical researchers and other health professionals in the Holocaust and other National Socialist (Nazi) crimes, scholars in recent years have produced a growing body of research that reveals the pervasive extent of that complicity. This interdisciplinary collection of studies presents documentation of the critical role medicine played in realizing the policies of Hitler's regime. It traces the history of Nazi medicine from its roots in the racial theories of the 1920s, through (...) its manifestations during the Nazi period, on to legacies and continuities from the postwar years to the present. (shrink)

Référence de la pensée critique contemporaine et de la lutte contre les discriminations sexuelles et « culturelles », Judith Butler passe pour une grande philosophe. En prise sur notre actualité, ce livre, dont le titre fait allusion à l'autorité usurpée des Jésuites moqués par Pascal dans Les Provinciales, questionne cette évidence, par une critique sévère et argumentée de la « pensée Butler ».

We all know what a voluntary action is - we all think we know when an action is voluntary, and when it is not. Yet, performing and action and defining it are different matters. What counts as an action? When does it begin? Does the conscious desire to perform an action always precede the act? If not, is it really a voluntary action? This is a debate that crosses the boundaries of Philosophy, Neuroscience, Psychology, and Social Science. This book brings (...) together some to the leading thinkers from these disciplines to consider this deep and often puzzling topic. The result is a fascinating and stimulating debate that will challenge our fundamental assumptions about our sense of free-will. (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)

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)

'A comprehensive and important collection that includes essays by some of the leading figures in the field....Essential reading for anyone interested in risk assessment.' Professor Kristin Shrader-Frechette, University of Notre Dame 'The editors are to be congratulated for bringing together a distinguished international group of theorists to reflect on the issues. This volume will be sure to raise the level of debate while at the same time showing the importance of philosophical reflection in approaches to the problems of the age.' (...) Professor Jonathan Wolff, University College London This volume brings together top authors from the fields of risk, philosophy, social sciences and psychology to address the issue of how we should decide how far technological risks are morally acceptable or not. The underlying principles are examined, along with methodological challenges, public involvement and instruments for democratization. A strong theoretical basis is complemented by a range of case studies from some of the most contentious areas, including medical ethics and GM crops. This book is a vital new resource for researchers, students and anyone concerned that traditional approaches to risk management don't adequately address ethical considerations. (shrink)

The Information Artifact Ontology (IAO) was created to serve as a domain‐neutral resource for the representation of types of information content entities (ICEs) such as documents, data‐bases, and digital im‐ages. We identify a series of problems with the current version of the IAO and suggest solutions designed to advance our understanding of the relations between ICEs and associated cognitive representations in the minds of human subjects. This requires embedding IAO in a larger framework of ontologies, including most importantly the Mental (...) Func‐tioning Ontology (MFO). It also requires a careful treatment of the aboutness relations between ICEs and associated cognitive representa‐tions and their targets in reality, which implies in turn a new treatment of the relation of truthmaking. (shrink)

“Acceptable Risk” – On the Rationality of Emotional Evaluations of Risk What is “acceptable risk”? That question is appropriate in a number of different contexts, political, social, ethical, and scienti c. Thus the question might be whether the voting public will support a risky proposal or project, whether people will buy or accept a risky product, whether it is morally permissible to pursue this or that potentially harmful venture, or whether it is wise or prudent to test or try out (...) some possibly dangerous hypothesis or product. But complicating all of these queries, the “sand in the machinery” of rational decision-making, are the emotions. It is often noted that voters are swayed by their passions at least as much as they are convinced by rational arguments. And it is obvious to advertisers and retailers that people are seduced by all sorts of appeals to their vanities, their fears, their extravagant hopes, their insecurities. At least one major thread of ethical discourse, the one following Kant, minimizes the importance of the emotions in favor of an emphatically rational decision-making process, and it is worth mulling over the fact that many of those who do not accept Kant’s ethical views more or less applaud his rejection of the “moral sentiment theory” of the time, promoted by such luminary philosophers as David Hume and Adam Smith. (shrink)

Plato's dialogues frequently criticize traditional Greek myth, yet Plato also integrates myth with his writing. Daniel S. Werner confronts this paradox through an in-depth analysis of the Phaedrus, Plato's most mythical dialogue. Werner argues that the myths of the Phaedrus serve several complex functions: they bring nonphilosophers into the philosophical life; they offer a starting point for philosophical inquiry; they unify the dialogue as a literary and dramatic whole; they draw attention to the limits of language and the (...) limits of knowledge; and they allow Plato to co-opt cultural authority as a way of defining and legitimating the practice of philosophy. Platonic myth, as a species of traditional tale, is thus both distinct from philosophical dialectic and similar to it. Ultimately, the most powerful effect of Platonic myth is the way in which it leads readers to participate in Plato's dialogues and to engage in a process of self-examination. (shrink)

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.

