ZusammenfassungDie jüngste höchstrichterliche Rechtsprechung zur Selbstbestimmung der Patienten und zur Normierung medizinischer Handlungen am Lebensende hat eine intensive Debatte ausgelöst. Das Urteil und die akademisch vorgetragene Kritik werden einer grundlegenden medizinethischen Analyse unterworfen. Sie betrifft die objektive Eingrenzung der Zulässigkeit einer Behandlungsbegrenzung und die Subsumtion des Wachkomas als irreversibel tödliches Grundleiden, das ärztliche Ermessen bei der Indikationsstellung, die normative Einordnung einer Ernährungstherapie am Lebensende und die Verbindlichkeit von Patientenverfügungen. Die medizinethische Kritik offenbart eine unzureichende Wahrnehmung medizinischer und medizinethischer professioneller Dokumente (...) und den Rückgriff auf medizinethisch veraltete Konzeptionen der Sterbehilfe durch das Gericht. Die Folge ist eine fehlerhafte Subsumtion der Wachkomapatienten in die Kategorie irreversibel tödlicher Erkrankungen und eine inhaltliche Schwächung der Verbindlichkeit von Patientenverfügungen. Beides bedarf dringend der Korrektur. (shrink)

Die jüngste höchstrichterliche Rechtsprechung zur Selbstbestimmung der Patienten und zur Normierung medizinischer Handlungen am Lebensende hat eine intensive Debatte ausgelöst. Das Urteil und die akademisch vorgetragene Kritik werden einer grundlegenden medizinethischen Analyse unterworfen. Sie betrifft die objektive Eingrenzung der Zulässigkeit einer Behandlungsbegrenzung und die Subsumtion des Wachkomas als irreversibel tödliches Grundleiden, das ärztliche Ermessen bei der Indikationsstellung, die normative Einordnung einer Ernährungstherapie am Lebensende und die Verbindlichkeit von Patientenverfügungen. Die medizinethische Kritik offenbart eine unzureichende Wahrnehmung medizinischer und medizinethischer professioneller Dokumente (...) und den Rückgriff auf medizinethisch veraltete Konzeptionen der Sterbehilfe durch das Gericht. Die Folge ist eine fehlerhafte Subsumtion der Wachkomapatienten in die Kategorie irreversibel tödlicher Erkrankungen und eine inhaltliche Schwächung der Verbindlichkeit von Patientenverfügungen. Beides bedarf dringend der Korrektur. (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)

ZusammenfassungDie jüngste höchstrichterliche Rechtsprechung zur Selbstbestimmung der Patienten und zur Normierung medizinischer Handlungen am Lebensende hat eine intensive Debatte ausgelöst. Das Urteil und die akademisch vorgetragene Kritik werden einer grundlegenden medizinethischen Analyse unterworfen. Sie betrifft die objektive Eingrenzung der Zulässigkeit einer Behandlungsbegrenzung und die Subsumtion des Wachkomas als irreversibel tödliches Grundleiden, das ärztliche Ermessen bei der Indikationsstellung, die normative Einordnung einer Ernährungstherapie am Lebensende und die Verbindlichkeit von Patientenverfügungen. Die medizinethische Kritik offenbart eine unzureichende Wahrnehmung medizinischer und medizinethischer professioneller Dokumente (...) und den Rückgriff auf medizinethisch veraltete Konzeptionen der Sterbehilfe durch das Gericht. Die Folge ist eine fehlerhafte Subsumtion der Wachkomapatienten in die Kategorie irreversibel tödlicher Erkrankungen und eine inhaltliche Schwächung der Verbindlichkeit von Patientenverfügungen. Beides bedarf dringend der Korrektur. (shrink)

