Clinical ethics support (CES) for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria (CEGD) at Amsterdam University Medical Center. We specifically aimed to integrate CES (...) into daily work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

BackgroundClinical ethics support aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.MethodsThis integrative approach was developed in an iterative process, combining actual experiences in a case study (...) in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.ResultsIn this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.ConclusionsIn the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Gerhard Kruger (1902-1972) konnte seine philosophiegeschichtlichen Untersuchungen nicht zum Abschluss bringen. Dieses Manuskript uas dem Nachlass stellt radikal die Frage nach der Geschichtlichkeit, die nach Kruger in dem Satz gipfelt: Wir leben in einer Zeit totaler Geschichtlichkeit. Ein Vorwort von Richard Schaeffler eroffnet den Zugang zu Gerhard Krugers Denken.

Menschenaffen erganzen ihr Instinkt- und Triebleben positivistisch durch individuelle Intelligenz, Sozialitat und Kulturalitat.

1. Im Angesicht der Zeit.--2. Im Umkreis der Kunst.--3. Im Horizont des Absoluten.

One of the reasons for this is that Schelling's most significant work on this subject, Urfassung der Philosophie der Offenbarung, was not published until 1992.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 17-21 [Access article in PDF] Self-Injury:Symbolic Sacrifice/Self-Assertion Renders Clinicians Helpless Christa Krüger Keywords feminism, iconic communication, moral conflict, oppression, psychiatrist/psychologist roles, societal norms. POTTER'S PAPER CONSIDERS self-injury in women diagnosed with borderline person ality disorder (BPD) to be a form of body modification where the body is used to communicate meaning. She touches on symbolism as a possible explanatory theory for this sort (...) of self-injury. She also refers to the culture of body commodification as underlying self-injury. She then argues that clinicians have a duty to give uptake to the patient's own interpretations about the meaning of the self-injury. Giving uptake is a virtuous approach for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity, along with other benefits. Potter offers five maxims for giving uptake properly. However, I shall argue that giving uptake can be very difficult for clinicians, and that an appreciation of this difficulty depends on an expansion and linkage of some of the theories that she touched on. Self-injury is revisited experimentally as a double-edged sword of symbolic sacrifice and iconic-symbolic self-assertion. This revisiting aims to illustrate how clinicians might be caught in a double bind, where giving uptake properly might be very difficult if not more or less doomed to fail.Potter's paper starts by situating self-injury in a broader discourse of body modifications. In this discourse the body is being used as a text, a tool to communicate meaning. The meaning that is communicated might be difficult or impossible to articulate otherwise (by using words, for example). The meaning of the communication is embedded in a context of social, cultural, religious, political, and other norms. Potter explores possible interpretations of the meaning of self-injury in women with BPD, including an interpretation of self-injury as symbolic sacrifice. She suggests that a cultural understanding/nonunderstanding of the meaning of a particular instance of self-injury is an important determinant of whether such self-injury is considered pathological/nonpathological. She then shifts the focus to the present-day culture in which women's bodies are commodified and objectified, and where women become alienated from their bodies. Self-injury might then be interpreted as an attempt to re-own one's body as a part of oneself. This re-owning is a socially transgressive act that violates repressive norms for the bodies of women. [End Page 17]Notwithstanding these possible significations of self-injury, Potter then argues that clinicians have a duty to give uptake to the patient's own interpretations, instead of jumping to conclusions (my oversimplification) about the meaning of the self-injury. Giving uptake, then, constitutes a framework for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity. Potter offers five maxims for giving uptake properly.At the risk of losing their essence, I translate the five maxims for practicing psychiatrists as involving the following: critical self-reflection about one's own conceptual framework and cultural context; being receptive to the patient's conceptual framework and cultural context; giving the patient the benefit of the doubt; being open to the emergence of new meanings of self-injury; and keeping a range of possible interpretative options open, rather than insisting on having the final word. We should try to understand what the world looks like from the patient's position. All of this requires some moral effort.Potter describes a number of benefits that result from giving uptake. Giving uptake is a crucial corrective to the human tendencies of becoming overly committed to prevailing societal norms and conceptual schemes (stuck in our ways), of imposing our views on others, and of silencing or distorting the communications of our patients. Giving uptake allows clinicians to be dialogically responsive and to treat patients with respect and dignity. Giving uptake fosters trust in a therapeutic relationship where clinicians do not exploit their patients' vulnerabilities. Giving... (shrink)

Abstract John McDowell argues for minimal empiricism via using the notion of second nature of human beings. I should like to invite him to discuss Helmuth Plessner's Philosophical Anthropology in order to elaborate a more substantial conception of second nature. McDowell seems to think that it is adequate for his more epistemological aim to remind us of second nature as though it were to be taken for granted. But I think, following Plessner, that this right reminder needs a therapeutic elaboration (...) in Kant's sense of propaedeutics. What had been called our second nature found itself being questioned in order to limit the range of ways of treating the self we can authorize. (shrink)

