Problems and choices -- Who shall live? -- The physician : the captain of the team -- The hospital : the house of hope -- Drugs : the key to modern medicine -- Paying for medical care.

Book reviewed in this article: The Needs of Strangers. By Michael Ignatieff. The Health Economy. By Victor Fuchs. Just Health Care. By Norman Daniels.

The European project European and Latin American Systems of Ethics Regulation of Biomedical Research Project (EULABOR) has carried out the first comparative analysis of ethics regulation systems for biomedical research in seven countries in Europe and Latin America, evaluating their roles in the protection of human subjects. We developed a conceptual and methodological framework defining ‘ethics regulation system for biomedical research’ as a set of actors, institutions, codes and laws involved in overseeing the ethics of biomedical research on humans. This (...) framework allowed us to develop comprehensive national reports by conducting semi-structured interviews to key informants. These reports were summarised and analysed in a comparative analysis. The study showed that the regulatory framework for clinical research in these countries differ in scope. It showed that despite the different political contexts, actors involved and motivations for creating the regulation, in most of the studied countries it was the government who took the lead in setting up the system. The study also showed that Europe and Latin America are similar regarding national bodies and research ethics committees, but the Brazilian system has strong and noteworthy specificities. (shrink)

Academic freedom and tenure, both cherished institutions of higher education, are currently under attack by many both outside and within the academy. Richard DeGeorge argues that they can be defended on ethical grounds only if they are joined with appropriate accountability, publicly articulated and defended standards, and conscientious enforcement of these standards by academic institutions and the members of the academic community.

Public officials rely on performance data that are self-reported by organizations to evaluate progress on a wide range of prosocial outcomes. Policies that require public disclosure of performance in health care are thought to enable patients to select high-quality providers, which in turn may spur quality improvements as providers seek to protect their reputation or increase economic returns. Drawing on institutional theory that examines how conflicting institutional pressures influence organizational decisions, we theorize how profit orientation may mediate the response of (...) health care providers to disclosure mandates in a public health crisis. We focus on measures of data quality—completeness and accuracy—in self-reported data on COVID-19 status and outcomes generated by thousands of long-term care facilities. Using pooled regressions and a difference-in-differences style design, we find that overall, for-profit and not-for-profit facilities report similarly complete data but that for-profit facilities report less accurate data than their not-for-profit counterparts. Our results suggest that it may be important to incentivize each dimension of data quality separately to address differential institutional pressures that affect reporting practices. (shrink)

Das Wiskott-Aldrich-Syndrom (WAS), ein genetisch bedingter Immundefekt mit klinischer Manifestation im Kleinkindalter, wird voraussichtlich in näherer Zukunft erstmals versuchsweise durch eine somatische Gentherapie behandelt werden. Im vor- liegenden Beitrag werden die wichtigsten medizinisch-naturwissenschaftlichen Fakten dieses Krankheitsbildes sowie die bisherigen Erfahrungen mit somatischen Gentherapien bei anderen Immunmangelsyndromen ausführlich dargestellt. Sodann erfolgt eine ethische Analyse eines möglichen gentherapeutischen Eingriffs bei WAS-Patienten, bei der die spezifischen Aspekte des Wiskott-Aldrich-Syndroms – insbesondere die fast ausschließliche Betroffenheit von Kindern sowie die unterschiedlich aussichtsreiche Alter- nativoption einer (...) allogenen Knochenmarktransplantation–wesentliche Aspekte der Beurteilung sind. Im Ergebnis zeigt sich, dass ein gentherapeutischer Eingriff im vorliegenden Fall nicht im Rahmen einer Forschungsstudie, d.h. als Humanexperiment, gerechtfertigt werden kann, sondern allein als individueller Heilversuch. Gleichwohl las- sen die besonderen Risiken und die Innovativität eines solchen Eingriffs es notwendig erscheinen, diesen Heilversuch – anders als andere Heilbehandlungen mit bislang unerprobten Mitteln – in streng kontrollierter Form durchzuführen. Der neuartige Gedanke eines kontrollierten individuellen Heilversuchs zeichnet sich daher für den vorliegenden Fall, und womöglich auch für vergleichbare risikoreiche Behandlungsansätze namentlich im Bereich der Gentherapie, als geeignetes Instrument der Konzeption und Beurteilung ab. (shrink)