For valid informed consent, it is crucial that patients or research participants fully understand all that their consent entails. Testing and revising informed consent documents with the assistance of their addressees can improve their understandability. In this study we aimed at further developing a method for testing and improving informed consent documents with regard to readability and test-readers’ understanding and reactions. We tested, revised, and retested template informed consent documents for biobank research by means of 11 focus group interviews with (...) members from the documents’ target population. For the analysis of focus group excerpts we used qualitative content analysis. Revisions were made based on focus group feedback in an iterative process. Focus group participants gave substantial feedback on the original and on the revised version of the tested documents. Revisions included adding and clarifying explanations, including an info-box summarizing the main points of the text and an illustrative graphic. Our results indicate positive effects on the tested and revised informed consent documents in regard to general readability and test-readers’ understanding and reactions. Participatory methods for improving informed consent should be more often applied and further evaluated for both, medical interventions and clinical research. Particular conceptual and methodological challenges need to be addressed in the future. (shrink)

ZusammenfassungDie Einführung der Fallpauschalen-basierten Finanzierung der Krankenhäuser ist ein erneuter Versuch, die Kosten in diesem Bereich zu reduzieren. Folge dieses Anreizsystems ist u. a. eine deutliche Verkürzung der Verweildauer der Patienten im Krankenhaus. Das wiederum führt zu durchschnittlich kränkeren Patienten und einer deutlichen Arbeitsverdichtung für alle. Vor diesem Hintergrund wird anhand empirischer Daten die Situation der Pflege mit drastischen Einschränkungen beschrieben und es werden Hypothesen zur Begründung aufgestellt. Daran knüpft sich die Frage, welche Art der Versorgung die Patienten mit kürzer (...) werdender Verweildauer und immer häufiger auftretenden chronischen Krankheiten neben der ärztlichen Therapie benötigen. Dies baut auf der Theorie der Aufgaben zur Krankheitsbewältigung auf, die Patienten befähigen sollen, mit Krankheiten in ihrem eigenen Sinne umgehen zu können. Die Kernaufgaben der Pflege werden hier mit dem Ziel der forcierten Förderung der Entlassungsfähigkeit verbunden mit einem Empowerment der Patienten verknüpft. Organisatorisch bietet sich als Lösung der Einsatz von Primary Nurses an. Die derzeitige Situation in der Pflege widerspricht den genannten Sollvorstellungen diametral. Im Sinne einer sicheren und effektiven Versorgung von Patienten im Krankenhaus muss der Pflegedienst inhaltlich völlig anders aufgestellt und mit weiteren Kompetenzen ausgestattet werden. (shrink)

Not all countries do their fair share in the effort of preventing dangerous climate change. This presents those who are willing to do their part with the question whether they should 'take up the slack' and try to compensate for the non-compliers' failure to reduce emissions. There is a pro tanto reason for doing so given the human rights violations associated with dangerous climate change. The article focuses on fending off two objections against a duty to take up the slack: (...) that it is unfair and ineffective. We grant that it is unfair if some have to step in for others but argue that this does not amount to a decisive objection under conditions of partial compliance. With regard to the charge of emission reductions being ineffective, we argue that the empirical case for this claim is missing and that even if it were not, there still remains the option of taking up the slack in other forms. (shrink)