ZusammenfassungDie jüngste höchstrichterliche Rechtsprechung zur Selbstbestimmung der Patienten und zur Normierung medizinischer Handlungen am Lebensende hat eine intensive Debatte ausgelöst. Das Urteil und die akademisch vorgetragene Kritik werden einer grundlegenden medizinethischen Analyse unterworfen. Sie betrifft die objektive Eingrenzung der Zulässigkeit einer Behandlungsbegrenzung und die Subsumtion des Wachkomas als irreversibel tödliches Grundleiden, das ärztliche Ermessen bei der Indikationsstellung, die normative Einordnung einer Ernährungstherapie am Lebensende und die Verbindlichkeit von Patientenverfügungen. Die medizinethische Kritik offenbart eine unzureichende Wahrnehmung medizinischer und medizinethischer professioneller Dokumente (...) und den Rückgriff auf medizinethisch veraltete Konzeptionen der Sterbehilfe durch das Gericht. Die Folge ist eine fehlerhafte Subsumtion der Wachkomapatienten in die Kategorie irreversibel tödlicher Erkrankungen und eine inhaltliche Schwächung der Verbindlichkeit von Patientenverfügungen. Beides bedarf dringend der Korrektur. (shrink)

ZusammenfassungIm Gesetzentwurf des Bundesrates zur Änderung des Betreuungsrechts ist eine regelhafte Stellvertretung durch Angehörige für zur Entscheidung unfähige Patienten vorgesehen. Mithilfe eines strukturierten Fragebogens wurden die Einstellungen von Tumorpatienten, gesunden Kontrollpersonen, Pflegenden und Ärzten zur Präferenz der zu bevollmächtigenden Personen ermittelt. Nur 10–20% der Befragten haben eine Patientenverfügung verfasst. Als Entscheidungbefugte im Falle akuter Erkrankung werden Angehörige und Ärzte gemeinsam genannt. Als Gesundheitsbevollmächtigte werden Ehepartner/lebenspartner bevorzugt und nichtangehörige Personen nur von einer Minderheit genannt. Die grundsätzliche Bereitschaft, als Gesundheitsbevollmächtigte Verantwortung zu (...) übernehmen, ist hoch, erstreckt sich jedoch überwiegend auf Angehörige. Nur Ärzte sind in bis zu 50% auch für nichtangehörige Personen bereit, als Bevollmächtigte zu entscheiden. Die regelhafte Stellvertretung in Gesundheitsfragen durch Angehörige entspricht den Wünschen der Mehrheit von Tumorpatienten, gesunden Vergleichspersonen und medizinischem Personal. (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)

Diminishing resources seem to be forcing rationing of medical services. Rationing the public health care system means that there needs to be ethical discussion on justice. Several years before resource allocation could impact on the levels of morbidity and mortality, economic problems created numerous methods of regulating medical and nursing services. In clinical practice, regularisation means a reduction of the possibility to decide autonomously and therefore requires specific ethical discussion. The different methods of regularisation from standards and quality control to (...) managed care are discussed with respect to their influence on medical thinking and decision making. Formalised decisions in severe disease can also be a field for regularisation, for example guidelines on the termination of life sustaining treatment (vs. Do-Not-Attempt-Resuscitation Orders). The debate on futility is discussed as a part of the economic discussion, with special regard to the impact of the macroeconomic situation on ”peripheral” medical decisions, which very often are made unconsciously, as shown by a new German study. It is impossible to discuss the influence of macroeconomy, different attempts at regularisation and the individual decision of the doctor without reflecting on their principle interdependency. Ethical reflection in this field cannot be sectioned into an economic, medical decision-making and futility sections. (shrink)

