The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians’ duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different in (...) content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany’s recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as “due care” is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care. (shrink)

Objectives: After years of public discussion too little is still known about willingness to accept the idea of writing an advance directive among various groups of people in EU countries. We investigated knowledge about and willingness to accept such a directive in cancer patients, healthy controls, physicians, and nursing staff in Germany.Methods: Cancer patients, healthy controls, nursing staff, and physicians were surveyed by means of a structured questionnaire.Results: Only 18% and 19% of the patients and healthy controls respectively, and 10% (...) of the medical staff had written an advance directive. However, 50–81% of those surveyed indicated that they wished to write one. This intention was associated with deteriorating health . Only 29% of the healthy controls and 43% of the patients knew about the possibility of appointing a health care proxy. A majority in all groups believed that advance directives may influence the course of treatment , yet half of those surveyed in all groups fear that patients could be pressurised into writing an advance directive, and 38–65% thought that relatives could abuse such documents.Conclusions: Only a minority of the participants had written an advance directive and knew about the possibility of authorising a health care proxy. Deteriorating health was associated with increasing willingness to make a directive. Despite a majority belief that advance directives may influence treatment at the end of life, other factors limit their employment, such as fear of abuse. (shrink)

In September 1998 the Bundesrztekammer, i.e., the German Medical Association, published new principles concerning terminal medical care. Even before publication, a draft of these principles was very controversial, and prompted intense public debate in the mass media. Despite some of the critics' suspicions that the principles prepared the way for liberalization of active euthanasia, euthanasia is unequivocally rejected in the principles. Physician-assisted suicide is considered to violate professional medical rules. In leaving aside some of the notions customarily used in the (...) euthanasia debate, e.g., passive euthanasia, the principles emphasize the obligation of physicians to offer and the right of patients to receive palliative care. The principles explicitly list modalities of basic treatment that are indispensable in all cases, such as the obligation to satisfy hunger and thirst. This statement is meant to resolve the dispute on nutrition and hydration at the end of life, as it shifts the focus of care from maintaining physiological parameters to satisfying subjective needs. For patients in a persistent vegetative state, artificial feeding is held to be obligatory. Yet, the principles make reference to recent German jurisdiction which permit the stopping of artificial feeding if it is in accordance with the patient's presumed will. Additionally, the wording concerning this issue is found to remain unclear. Patients' autonomy is strengthened by explicitly welcoming advance directives as a means to ascertain patients' wills. The principles mark some changes compared to earlier documents. They deserve careful analysis and should be considered in the international debate on issues concerning the end of life. (shrink)

Medical practitioners owe much of the significant progress made in the diagnosis and treatment of disease to industrial research. Hence, co-operation between providers of medical services, most notably medical practitioners, and the pharmaceutical industry is in the best interest of patients. Yet, empirical evidence shows how well-directed influence exerted by the pharmaceutical industry impacts physicians’ decision-making. Profit-motivated inducement by the pharmaceutical industry may expose patients to considerable risks. Against what many think to be based on overwhelming evidence, Joao Calinas-Correia takes (...) the view that the criticism levelled at the pharmaceutical industry as well as the call for transparency in the relationships between physicians and the industry are exaggerated. In his polemic he praises “Big Pharma” as a success and espouses the view that the undesired consequences of its activities are allegedly inherent in the underlying market environment shaped by politics. Moreover, he believes that the proposals made to control and eliminate such undesired effects will lead to mediocrity. Astonishingly, his polemic reaches out to contest the appropriateness of setting rules at all—even if being set by a democratic process. Calinas-Correia’s assertions are based on the wrong premises. They fail to recognize that today individual civil rights and liberties often enough do not have to be defended against encroachments by governmental authorities. Rather, it is incumbent on the state to create rules designed to defend the individual against infringements by overly powerful non-governmental institutions, in our case the medical-industrial complex. Given the power exercised by physicians and the special nature of their role in public health, clear-cut rules have to be enacted and implemented with respect to their relationship to Big Pharma. (shrink)

