Background Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. Objective To examine the role of advance directives, orally expressed wishes, or the presumed will of (...) patients in a VS for family caregivers' decisions on life-sustaining treatment. Methods and sample A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. Results The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. Conclusions Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

ZusammenfassungEin Großteil der medizinisch und ethisch schwierigen Therapieentscheidungen betrifft kritisch kranke, einwilligungsunfähige Patienten und wird auf Basis des mutmaßlichen Patientenwillens getroffen. Das Gesetz kann hierzu nur allgemeine Vorgaben geben. Es ist für die behandelnden Ärzte essentiell, sich ein konkretes Vorgehen zu erarbeiten. Wie in der Praxis vorgegangen wird, ist bisher kaum untersucht. Ziel dieser Studie ist es, die Vielfalt der Herangehensweisen und Erfahrungen von Klinikern zum mutmaßlichen Patientenwillen zu erforschen. Wir führten semistrukturierte Interviews mit 18 Ärzten und elf Pflegekräften von (...) intensiv- und palliativmedizinischen Abteilungen eines Universitätsklinikums durch. Die Abschriften der Tonaufnahmen wurden mithilfe der Qualitativen Datenanalyse ausgewertet. Auf einer numerischen Ratingskala wurde erhoben, wie hilfreich die Kliniker das Konzept des mutmaßlichen Willens fanden. Die meisten Studienteilnehmer hielten das Konzept des mutmaßlichen Willens für sehr hilfreich. Zu ihrem Vorgehen berichteten sie, dass sie zumeist die nächsten Angehörigen befragen, zuweilen auch Professionelle und falls möglich die Patienten selbst. Gefragt werde nach früheren Äußerungen der Patienten, nach ihrer Lebenspraxis und -einstellung sowie ihrem aktuellen Verhalten. Benannt wurden auch zahlreiche Unsicherheiten und Schwierigkeiten psychologischer, sozialer, praktischer und konzeptioneller Natur. Der mutmaßliche Patientenwille wird, so unser Ergebnis, in der von uns untersuchten klinischen Praxis entsprechend den gesetzlichen Vorgaben ermittelt. Da jedoch zahlreiche Probleme berichtet werden, stellen wir konkrete Empfehlungen zur Ermittlung des mutmaßlichen Willens vor. (shrink)

Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in (...) Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment. (shrink)

Die Verbindlichkeit von Patientenverfügungen (PV) wird kontrovers diskutiert. Dabei ist nicht bekannt, wie verbindlich PV von denen gewollt sind, die sie verfassen. Mit Hilfe eines anonymen Fragebogens wurden Verfasser von PV in bayerischen Palliativeinrichtungen und Beratungsstellen hierzu befragt. Von den 402 Befragten gaben 69,1% an, dass ihre PV auch für Bevollmächtigte und Betreuer strikt verbindlich sein soll. Demgegenüber räumten 23,9% ihrem Stellvertreter ein, von der PV abzuweichen. Die lebensbedrohlich Erkrankten unter den Befragten legten nicht weniger, sondern signifikant mehr Wert auf (...) hohe Verbindlichkeit. Für den Fall, dass die PV nicht anwendbar sein sollte, wünschen deren Verfasser eine Entscheidung durch ihren Vertreter. Abgelehnt wird die richterliche Entscheidung bei Dissens. (shrink)

Some of the foundations of Heyes’ radical reasoning seem to be based on a fractional selection of available evidence. Using an ethological perspective, we argue against Heyes’ rapid dismissal of innate cognitive instincts. Heyes’ use of fMRI studies of literacy to claim that culture assembles pieces of mental technology seems an example of incorrect reverse inferences and overlap theories pervasive in cognitive neuroscience.

Shadmehr and Ahmed cogently argue that vigor of appetitive movements is positively correlated with their value, and that value can therefore be inferred by measuring vigor. Here, we highlight three points to consider when interpreting this account: (1) The correlation between vigor and value is not obligatory, (2) the vigor effect also arises in frameworks other than optimal foraging, and (3) the term vigor can be misinterpreted, thereby affecting rigor.

Theory of language is an important factor in the plans of political and educational reform drawn by Italian philosophers of the eighteenth century. Analysis of language is a technique they often resort to when discussing the foundations of political philosophy and the ways and means of social communication. Interesting suggestions concerning philosophy of language can be found in the works of writers on political economy and philosophy of jurisprudence (Antonio Genovesi, Gaetano Filangieri, Cesare Beccaria, Melchiorre Gioia, Gian Domenico (...) Romagnosi, among others), where subjects such as abuse of words and linguistic arbitrarism are connected to theoretical and practical problems of the transition from feudal to bourgeois régime. (shrink)