Empirical research has proven the influence exerted by the medical industry on physicians’ decision-making. Physicians are the gatekeepers who determine how money is spent within the healthcare system. Hence, they are the target group of powerful lobbies in the field, i.e. the manufacturers of medical devices and the pharmaceutical industry. As clinical research lies in the hands of physicians, they play an exclusive and central role in launching new medical products. There are many ethical problems involved here: physicians may develop (...) a mindset of entitlement; biased decisions may put patients at risk; academic interests and research activities will no longer be free if they are influenced considerably by financial incentives; fair resource allocation may be restricted. An aspect that has been neglected so far is the administrators’ involvement as they not rarely expect physicians to acquire external financial resources from industry as benefits often lie with the institutions. To “protect” physicians from undue sway may be in the best interest of patients in order to guarantee a fair allocation of resources and to prevent the application of technologies (and medications) that would not have been used according to current standards of care. The latter may and obviously does put patients at risk. On the other hand, medico–industrial relations are of great importance. A considerable part of medical progress is driven by private industry. Yet, any co-operation between those who care for patients and industry ultimately has to serve the patient. Hence, strong policies to guide conduct are sorely needed. The following points are held to be pivotal in order to secure ethical conduct: (1) professional codes of ethics; (2) a stronger academic attitude amongst medical staff, (3) rules of transparency for medico−industrial relations including online disclosure and limiting scale of payments, (4) establishing rules (and laws) that ban unethical conduct and mandate vigorous surveillance of adherence to guidelines. (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)

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)

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)

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)

Bayesian epistemology addresses epistemological problems with the help of the mathematical theory of probability. It turns out that the probability calculus is especially suited to represent degrees of belief (credences) and to deal with questions of belief change, confirmation, evidence, justification, and coherence. Compared to the informal discussions in traditional epistemology, Bayesian epis- temology allows for a more precise and fine-grained analysis which takes the gradual aspects of these central epistemological notions into account. Bayesian epistemology therefore complements traditional epistemology; it (...) does not re- place it or aim at replacing it. (shrink)

Among the questions to be raised under the heading of “personal identity” are these: “What are we?” (fundamental nature question) and “Under what conditions do we persist through time?” (persistence question). Against the dominant neo-Lockean approach to these questions, the view known as animalism answers that each of us is an organism of the species Homo sapiens and that the conditions of our persistence are those of animals. Beyond describing the content and historical background of animalism and its rivals, this (...) entry explores some of the arguments for and objections to this controversial account of our nature and persistence. (shrink)

This comprehensive new book introduces the core history of phenomenology and assesses its relevance to contemporary psychology, philosophy of mind, and cognitive science. From critiques of artificial intelligence research programs to ongoing work on embodiment and enactivism, the authors trace how phenomenology has produced a valuable framework for analyzing cognition and perception, whose impact on contemporary psychological and scientific research, and philosophical debates continues to grow. The first part of _An Introduction to Phenomenology_ is an extended overview of the history (...) and development of phenomenology, looking at its key thinkers, focusing particularly on Husserl, Heidegger and Merleau-Ponty, as well as its cultural and intellectual precursors. In the second half Chemero and Käufer turn their attention to the contemporary interpretations and uses of phenomenology in cognitive science, showing that phenomenology is a living source of inspiration in contemporary interdisciplinary studies of the mind. Käufer and Chemero have written a clear, jargon-free account of phenomenology, providing abundant examples and anecdotes to illustrate and to entertain. This book is an ideal introduction to phenomenology and cognitive science for the uninitiated, as well as for philosophy and psychology students keen to deepen their knowledge. (shrink)

What are we? What is the nature of the human person? Animalism has a straightforward answer to these long-standing philosophical questions: we are animals. After being ignored for a long time in philosophical discussions of our nature, this idea has recently gained considerable support in metaphysics and philosophy of mind. Containing mainly new papers as well as two highly important articles that were recently published elsewhere, this volume's contributors include both emerging voices in the debate and many of those who (...) have been instrumental in shaping it. Some of their contributions defend animalism, others criticize it, still others explore its more general implications. The book also contains a substantial introduction by the editors explaining what animalism is, identifying leading issues that merit attention, and highlighting many of the issues that the contributors have raised. (shrink)

The relation of global supervenience is widely appealed to in philosophy. In slogan form, it is explained as follows: a class of properties A supervenes on a class of properties B if no two worlds differ in the distribution of A-properties without differing in the distribution of B-properties. It turns out, though, that there are several ways to cash out that slogan. Three different proposals have been discussed in the literature. In this paper, I argue that none of them is (...) adequate. Furthermore, I present a puzzle that reveals a tension in our concept of global supervenience. (shrink)

The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.