This article is concerned with extensions of a continuous ordering R on a set X to a subset P of the power set of X. The underlying topology will be the Hausdorff metric topology. We will see that continuous extensions of R do not require that P contain every nonempty finite subset of X. Therefore, the analysis can be applied to consumer theory and inverse choice functions. In analogy to these functions budget correspondences are established which relate alternatives x with (...) certain subsets of X, according to the extended ordering. (shrink)

Our aim with this descriptive phenomenological study was to identify and describe the essential meaning structure in the experience of postpartum depression . We interviewed four women diagnosed with major depression and analyzed the data with Giorgi’s descriptive phenomenological method. Our analysis revealed two essential meaning structures of PPD. The first structure describes the mother as thrown into a looming, dangerous world, coupled with a restricted, heavy body that hindered her attunement to her baby. Tormented by anxiety, guilt and shame, (...) she tried to deal with her pain by analytical reflection and social isolation. The second structure describes sudden lapses into intense feelings of alienation from the self, the baby, and from the social and material world. With a distorted primordial self-awareness, the mother no longer felt that she existed as herself in the world. We reflect on these findings using the insights of Fuchs, Van den Berg, Heidegger and Merleau-Ponty. (shrink)

The book is divided into two parts, the shorter of which documents and discusses the authoritative and Biblical sources for the Christian, and specifically Catholic, notion of natural law. The second section is taken up with conceptual analyses of such notions as the relation between nature and grace, nature and historical situation, and primary and secondary determinations of the natural law. A final chapter considers the possibility and scope of a Christian Sociology. The, in principle, complete integration of nature and (...) grace is maintained throughout in opposition to what Fuchs types as the postulated antinomy between these two orders that characterizes most Protestant theologies. The major confrontation between the Catholic and Protestant positions takes place in the footnotes, which are consequently of extensive bibliographical value.—E. A. R. (shrink)

In an age of growing virtual communication the question arises what role the human capacity of empathy plays in virtual relations. May empathy be detached from the immediate, embodied contact with others and be transferred to such relations? In order to answer this question, the paper distinguishes between primary, intercorporeal empathy and extended empathy which is based on the imaginative representation of the other, and fictional empathy which is directed to imagined or completely fictitious persons. The latter is characterized by (...) an 'as-if-consciousness' that maintains the difference between fiction and reality despite the empathy that one feels for the fictitious person. Based on these analyses, the paper further investigates the impact of the growing virtualization in postmodern culture. This is captured by the notions of phantomization as a media-based simulation of direct reality which undermines the as-if-consciousness, and disembodied communication which shifts the modes of empathy towards the fictional pole at the risk of merely projecting one's own feelings onto the other. In sum, human empathy is not bound to immediate intercorporeal contact, but becomes a crucial medium of virtual relations as well, albeit at the risk of projecting fictional emotions. (shrink)