Theory of language is an important factor in the plans of political and educational reform drawn by Italian philosophers of the eighteenth century. Analysis of language is a technique they often resort to when discussing the foundations of political philosophy and the ways and means of social communication. Interesting suggestions concerning philosophy of language can be found in the works of writers on political economy and philosophy of jurisprudence (Antonio Genovesi, Gaetano Filangieri, Cesare Beccaria, Melchiorre Gioia, Gian Domenico (...) Romagnosi, among others), where subjects such as abuse of words and linguistic arbitrarism are connected to theoretical and practical problems of the transition from feudal to bourgeois régime. (shrink)

An outdated geography supplies the bond among the thirty‐one articles in Sur les traces des Cassini. In the seventeenth century, when the Italians Gian Domenico Cassini and his nephew Giacomo Filippo Maraldi were born in Perinaldo, north of Genoa, their birthplace belonged to the County of Nice. Hence the rationale of building a set of papers on astronomy in the south of France around Cassini I and his family, which for four generations ran the Royal Observatory in Paris.Over (...) half the articles concern the Cassinis, mostly Cassini I and his great‐great‐grandson and namesake Cassini IV. There was also a Cassini V, Henri de Cassini, who countered the family genius and stamina by preferring botany and dying early, of the same outbreak of cholera that took the life of Sadi Carnot, without having created Cassini VI. He had already entered the Academy of Sciences with a push from his father. “I dare to beg of you [Cassini IV wrote to his fellow academician A. M. Ampère] to consider whether this unique situation in the history of letters, [a family's] devotion to the sciences for five successive generations and 170 years, ought not add some weight to the scientific credentials of my son.” It is hard to refuse the children of important alumni.The portion of Traces dealing more directly with astronomy in the south of France gets off to a distant start. Pytheas of Marseilles, who lived about 350 b.c., sailed to the Orkneys and the Baltic and earned himself the reputation of a liar back home for his stories of midnight suns and frozen lakes. He measured the latitude of Marseilles, the obliquity of the ecliptic, and the size of the earth. Ptolemy praised him. Strabo did not: “Pytheas lied about everything and covered it up with his knowledge of astronomy and numbers.”No traces worth following up were laid down for just under two thousand years. Then, in 1580, Nicolas Fabri de Peiresc first saw the light of day. He lived in Italy for four years as a very young man, deepening his knowledge of astronomy and human nature and meeting the main future actors in the Galileo affair: Galileo himself, Bellarmine, and Matteo Barberini . At his center in Aix‐la‐Provence, Peiresc made many useful astronomical observations, some in collaboration with Pierre Gassendi. He died in harness, worrying about the change of the obliquity since the days of Pytheas.There follow articles on Provençal astronomers who determined longitude and latitude at sea, on neglected observers in Languedoc who assisted the cause of the Enlightenment, and on modern observatories in the south of France. The political circumstances after the defeat of 1870–1871 favored decentralization of astronomy away from the Paris Observatory. In Italy, too, recent political events—the unification of 1870—made a restructuring of astronomical institutions desirable and possible. But whereas France had too few observatories, Italy had too many. Georges Rayet and Pietro Tacchini, both astrophysicists, compared the circumstances in their countries and made mutually reinforcing proposals to their colleagues and governments. Their respective proposals, most of which were enacted, called for reassigning some Italian observatories to meteorological work, building new observatories in Besançon, Bordeaux, and Lyon, and refurbishing older ones at Marseilles and Toulouse. Once again, as in the days of Cassini I, Italy made a decisive contribution to the practice of astronomy in France.Sur les traces des Cassini mixes slight and weighty work, admits antiquarian and broader approaches, offers new documentation, displays pertinent illustrations, and does it all at a high level of scholarship. Since, because of its title, the book's primary audience probably will be people interested in the Cassinis, its fullest articles about them may usefully be mentioned here: Anna Cassini on Cassini's brief return to Italy, 1694–1696; Claude Teillet on the provincial life and poetry of Cassini IV; Christiane Demeulenaere‐Douyère on the Cassinis and the Académie des Sciences; Fabrizio Bonoli and Alessandro Braccesi on Cassini I's astronomical work in Bologna, with full bibliography; and Monique Pelletier on the Cassini map of France, on which she has written a book . Pytheas and Peiresc are the subjects of collaborative articles by Simone Arzano and Yvon Georgelin. (shrink)

In this paper we show that the Gupta-Belnap systems S# and S* are П12. Since Kremer has independently established that they are П12-hard, this completely settles the problem of their complexity. The above-mentioned upper bound is established through a reduction to countable revision sequences that is inspired by, and makes use of a construction of McGee.