This entry sketches the theory of personal identity that has come to be known as animalism. Animalism’s hallmark claim is that each of us is identical with a human animal. Moreover, animalists typically claim that we could not exist except as animals, and that the (biological) conditions of our persistence derive from our status as animals. Prominent advocates of this view include Michael Ayers, Eric Olson, Paul Snowdon, Peter van Inwagen, and David Wiggins.

This book successfully achieves to serve two different purposes. On the one hand, it is a readable physics-based introduction into the philosophy of science, written in an informal and accessible style. The author, himself a professor of physics at the University of Notre Dame and active in the philosophy of science for almost twenty years, carefully develops his metatheoretical arguments on a solid basis provided by an extensive survey along the lines of the historical development of physics. On the other (...) hand, this book supplies one long argument for Cushing´s own attitude in the philosophy of science. While former studies of the author, from which this book draws in part, focused each on one special episode in the history of science, this book gathers case material from many different parts of physics and epochs. The main goal of this book is ”to impress upon the reader the essential and ineliminable role that philosophical considerations have played in the actual practice of science” (p. xv). (shrink)

In the opinion of most philosophers, the capacity to entertain I-thoughts is grounded on a basic capacity to self-consciousness. It is because a creature has a concept of herself that she is able to say “I”. The aim of that book is to reverse the order of dependence and to show that the capacity to form I-thoughts is the primitive aptitude that transforms an impersonal consciousness into a Self.

" Le normal a pris la relève de l'ancestral ". C'est en ces termes que Michel Foucault salua l'avènement d'une nouvelle ère, celle des disciplines - moment où les sujets cessent de s'identifier par leurs généalogies et leurs positions dans un système d'alliances, par des mécanismes historico-rituels, mais sont plutôt voués à l'interminable hantise de la norme, à ne plus se connaître et se reconnaître que par le détour de l'altérité de l'anormal : voués à ne ressaisir leur identité et (...) à n'être auprès d'eux-mêmes qu'au plus proche du spectre inquiétant de ce tout autre qu'ils repoussent au plus loin. Alors, l'enfance de l'homme n'est plus la mémoire de son innocence perdue, mais la forme première de son insoumission ; le primitif n'est plus celui qui, depuis l'autre rive d'un quelconque voyage, lui fait signe vers le mirage de sa bonté native, mais celui qui indique, sous les espèces de la plus honteuse barbarie, le danger qu'il représente pour sa propre race ; et la folie n'est plus le masque grotesque ou sublime d'un au-delà de la raison, mais le miroir tendu de sa propre faiblesse. Car, si le temps est venu où " l'homme calculable " a remplacé " l'homme mémorable ", il n'en reste pas moins que le travail de la norme ne consiste pas, comme on le croit trop souvent, à produire un effet d'uniformisation sociale, mais fait bien plutôt jouer un complexe système de codage différentiel des conduites, à l'intérieur duquel nous sommes pris et advenons comme sujets. Pour autant qu'il engage notre mode d'être de sujets modernes, il nous appartient donc d'explorer ce code étrange et familier : c'est la tâche que se fixe l'auteur, à partir de l'un des concepts-clé de l'œuvre de Foucault. (shrink)

Nancy Cartwright is one of the most distinguished and influential contemporary philosophers of science. Despite the profound impact of her work, there is neither a systematic exposition of Cartwright’s philosophy of science nor a collection of articles that contains in-depth discussions of the major themes of her philosophy. This book is devoted to a critical assessment of Cartwright’s philosophy of science and contains contributions from Cartwright's champions and critics. Broken into three parts, the book begins by addressing Cartwright's views on (...) the practice of model building in science and the question of how models represent the world before moving on to a detailed discussion of methodologically and metaphysically challenging problems. Finally, the book addresses Cartwright's original attempts to clarify profound questions concerning the metaphysics of science. With contributions from leading scholars, such as Ronald N. Giere and Paul Teller, this unique volume will be extremely useful to philosophers of science the world over. (shrink)