Für ökonomische Evaluationen medizinischer Leistungen steht ein etabliertes Methodenspektrum zur Verfügung. Ziel der Arbeit ist, anhand ausgewählter Aspekte herauszuarbeiten, inwieweit diese Methoden für den derzeit viel diskutierten Bereich der Personalisierten Medizin anwendbar sind bzw. welche Besonderheiten dabei auftreten und wie diese adressiert werden können. Für die vorliegende Arbeit wurde eine explorative Literaturrecherche durchgeführt. In Abgrenzung zur herkömmlichen Medizin kann je nach Blickwinkel die Personalisierte Medizin entweder hinsichtlich der physiologischen Unterschiede oder hinsichtlich der individuellen Präferenzen der Beteiligten betrachtet werden. Je nach (...) Betrachtungsweise ergeben sich unterschiedliche methodische Herausforderungen an gesundheitsökonomische Evaluationen. Verbesserte Ausrichtung der Versorgung an physiologischen Unterschieden stellt die Evaluation beispielsweise vor das Problem, dass aufgrund des oftmals kleinen Stichprobenumfangs häufig Evidenz zur Parametrisierung von Entscheidungsmodellen fehlt. Informationswertanalysen können Hinweise über den potenziellen Nutzen weiterer Forschung geben. Das Konzept des „Expected Value of Individualized Care“ bietet einen den Informationswertanalysen sehr ähnlichen Ansatz, um den potenziellen Wert eines Einbezugs individueller Präferenzen in die Versorgung zu quantifizieren. Welfarismus und Extra-Welfarismus bieten unterschiedliche Lösungsansätze, wie Nutzen Biomarker-basierter Information im Sinne von „Empowerment“ in Evaluationen einbezogen werden können. Generell sind die Methoden der gesundheitsökonomischen Evaluation auch auf den Bereich der Personalisierten Medizin anwendbar. Es stellen sich jedoch eine Reihe spezifischer Herausforderungen, zu deren Lösung weiterer Forschungsbedarf besteht. (shrink)

Für ökonomische Evaluationen medizinischer Leistungen steht ein etabliertes Methodenspektrum zur Verfügung. Ziel der Arbeit ist, anhand ausgewählter Aspekte herauszuarbeiten, inwieweit diese Methoden für den derzeit viel diskutierten Bereich der Personalisierten Medizin anwendbar sind bzw. welche Besonderheiten dabei auftreten und wie diese adressiert werden können. Für die vorliegende Arbeit wurde eine explorative Literaturrecherche durchgeführt. In Abgrenzung zur herkömmlichen Medizin kann je nach Blickwinkel die Personalisierte Medizin entweder hinsichtlich der physiologischen Unterschiede oder hinsichtlich der individuellen Präferenzen der Beteiligten betrachtet werden. Je nach (...) Betrachtungsweise ergeben sich unterschiedliche methodische Herausforderungen an gesundheitsökonomische Evaluationen. Verbesserte Ausrichtung der Versorgung an physiologischen Unterschieden stellt die Evaluation beispielsweise vor das Problem, dass aufgrund des oftmals kleinen Stichprobenumfangs häufig Evidenz zur Parametrisierung von Entscheidungsmodellen fehlt. Informationswertanalysen können Hinweise über den potenziellen Nutzen weiterer Forschung geben. Das Konzept des „Expected Value of Individualized Care“ bietet einen den Informationswertanalysen sehr ähnlichen Ansatz, um den potenziellen Wert eines Einbezugs individueller Präferenzen in die Versorgung zu quantifizieren. Welfarismus und Extra-Welfarismus bieten unterschiedliche Lösungsansätze, wie Nutzen Biomarker-basierter Information im Sinne von „Empowerment“ in Evaluationen einbezogen werden können. Generell sind die Methoden der gesundheitsökonomischen Evaluation auch auf den Bereich der Personalisierten Medizin anwendbar. Es stellen sich jedoch eine Reihe spezifischer Herausforderungen, zu deren Lösung weiterer Forschungsbedarf besteht. (shrink)

In dieser Arbeit wird ein erster Schritt unternommen, die traditionelle wissenschaftliche Konzeption der Psychologie im Diskurs des Radikalen Konstruktivismus zu betrachten und die Grundlegung einer neuen radikal konstruktivistischen Psychologie zu versuchen. Dabei stellen sich mehrere Aufgaben: - erstens muß ein geeigneter erkenntnistheoretischer Standpunkt für die Analyse, den Ver gleich bzw. dessen Diskurs gefunden werden, - zweitens muß in groben Umrissen eine Fragestellung für den Vergleich von traditionel lem und neuem Paradigma entworfen werden, - drittens ist es notwendig, das vorherrschende wissenschaftliche (...) Paradigma der Psycholo gie offenzulegen, schließlich ist - viertens das neue Paradigma des Radikalen Konstruktivismus, insofern es für eine wis senschaftliche Psychologie geeignet ist, darzustellen, und nicht - zuletzt muß auch der Nachweis angetreten werden, daß eine radikal konstruktivistische Psychologie überhaupt möglich ist. Diese fünf Problemkreise entsprechen im großen und ganzen dem Aufbau dieser Ar beit, wobei aufgrund der engen Verflechtung dieser Aufgaben zahlreiche Wechselbezie hungen und Querverbindungen bestehen, die eine bloß - für manche vielleicht wünschens werte - lineare Anordnung nicht immer zulassen. Es ist für den Diskurs des Radikalen Konstruktivismus geradezu kennzeichnend, daß in ihm ein Ende immer zugleich ein An fang ist bzw. vice versa, sodaß er sich grundsätzlich als niemals abschließbarer zirkulärer Prozeß darstellt, dessen erster Durchlauf in dieser Arbeit geleistet werden soll. (shrink)