Despite the burgeoning literature on the governance and impact of cross-sector partnerships in the past two decades, the debate on how and when these collaborative arrangements address globally relevant problems and contribute to systemic change remains open. Building upon the notion of wicked problems and the literature on governing such wicked problems, this paper defines harnessing problems in multi-stakeholder partnerships as the approach of taking into account the nature of the problem and of organizing governance processes accordingly. The paper develops (...) an innovative analytical framework that conceptualizes MSPs in terms of three governance processes harnessing three key dimensions of wicked problems. The Roundtable on Sustainable Palm Oil provides an illustrative case study on how this analytical framework describes and explains organizational change in partnerships from a problem-based perspective. The framework can be used to better understand and predict the complex relationships between MSP governance processes, systemic change and societal problems, but also as a guiding tool in organizing governance processes to continuously re-assess the problems over time and address them accordingly. (shrink)

Gian Aldo Antonelli and Cristina Bicchieri. Forward Induction.

We present a simple and completely model-theoretical proof of a strengthening of a theorem of Ajtai: The independence of the pigeonhole principle from IΔ0. With regard to strength, the theorem proved here corresponds to the complexity/proof-theoretical results of [10] and [14], but a different combinatorics is used. Techniques inspired by Razborov [11] replace those derived from Håstad [8]. This leads to a much shorter and very direct construction.

We characterize the collapse of Buss' bounded arithmetic in terms of the provable collapse of the polynomial time hierarchy. We include also some general model-theoretical investigations on fragments of bounded arithmetic.

In this paper we introduce three methods to approach philosophical problems informationally: Minimalism, the Method of Abstraction and Constructionism. Minimalism considers the specifications of the starting problems and systems that are tractable for a philosophical analysis. The Method of Abstraction describes the process of making explicit the level of abstraction at which a system is observed and investigated. Constructionism provides a series of principles that the investigation of the problem must fulfil once it has been fully characterised by the previous (...) two methods. For each method, we also provide an application: the problem of visual perception, functionalism, and the Turing Test, respectively. (shrink)

Offers a glimpse into the world of science and technology between 1950 and 1990 as seen through the eyes of a mathematician, and debunks various myths of scientific philosophy. Portrays some of the great scientific personalities of the period, including Stanislav Ulam, who patented the hydrogen bomb, and Jack Schwartz, one of the founders of computer science. Also discusses phenomenology of mathematics, and philosophy and computer science. Includes book reviews. For students and academics. Annotation copyright by Book News, Inc., Portland, (...) OR. (shrink)

This paper explores the relationship between business experience in cross-sector partnerships and the co-creation of what we refer to as ‘dynamic capabilities for stakeholder orientation,’ consisting of the four dimensions of sensing, interacting with, learning from and changing based on stakeholders. We argue that the co-creation of dynamic capabilities for stakeholder orientation is crucial for CSPs to create societal impact, as stakeholder-oriented organizations are more suited to deal with “wicked problems,” i.e., problems that are large, messy, and complex. By means (...) of a grounded theory approach of inductive research, we collected and interpreted data on four global agri-food companies which have heterogeneous experience in participating in CSPs. The results of this paper highlight that only companies’ capability of interacting with stakeholders continually increases, while their capabilities of sensing, learning from, and changing based on stakeholders first increase and then decrease as companies gain more experience in CSP participation. To a large extent, this can be attributed to the development of corporate strategies on sustainability after a few years of CSP participation, which entails a shift from a reactive to a proactive attitude towards sustainability issues and which may decrease the need or motivation for stakeholder orientation. These findings open up important issues for discussion and for future research on the impact of CSPs in a context of wicked problems. (shrink)

In this paper we argue that data science is a coherent and novel approach to empirical problems that, in its most general form, does not build understanding about phenomena. Within the new type of mathematization at work in data science, mathematical methods are not selected because of any relevance for a problem at hand; mathematical methods are applied to a specific problem only by `forcing’, i.e. on the basis of their ability to reorganize the data for further analysis and the (...) intrinsic richness of their mathematical structure. In particular, we argue that deep learning neural networks are best understood within the context of forcing optimization methods. We finally explore the broader question of the appropriateness of data science methods in solving problems. We argue that this question should not be interpreted as a search for a correspondence between phenomena and specific solutions found by data science methods; rather, it is the internal structure of data science methods that is open to precise forms of understanding. (shrink)

In the paper it is argued that bridging the digital divide may cause a new ethical and social dilemma. Using Hardin's Tragedy of the Commons, we show that an improper opening and enlargement of the digital environment (Infosphere) is likely to produce a Tragedy of the Digital Commons (TDC). In the course of the analysis, we explain why Adar and Huberman's previous use of Hardin's Tragedy to interpret certain recent phenomena in the Infosphere (especially peer-to-peer communication) may not be entirely (...) satisfactory. We then seek to provide an improved version of the TDC that avoids the possible shortcomings of their model. Next, we analyse some problems encountered by the application of classical ethics in the resolution of the TDC. In the conclusion, we outline the kind of work that will be required to develop an ethical approach that may bridge the digital divide but avoid the TDC. (shrink)

We show that every model of IΔ0 has an end extension to a model of a theory where log-space computable function are formalizable. We also show the existence of an isomorphism between models of IΔ0 and models of linear arithmetic LA.