In this article the public-theological motives in the film As it is in heaven is analised to demonstrate the film producer Kay Pollack's ideal to communicate through the film that people should live their lives here and now authentically without seeking excuses for being happy. In this article the principles of narratology is applied in the analysis of the film's plot, characterisation, plotted time and narrated spaces. It is also argued that the protagonist in the film can be regarded as (...) a 'Christ-figure' and that the film conveys a 'Christ narrative' in a secularised context. Societal issues such as emotional abuse and violence against children, women, people with disability and animals constitute building blocks of the narrative. Ecclesiastical hypocrisy and outdated sexual values endorsed by the institutional church are replaced by a choir consisting of common people which leads a whole world to sing in harmony. (shrink)

Mitchell: Could we begin by discussing the problem of public art? When we spoke a few weeks ago, you expressed some uneasiness with the notion of public art, and I wonder if you could expand on that a bit.Kruger: Well, you yourself lodged it as the “problem” of public art and I don’t really find it problematic inasmuch as I really don’t give it very much thought. I think on a broader level I could say that my “problem” is (...) with categorization and naming: how does one constitute art and how does one constitute a public? Sometimes I think that if architecture is a slab of meat, then so-called public art is a piece of garnish laying next to it. It has a kind of decorative function. Now I’m not saying that it always has to be that way—at all—and I think perhaps that many of my colleagues are working to change that now. But all too often, it seems the case.Mitchell: Do you think of your own art, insofar as it’s engaged with the commercial public sphere—that is, with advertising, publicity, mass media, and other technologies for influencing a consumer public—that it is automatically a form of public art? Or does it stand in opposition to public art?Kruger: I have a question for you: what is a public sphere which is an uncommercial public sphere? Barbara Kruger is an artist who works with words and pictures. W. J. T. Mitchell, editor of Critical Inquiry, is Gaylord Donnelly Distinguished Professor of English and art at the University of Chicago. (shrink)

This target article presents a theory of human cultural learning. Cultural learning is identified with those instances of social learning in which intersubjectivity or perspective-taking plays a vital role, both in the original learning process and in the resulting cognitive product. Cultural learning manifests itself in three forms during human ontogeny: imitative learning, instructed learning, and collaborative learning – in that order. Evidence is provided that this progression arises from the developmental ordering of the underlying social-cognitive concepts and processes involved. (...) Imitative learning relies on a concept of intentional agent and involves simple perspective-taking. Instructed learning relies on a concept of mental agent and involves alternating/coordinated perspective-taking (intersubjectivity). Collaborative learning relies on a concept of reflective agent and involves integrated perspective-taking (reflective intersubjectivity). A comparison of normal children, autistic children and wild and enculturated chimpanzees provides further evidence for these correlations between social cognition and cultural learning. Cultural learning is a uniquely human form of social learning that allows for a fidelity of transmission of behaviors and information among conspecifics not possible in other forms of social learning, thereby providing the psychological basis for cultural evolution. (shrink)

We cooperate with other people despite the risk of being exploited or hurt. If future artificial intelligence (AI) systems are benevolent and cooperative toward us, what will we do in return? Here we show that our cooperative dispositions are weaker when we interact with AI. In nine experiments, humans interacted with either another human or an AI agent in four classic social dilemma economic games and a newly designed game of Reciprocity that we introduce here. Contrary to the hypothesis that (...) people mistrust algorithms, participants trusted their AI partners to be as cooperative as humans. However, they did not return AI's benevolence as much and exploited the AI more than humans. These findings warn that future self-driving cars or co-working robots, whose success depends on humans' returning their cooperativeness, run the risk of being exploited. This vulnerability calls not just for smarter machines but also better human-centered policies. (shrink)

The goal of the present volume is to discuss the notion of a 'conceptual framework' or 'conceptual scheme', which has been dominating much work in the analysis and justification of knowledge in recent years. More specifi cally, this volume is designed to clarify the contrast between two competing approaches in the area of problems indicated by this notion: On the one hand, we have the conviction, underlying much present-day work in the philosophy of science, that the best we can hope (...) for in the justifi cation of empirical knowledge is to reconstruct the conceptual means actually employed by science, and to develop suitable models for analyzing conceptual change involved in the progress of science. This view involves the assumption that we should stop taking foundational questions of epistemology seriously and discard once and for all the quest for uncontrovertible truth. The result ing program of justifying epistemic claims by subsequently describing patterns of inferentially connected concepts as they are at work in actual science is closely connected with the idea of naturalizing epistemology, with concep tual relativism, and with a pragmatic interpretation of knowledge. On the other hand, recent epistemology tends to claim that no subsequent reconstruction of actually employed conceptual frameworks is sufficient for providing epistemic justification for our beliefs about the world. This second claim tries to resist the naturalistic and pragmatic approach to epistemology and insists on taking the epistemological sceptic seriously. (shrink)