While linear time results from the measurement of physical events, the temporality of life is characterized by cyclical processes, which also manifest themselves in subjective bodily experience. This applies for the periodicity of heartbeat, respiration, sleep-wake cycle, or circadian hormone secretion, among others. The central integration of rhythmic bodily signals in the brain forms the biological foundation of the phenomenal sense of temporal continuity. Cyclical repetitions are also found in the recurring phases of need, drive, and satisfaction. Finally, the cyclical (...) structure of bodily time manifests itself at an extended level in the form of implicit or body memory. However, this cyclical structure of lived time comes into tension with the orders of linear time which have been increasingly established in Western societies since the modern age. This tension creates both individual as well as societal conflicts and may also result in psychopathological phenomena. As an example, depression and burn-out syndromes will be discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 323-326 [Access article in PDF] The Tacit Dimension Thomas Fuchs Thirty years after its appearance, Blankenburg's "Psychopathology of common sense" has not lost its relevance. In my commentary I will try to illustrate the fruitfulness of his approach by pointing to some connections with the phenomenology of the body as well as with recent memory and infant research.As Blankenburg himself indicates, the notion (...) of common sense developed by a shift of meaning from the classical sensus communis and thus has its original basis in the sensual-bodily experience. By the koinè aísthesis, Aristoteles meant a central sense organ integrating all single modalities of sensation (which he localized in the heart). In German physiology and psychiatry of the nineteenth century, the sensus communis was still translated as "Gemeingefühl" ("common feeling") or "cenesthesia" (Fuchs 1995). This term denoted the inner, proprioceptive bodily sensations, but also an original unity of the senses, which has been rediscovered by recent infant research as intermodal sensory perception. The affection of the body was thus regarded as the common basis of all sensation.Looking on this track for a bodily basis of the common sense, we find it in the habitual structure of the lived-body as analysed by Merleau-Ponty (1945). The body is the primary "matter-of-course," namely, the tacitly functioning medium of our everyday being-in-the-world prior to any subject-object split. The body schema, in Merleau-Ponty's view, is not only a system of familiar units of movement or "kinetic melodies," it also incorporates the surrounding things, tools, and spaces that are familiar to us and that we "inhabit." Thus, the musician "does not only manipulate the instrument like a separate object, but lives in it like a limb and inhabits the expressive musical space it opens" (Behnke 1997). But for Merleau-Ponty, the body schema is also the basis of "intercorporeity," i.e., a prepersonal sphere of reciprocal comportment and understanding prior to any explicit consensus and symbolic communication. In this sphere of elementary contact, the "atmospheric" senses play a major role: The sense of smell (as shown, e.g., by the expression "to scent treason" or in German, "jemand nicht riechen können" [not be able to "smell" or stand someone]) as well as the sense of taste whose ambiguous meaning, mentioned by Blankenburg, points to the bodily basis of the feeling for what is suitable, decent, or aesthetically pleasing. Even the designation of homo sapiens that we give to ourselves is derived from the latin sapere (to taste/to know), and thus shows that the knowledge characteristic for man is not an explicit one, but an intuitive, implicit knowing or "feel" for his surroundings, or as Kant says, an "aesthetic rather than intellectual judgment" (cited by Blankenburg).Polanyi (1967) has analysed this knowledge at the roots of common sense as "tacit knowledge." It is based on processes of Gestalt formation that enable us to grasp unified wholes through their constituting elements without still being aware of the latter. Thus, we understand the facial expression of others immediately but cannot tell from which details. Or we know how [End Page 323] to waltz without knowing the single movements or being able to explain it. Tacit knowledge implies all the taken-for-granted that we have forgotten once it has become our second nature and part of our bodily habits. It is mainly based on the neuronal coupling of single sensori-motor units by repeated perception or action. This unconscious knowing has only recently come to be explored by psychology under the heading of "implicit" or "procedural memory" (Schacter 1987, 1996). It contains familiar styles or "melodies" of moving, perceiving, and being-with-others in which our whole bodily and emotional experience is engaged. There is an atmospheric, "felt" quality about them that cannot be analysed into single elements. Implicit knowledge may, therefore, never be wholly expressed by words—it is only realized in the concrete situation. It may only be circumscribed by expressions such as "how it feels...," "how it is...," e.g., how it is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 