Despite widespread support for the claim that death can harm the one who dies, debate continues over how to rescue this harm thesis (HT) from Epicurus’s challenge. Disagreements focus on two of the three issues that any defense of HT must resolve: the subject of death’s harm and the timing of its injury. About the nature of death’s harm, however, a consensus has emerged around the view that death harms a subject (when it does) by depriving her of the goods (...) life would’ve afforded had she continued living. This deprivation view of death’s harm (DV) derives some of its credibility from the general deprivation theory of which it is an instance: mortal harm is subject to the same kind of analysis plausibly given of other non-mortal harms. Furthermore, note that the weak formulation of HT—asserting only that death can inflict harm, not that it always or necessarily does—accommodates the intuition that instances of rational suicide and justifiable euthanasia present cases in which death fails to harm. DV is equipped to explain how in these cases the harms involved in continued existence outweigh the goods of which death deprives the subject. I agree that suicide can be rational and that euthanasia can be justifiable. Likewise I accept both HT and DV as far as they go. But they do not go far enough. Specifically, I argue here that death harms even those who die as a result of rational suicide or justifiable euthanasia; that death’s harm is neither undifferentiated nor wholly contingent, but multifaceted and partly necessary; that the necessary part of death’s harm is distinctive, inflicting a peculiar restriction on the autonomy of one who dies; and, regarding the timing and subject issues, that this restriction harm is inflicted on the antemortem subject prior to her death. (shrink)

Why is there a specific problem with biological individuality? Because the living realm contains a wide range of exotic particular concrete entities that do not easily match our ordinary concept of an individual. Slime moulds, dandelions, siphonophores are among the Odd Entities that excite the ontological zeal of the philosophers of biology. Most of these philosophers, however, seem to believe that these Odd Cases oblige us to refine or revise our common concept of an individual. They think, explicitly or tacitly, (...) that to be a living, evolutionary entity is to be a living individual. In this paper, we explore an alternative proposal: the variety and oddity of the forms of the living realm might be ontologically regimented through an increase in the categorial complexity of the living realm, by admitting, beside living individuals, living non-individuals or by acknowledging, more generally, that the evolutionary development of the living forms is not necessarily a process of building individuals, that life is not necessarily individuals-oriented. We claim that, from an ontological point of view, the spectacle of the living realm obliges us to take aggregativity seriously. (shrink)

This study examined narrative identity in a group of 81 patients with schizophrenia and 50 healthy controls through the recall of self-defining memories. The results indicated that patients’ narratives were less coherent and elaborate than those of controls. Schizophrenia patients were severely impaired in the ability to make connections with the self and extract meaning from their memories, which significantly correlated with illness duration. In agreement with earlier research, patients exhibited an early reminiscence bump. Moreover, the period of the reminiscence (...) bump, which is highly relevant for identity development, was characterized by fewer achievements and more life-threatening event experiences, compared with controls. A negative correlation was found between negative symptoms, number of self-event connections and specificity of narratives. Our results suggest that schizophrenia patients have difficulties to organize and extract meaning from their past experiences in order to create coherent personal narratives. (shrink)

The view known as animalism asserts that we are human animals—that each of us is an instance of the Homo sapiens species. The standard argument for this view is known as the thinking animal argument . But this argument has recently come under attack. So, here, a new argument for animalism is introduced. The animal ancestors argument illustrates how the case for animalism can be seen to piggyback on the credibility of evolutionary theory. Two objections are then considered and answered.