Medical practitioners owe much of the significant progress made in the diagnosis and treatment of disease to industrial research. Hence, co-operation between providers of medical services, most notably medical practitioners, and the pharmaceutical industry is in the best interest of patients. Yet, empirical evidence shows how well-directed influence exerted by the pharmaceutical industry impacts physicians’ decision-making. Profit-motivated inducement by the pharmaceutical industry may expose patients to considerable risks. Against what many think to be based on overwhelming evidence, Joao Calinas-Correia takes (...) the view that the criticism levelled at the pharmaceutical industry as well as the call for transparency in the relationships between physicians and the industry are exaggerated. In his polemic he praises “Big Pharma” as a success and espouses the view that the undesired consequences of its activities are allegedly inherent in the underlying market environment shaped by politics. Moreover, he believes that the proposals made to control and eliminate such undesired effects will lead to mediocrity. Astonishingly, his polemic reaches out to contest the appropriateness of setting rules at all—even if being set by a democratic process. Calinas-Correia’s assertions are based on the wrong premises. They fail to recognize that today individual civil rights and liberties often enough do not have to be defended against encroachments by governmental authorities. Rather, it is incumbent on the state to create rules designed to defend the individual against infringements by overly powerful non-governmental institutions, in our case the medical-industrial complex. Given the power exercised by physicians and the special nature of their role in public health, clear-cut rules have to be enacted and implemented with respect to their relationship to Big Pharma. (shrink)

Background Teamwork in emergency medical services is a very important factor in efforts to improve patient safety. The potential differences of staff gender on communication, patient safety, and teamwork were omitted. The aim of this study is to evaluate these inadequately examined areas. Methods A descriptive and anonymous study was conducted with an online questionnaire targeting emergency physicians and paramedics. The participants were asked about teamwork, communication, patient safety and handling of errors. Results Seven hundred fourteen prehospital professionals from all (...) over Germany participated. A total of 65.7% of the women harmed a patient (men 72.9%), and 52.6% were ashamed when mistakes were made (men 31.7%). 19.0% of the female participants considered their communication skills to be very good, compared to 81% of the men. More women than men did not want to appear incompetent (28.4%, 15.5%) and therefore did not speak openly about mistakes. Both genders saw the character of their colleagues as a reason for poor team communication (women 89.4%, men 84.9.%). Under high stress, communication decreased (women 35.9%, men 31.0%) and expression became inaccurate (women 18.7%, men 20.1%). Conclusions Team communication problems and teamwork in rescue services are independent of gender. Women seem to have more difficulty with open communication about mistakes because they seem to be subject to higher expectations. Work organization should be adapted to women’s needs to enable more effective error management. We conclude that it is necessary to promote a positive error and communication culture to increase patient safety. (shrink)

Background Teamwork in emergency medical services is a very important factor in efforts to improve patient safety. The potential differences of staff gender on communication, patient safety, and teamwork were omitted. The aim of this study is to evaluate these inadequately examined areas. Methods A descriptive and anonymous study was conducted with an online questionnaire targeting emergency physicians and paramedics. The participants were asked about teamwork, communication, patient safety and handling of errors. Results Seven hundred fourteen prehospital professionals from all (...) over Germany participated. A total of 65.7% of the women harmed a patient (men 72.9%), and 52.6% were ashamed when mistakes were made (men 31.7%). 19.0% of the female participants considered their communication skills to be very good, compared to 81% of the men. More women than men did not want to appear incompetent (28.4%, 15.5%) and therefore did not speak openly about mistakes. Both genders saw the character of their colleagues as a reason for poor team communication (women 89.4%, men 84.9.%). Under high stress, communication decreased (women 35.9%, men 31.0%) and expression became inaccurate (women 18.7%, men 20.1%). Conclusions Team communication problems and teamwork in rescue services are independent of gender. Women seem to have more difficulty with open communication about mistakes because they seem to be subject to higher expectations. Work organization should be adapted to women’s needs to enable more effective error management. We conclude that it is necessary to promote a positive error and communication culture to increase patient safety. (shrink)

This comprehensive and important volume includes contributions by activists, journalists, lawyers and scholars from twenty-one countries. The essays map the directions the movement for women's rights is taking--and will take in the coming decades--and the concomittant transformation of prevailing notions of rights and issues. They address topics such as the rapes in former Yugoslavia and efforts to see that a War Crimes Tribunal responds; domestic violence; trafficking of women into the sex trade; the persecution of lesbians; female genital mutilation; and (...) reproductive rights. (shrink)

Sally Sedgwick presents a fresh account of Hegel's critique of Kant's theoretical philosophy. She argues that Hegel offers a compelling critique of and alternative to the conception of cognition that Kant defended in his 'Critical' period, and explores Hegel's claim to derive from Kantian doctrines clues to a superior form of idealism.