195-198 [Access article in PDF] Implicit and Explicit Temporality Thomas Fuchs Keywords implicit/explicit temporality, embodiment, intersubjectivity, desynchronization, melancholia, schizophrenia Since Minkowski (1970), Strauss (1966), v. Gebsattel (1954), and Tellenbach (1980), temporality has been a main subject of phenomenological psychiatry. Drawing on philosophical concepts of Bergson, Husserl, and Heidegger, these authors have analyzed psychopathologic deviations of time experience, mainly from an individual point of (...) view, for example, as a slowing down or inhibition of lived time in depression or obsessive–compulsive disorder. Their analyses are still most valuable today, but may be carried further by introducing concepts such as embodied and intersubjective temporality into psychopathology. Martin Wyllie (2005), by opening up a wide scope of temporal phenomena and related concepts, makes a laudable effort to contribute to such a progress.In my commentary, I would like to propose a distinction that is suggested by much of Wyllie's analysis and may shed further light on psychopathology, namely between implicit and explicit temporality. If we look at a child while obliviously playing with his toys, lost to the world, we may assume that there is no sense of the time passing. Lived time runs with the movement of life, implicit in the child's experience of being engaged in his play and directed toward his goals. It "unfolds through the processes of bodily activity" (Wyllie 2005). Future and past do not stand out against the pure presence of "becoming." This implicit mode of temporality is retrieved every time that we are absorbed in what we are doing, and may even reach the climax of "flow experiences" (Csikszentmihalyi 1988) where the sense of time is lost in unimpeded, fluent performance.However, this changes when a gap arises between need and satisfaction, desire and fulfillment, or plan and execution. Now the future appears as a "not yet" or "yet to come," experienced as the temporality of awaiting, striving, or longing for. Time is felt as passing by and refusing the desired fulfillment; it becomes conscious or explicit. A similar gap arises between the present and something irretrievably lost, bringing the past to consciousness as a "no more." Again time is experienced explicitly, but now as moving on relentlessly and separating us from the lost object. The gap to the past may not be bridged any more: this is the temporality of missing or mourning. In both cases, explicit time arises as a negation of implicit or lived time (here my use of the term is a bit divergent from Wyllie's); it is experienced as a "not yet" or "no more," often with a component of displeasure or suffering (Fuchs 2001a, 2003)."Implicit" versus "explicit time" thus come near to another distinction well known in phenomenology, namely between the "lived" and [End Page 195] the "corporal body" (Leib versus Koerper). The first term refers to the body functioning in the tacit mode, as the medium of everyday performance. The second term points to the body as turning into the object of attention, for example, when it puts up resistance to our purposes, or is used as an instrument deliberately (Fuchs 2001b). In fact, implicit temporality and tacit performance of the body are nearly synonymous: Lived time may be regarded as a function of the lived body, opened up by its potentiality and capability. The more we are engaged in our tasks, the more we forget time as well as the body; we are, as it were, "inside time." On the other hand, in explicit temporality the body often appears in the corporal or explicit mode as well. For example, when falling ill, we experience our body no more as a tacit medium but rather as an object or obstacle, while we notice the slowing down of time and may even feel excluded from the movement of life. Thus, embodiment and temporality have a parallel background–foreground structure.I now try to carry these considerations further by including the intersubjective dimension of time. In an earlier paper, I describe the attunement of the living being to its environment as a continuous synchronization on the biological as... (shrink)

Reason and Value collects 15 new papers by leading contemporary philosophers on themes from the work of Joseph Raz. Raz has made major contributions in a wide range of areas, including jurisprudence, political philosophy, and the theory of practical reason; but all of his work displays a deep engagement with central themes in moral philosophy. The subtlety and power of Raz's reflections on ethical topics make his writings a fertile source for anyone working in this area. Especially significant are his (...) explorations of the connections between practical reason and the theory of value, which constitute a sustained and penetrating treatment of a set of issues at the very center of moral philosophy as it is practiced today. The contributors to the volume acknowledge the importance of Raz's contributions by engaging critically with his positions and offering independent perspectives on the topics that he has addressed. The volume aims both to honour Raz's accomplishments in the area of ethical theorizing, and to contribute to an enhanced appreciation of the significance of his work for the subject. (shrink)