Advance directives are propagated as instruments to maintain patients’ autonomy in case they can no longer decide for themselves. It has been never been examined whether patients’ and healthy persons themselves are inclined to adhere to these documents. Patients’ and healthy persons’ views on whether instructions laid down in advance directives should be followed because that is (or is not) “the right thing to do”, not because one is legally obliged to do so, were studied and compared with that of (...) medical staff. Method: Vignette study presenting five cases. Cancer patients, healthy persons, nursing staff and physicians (n = 100 in each group) were interviewed. An adherence score was calculated (maximum value 5). The adherence score is found to be low in all groups, yet lowest in patients (1.55; standard deviation 1.13) and healthy controls (1.60; 1.37). The scores are significantly different between nursing staff on the one hand and patients and healthy controls on the other (p < 0.005 and p < 0.05, respectively), and between doctors and patients (p < 0.05). Interviewees who want these documents to be followed tend to live alone and to have already written an advance directive. Conclusions: Cancer patients and healthy persons widely disregard instructions laid down in advance directives and consider them less binding than physicians and nursing staff do. Only a minority tends to adhere more to advance directives. To improve decision-making at the end of life when patients are no longer able to decide for themselves alternative concepts, such as advanced care planning, should be considered. (shrink)

In the past decade well-designed research studies have shown that the practice of collaborative philosophical inquiry in schools can have marked cognitive and social benefits. Student academic performance improves, and so too does the social dimension of schooling. These findings are timely, as many countries in Asia and the Pacific are now contemplating introducing Philosophy into their curricula. This paper gives a brief history of collaborative philosophical inquiry before surveying the evidence as to its effectiveness. The evidence is canvassed under (...) two categories: schooling and thinking skills; and schooling, socialisation and values. In both categories there is clear evidence that even short-term teaching of collaborative philosophical inquiry has marked positive effects on students. The paper concludes with suggestions for further research and a final claim that the presently-available research evidence is strong enough to warrant implementing collaborative philosophical inquiry as part of a long-term policy. (shrink)

The elucidations and regimentations of grounding offered in the literature standardly take it to be a necessary connection. In particular, authors often assert, or at least assume, that if some facts ground another fact, then the obtaining of the former necessitates the latter; and moreover, that grounding is an internal relation, in the sense of being necessitated by the existence of the relata. In this article, I challenge the necessitarian orthodoxy about grounding by offering two prima facie counterexamples. First, some (...) physical facts may ground a certain phenomenal fact without necessitating it; and they may co-exist with the latter without grounding it. Second, some instantiations of categorical properties may ground the instantiation of a dispositional one without necessitating it; and they may co-exist without grounding it. After arguing that these may be genuine counterexamples, I ask whether there are modal constraints on grounding that are not threatened by them. I propose two: that grounding supervenes on what facts there are, and that every grounded fact supervenes on what grounds there are. Finally, I attempt to provide a rigorous formulation of the latter supervenience claim and discuss some technical questions that arise if we allow descending grounding chains of transfinite length. (shrink)

ABSTRACT: Confronted with the “wrong kind of reason problem”, several proponents of the fitting attitude analysis of emotional values have argued in favor of an epistemic approach. In such a view, an emotion fits its object because the emotion is correct. However, I argue that we should reorient our search towards a practical approach because only practical considerations can provide a satisfying explanation of the fittingness of emotional responses. This practical approach is partially revisionist, particularly because it is no longer (...) an analysis of final value and because it is relativistic. (shrink)

A commonly held idea regarding the nature of time is that the future is open and the past is fixed or closed. This article investigates the notion that there is an asymmetry in openness between the past and the future. The following questions are considered: How exactly is this asymmetry in openness to be understood? What is the relation between an open future and various ontological views about the future? Is an open future a branching future? What is the relation (...) between an open future and the question of whether contingent statements about the future are true or false? Is an open future compatible with a single determinate future? (shrink)