Review of Primary Ousia: An Essay on Aristotle's Metaphysics Z and H, by Michael J. Loux (Cornell University Press: 1991).

This study investigates the variations in the quality and comprehensiveness of 104 corporate social responsibility reports published by the world’s largest financial institutions in 2012. Using a novel measure of CSR report quality, we examine the impact of certain national, legal, and firm-level factors that might explain differences in the overall quality and extent of coverage of various issues in these reports. Our findings show that legal factors and CSR environment in a firm’s country of headquarters play an important role (...) in firms’ CSR reporting quality. Common law countries exhibit systematically higher overall CSR reporting quality than code law countries. Countries with higher CSR standards, policies, and regulations in place also produce significantly higher quality CSR reports. Firm size, on the other hand, has no major impact on the overall quality of CSR reports. In further analysis of the individual aspects of CSR disclosures, namely environment, philanthropy, bribery and corruption, and integrity assurance, we document that larger firms report at a higher quality on philanthropy and bribery and corruption. Bribery and corruption is reported at a higher quality in countries with common law tradition, high-quality legal regimes, and high CSR standards and regulations in place. We also observe higher quality integrity assurance in common law countries. CSR-minded countries and countries with low-quality legal environment also report on philanthropy at a higher quality. Finally, we offer guidelines for companies toward improving the quality of their reports, and suggestions for scholars and researchers for further avenues of research. (shrink)

A brief presentation of the major conclusions contained in the recently published monograph entitled "The Ascent to Law: Searches and Solutions," written over a period of many years. Chapter headings are: The law - an objective reality. The dogma of the law. The drama of scholarship. Searching. "The entire" substance of the law. Juridical constructs. The logic of laws. The secret of the law. Law - the highest purpose. Law in the life and fate of mankind.

The purpose of the present study was to address the shortcomings of Cronbach’s alpha concerning the semantic overlap between items. Using an example from a motivational measure, the correction of Cronbach’s alpha was applied by partialing out the effects due to conceptual overlap. The significance of Cronbach’s alpha was tested using simulated random data derived from the measure and by estimating the confidence intervals with known and unknown distributions. The results indicated that the uncorrected conceptual overlap coefficient alpha was equal (...) to 0.89 and 0.66 following the correction. After simulating the corrected statistical results, the distribution of alpha with random numbers had an estimate of 95%, equal to 0.41. The lower bound of the corrected alpha distribution was equal to 0.41, suggesting that the corrected alpha could easily belong to the distribution of alpha developed from simulated random numbers. Thus, the semantic overlap between items on a measure represents a significant threat to the validity of the alpha coefficient. (shrink)

This paper brings together the work of Nicholas Wolterstorff and William Alston in speech-act theory with the aim of providing a deeper understanding of the nature of divine speaking through the medium of Scripture. Despite the fecundity of Wolterstorff's seminal work on the philosophical theology of Scripture, aspects of his speech-act centric account are underdeveloped and would benefit from the contributions of William Alston. In particular, his account of divine speech-acts could be fruitfully expanded by incorporating the concept of ‘taking (...) responsibility’ that is central to Alston's analysis of the nature of illocutionary acts. This would elucidate both the way in which readers of Scripture encounter divine practical authority in the reading process and the nature of the response of faith that is demanded of them. (shrink)

Several recent papers dealing with Plato's position on the imperfection of the phenomenal world draw heavily on the differences between two kinds of predicates in order to show the following: In the middle dialogues, Plato posits Forms only as referents of what the writers call incomplete predicates. He does not posit Forms as referents for complete predicates. When interpreters ignore the differences between these kinds of predicates, they ascribe too radical a view regarding the imperfection of the phenomenal world to (...) the middle dialogues. The ontology of these dialogues includes sensible particulars which retain their identity over time even though they are continually changing in some respect or other. (shrink)