Using the example of architecture, this article defends the thesis that designing should not be regarded as a kind of experimenting. This is in contrast to a widespread methodological claim that design processes are equivalent to experimentation processes. The contrary thesis can be proven by focusing on actual practices, techniques and design strategies. Closely connected with the thesis is an even more important epistemological claim, which contends that designing serves not only to develop artefacts but is also a means of (...) acquiring genuine knowledge. When the epistemic relevance of said practices, techniques and strategies is reassessed, designing emerges clearly as an independent epistemic praxis. To defend the thesis, the present article draws on and analyses empirical material from an ethnographic field study in order to back up the conceptual analysis. (shrink)

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)

Flach bringt Kants geltungs- und prinzipientheoretische Freiheitslehre zur Darstellung und sucht zu zeigen, welches Erklärungspotential diese Lehre in puncto Humanität hat. Krijnen bringt Hegels logische und geistphilosophische Freiheitslehre zur Darstellung und sucht zu zeigen, daß und wie in ihr ein fundamentaler Aspekt der Freiheit thematisch wird, der in Kants Lehre unterbeleuchtet bleibt. Die Diskussionsbeiträge zeigen, welchen Stellenwert dem einen und dem anderen Paradigma im aktuellen Urteil zuerkannt wird. Flach presents Kant’s conception of freedom as well as its potential for understanding (...) what it means to be human. Krijnen presents Hegel’s conception of freedom and shows that Kant’s conception underestimates an essential feature of freedom. The contributions of other authors assess the results. (shrink)

Der Band gibt einen exemplarischen Überblick über die Geschichte feministischer Theorie in den Sozialwissenschaften. Er verfolgt eine doppelte Zielsetzung: Die vertiefende Einführung in feministisches Denken soll zugleich eine Einübung in eine kritische wissenschaftliche Praxis der Historisierung von Problemen, Objekten und Denkwerkzeugen in der sozialwissenschaftlichen Frauen- und Geschlechterforschung sein. Feministische Theorie entwickelte sich aus einer Reihe von kritischen Analysen und Haltungen gegenüber geschlechtlich organisierten sozialen Ungleichheiten und Ausschlüssen, dominanten Diskursen und Repräsentationen, aber auch in ständiger selbstkritischer Reflexion des eigenen Denkens. Es (...) ist dieser an Widersprüchen und Paradoxien geschulte Blick, der feministisches Denken im Kern ausmacht. (shrink)

Before we can answer what society owes the psychopaths, we have to know wherein society's putative sin against psychopaths might consist. Is the society really responsible for the development of so...

This collection broadens the scientific discussion of modularity by bringing together experts from a variety of disciplines, including artificial life, ...

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.

Affective congruency effects in the evaluation task can be explained by either spreading of activation or response competition. Eliminating effects of response compatibility by using other tasks (semantic categorisation, naming task) typically also eliminates affective congruency effects. However, there is no need for processing the affective information of the stimuli in these tasks either, which could be necessary for an affectively mediated spreading of activation (Spruyt et al., 2007, 2009, 2012). We introduced a new task to further test this hypothesis. (...) The valent/neutral-categorisation task does not confound affective congruency with response compatibility, but still requires a processing of the stimuli's valence. No affective congruency effect was obtained with this task in two experiments, disfavouring a conditional spreading activation account. On the other hand, a significant priming effect was found for associated word pairs in Experiment 1, providing evidence for the sensitivity of the task to detect spreading activation processes. (shrink)