I suggest a way of extending Stalnaker’s account of assertion to allow for centered content. In formulating his account, Stalnaker takes the content of assertion to be uncentered propositions: entities that are evaluated for truth at a possible world. I argue that the content of assertion is sometimes centered: the content is evaluated for truth at something within a possible world. I consider Andy Egan’s proposal for extending Stalnaker’s account to allow for assertions with centered content. I argue that Egan’s (...) account does not succeed. Instead, I propose an account on which the contents of assertion are identified with sets of multi-centered worlds. I argue that such a view not only provides a plausible account of how assertions can have centered content, but also preserves Stalnaker’s original insight that successful assertion involves the reduction of shared possibilities. (shrink)

We provide a simple translation of the satisfiability problem for regular grammar logics with converse into GF2, which is the intersection of the guarded fragment and the 2-variable fragment of first-order logic. The translation is theoretically interesting because it translates modal logics with certain frame conditions into first-order logic, without explicitly expressing the frame conditions. It is practically relevant because it makes it possible to use a decision procedure for the guarded fragment in order to decide regular grammar logics with (...) converse. The class of regular grammar logics includes numerous logics from various application domains. A consequence of the translation is that the general satisfiability problem for every regular grammar logics with converse is in EXPTIME. This extends a previous result of the first author for grammar logics without converse. Other logics that can be translated into GF2 include nominal tense logics and intuitionistic logic. In our view, the results in this paper show that the natural first-order fragment corresponding to regular grammar logics is simply GF2 without extra machinery such as fixed-point operators. (shrink)

We provide a simple translation of the satisfiability problem for regular grammar logics with converse into GF2, which is the intersection of the guarded fragment and the 2-variable fragment of first-order logic. The translation is theoretically interesting because it translates modal logics with certain frame conditions into first-order logic, without explicitly expressing the frame conditions. It is practically relevant because it makes it possible to use a decision procedure for the guarded fragment in order to decide regular grammar logics with (...) converse. The class of regular grammar logics includes numerous logics from various application domains. A consequence of the translation is that the general satisfiability problem for every regular grammar logics with converse is in EXPTIME. This extends a previous result of the first author for grammar logics without converse. Other logics that can be translated into GF2 include nominal tense logics and intuitionistic logic. In our view, the results in this paper show that the natural first-order fragment corresponding to regular grammar logics is simply GF2 without extra machinery such as fixed-point operators. (shrink)

ABSTRACT: Confronted with the “wrong kind of reason problem”, several proponents of the fitting attitude analysis of emotional values have argued in favor of an epistemic approach. In such a view, an emotion fits its object because the emotion is correct. However, I argue that we should reorient our search towards a practical approach because only practical considerations can provide a satisfying explanation of the fittingness of emotional responses. This practical approach is partially revisionist, particularly because it is no longer (...) an analysis of final value and because it is relativistic. View HTML Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.The FA Analysis of Emotional Values and Practical Reasons*Volume 51, Issue 1Stephane Lemaire DOI: https://doi.org/10.1017/S0012217312000224Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. The FA Analysis of Emotional Values and Practical Reasons*Volume 51, Issue 1Stephane Lemaire DOI: https://doi.org/10.1017/S0012217312000224Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. The FA Analysis of Emotional Values and Practical Reasons*Volume 51, Issue 1Stephane Lemaire DOI: https://doi.org/10.1017/S0012217312000224Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

This article reflects a conversation between Jan G. van der Watt and Stephan Joubert. The article serves as the introduction to the Special Collection: ‘From timely exegesis to contemporary ecclesiology: Relevant hermeneutics and provocative embodiment of faith in a Corona-defined world – Festschrift for Stephan Joubert, sub-edited by Willem Oliver ’. Following a brief bio-statement as introduction, the following issues are discussed: the collection for the Jerusalem church; relevance of theology for society; social-scientific exegesis; the ancient concept of (...) grace; Bible translation in South Africa; public theology on the electronic platform; biblical examples of leadership and electronic media in religious activities and education.Contribution: This Festschrift represents current trends in biblical scholarship and ecclesial leadership. It contributes to the public discourse in church and society, especially the role of the electronic media in current Fourth Industrial Revolution. (shrink)