In this article I seek to explain Hegel’s significance to contemporary meta-ethics, in particular to Kantian constructivism. I argue that in the master–slave dialectic in the Phenomenology of Spirit , Hegel shows that self-consciousness and intersubjectivity arise at the same time. This point, I argue, shows that there is no problem with taking other people’s reasons to motivate us since reflection on our aims is necessarily also reflection on the needs of those around us. I further explore Hegel’s contribution to (...) the debate about internal and external reasons. I end by arguing that we should understand reasons as historically constructed in the sense that who counts as an intrinsic bearer of value changes over time. I thus argue that the struggle for recognition is in fact the beginning of the long march toward the idea of recognition and the Kantian kingdom of ends. This march, however, is driven by the need to overcome injustice as it is instantiated at the beginning of history by the master’s absolute domination of the slave. (shrink)

SummaryAn accurate framework for interpreting Kant's theory of knowledge must clearly distinguish between the six terms he uses to describe the various stages in the epistemological development of the‘object’of knowledge. Kant portrays the object transcendentally in the first Critique as passing from an unknowable‘thing in itself through the intermediate stage of being a‘transcendental object’, and finally attaining the ideal status of an‘appearance’. When the object is considered empirically, it passes through three corresponding stages: the‘phenomenon’is the real object as known in (...) experience, the‘negative noumenon’limits our knowledge to its intuitive manifestation, and the‘positive noumenon’is that aspect of the known object which remains ultimately transcendent. (shrink)

According to Aristotle, Metaphysics 2.3, 995a7–8, there are people who will take seriously the arguments of a speaker only if a poet can be cited as a ‘witness’ in support of them. Aristotle's passing observation sharply reminds us that Greek philosophy had developed within, and was surrounded by, a culture which extensively valued the authority of the poetic word and the poet's ‘voice’ from which it emanated. The currency of ideas, values, and images disseminated through familiarity with poetry had always (...) been a force with which philosophy, in its various manifestations, needed to reckon. As a mode of thought and discourse which proclaimed its aspiration to wisdom, philosophy could not easily eschew some degree of dialogue with an art whose practitioners had traditionally been ranked prominently among the sophoi. Even Aristotle, who keeps aloof from the assumption that philosophical contentions stand in need of poetic support, cites and quotes poetry regularly in his own writings in ways which indicate the influence on him of a prevailing mentality that regarded poets and philosophers as pursuers, up to a point at least, of a common wisdom. (shrink)

According to Aristotle, Metaphysics 2.3, 995a7–8, there are people who will take seriously the arguments of a speaker only if a poet can be cited as a ‘witness’ in support of them. Aristotle's passing observation sharply reminds us that Greek philosophy had developed within, and was surrounded by, a culture which extensively valued the authority of the poetic word and the poet's ‘voice’ from which it emanated. The currency of ideas, values, and images disseminated through familiarity with poetry had always (...) been a force with which philosophy, in its various manifestations, needed to reckon. As a mode of thought and discourse which proclaimed its aspiration to wisdom, philosophy could not easily eschew some degree of dialogue with an art whose practitioners had traditionally been ranked prominently among the sophoi. Even Aristotle, who keeps aloof from the assumption that philosophical contentions stand in need of poetic support, cites and quotes poetry regularly in his own writings in ways which indicate the influence on him of a prevailing mentality that regarded poets and philosophers as pursuers, up to a point at least, of a common wisdom. (shrink)

Frank Ebersole's extraordinary investigations of certain key philosophical ideas behind problems in epistemology and metaphysics are the subject of this article-review. I have resisted providing what many readers will expect me to provide, namely, a critical examination of his philosophical methodology. I do question his unwilligness to say why his investigations only yield I negative results, and I do have something to say about classifying him as an ordinary language philosopher. However, my main focus is on trying to engage critically (...) with what he actually does in his work. To this end, I provide a narrative of the investigation he carries out into the possibility of comparing the objects of perception and dreams, and I cite other works of his in support of my understanding of that investigation. Although one of his lengthiest essays seems to be devoted to an anticipation of an objection to his approach, I explain why even there he is not concerned with the question of why he always seems to get negative results. After suggesting why some of his later essays seem to be so hard to read, I conclude by saying something about what I take to be his achievement. (shrink)

ABSTRACT This article explores the proliferation of “feminine” language in Heidegger's “Die Sprache.” Through a close reading of the text, I trace Heidegger's use of certain terms such as Austragen, gebären, and Schied to show the manner in which Heidegger's reading of Trakl's poem is implicitly guided by a certain understanding of the feminine. I ultimately argue that the ontological difference is understood by Heidegger in terms of the carrying to term and birth of the world that comes about through (...) the intercourse between human beings and things. (shrink)