Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, we (...) introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...) paper, we argue for an approach that adopts the role of ethics consultants as its point of departure. In a first step, we describe empirical and ethical characteristics of evaluating clinical ethical case. We show that the mode of action and the explicit normative character of the interventions constitute two characteristics which pose challenges to the selection of appropriate quality criteria and require special attention. In a second step, we outline the way in which an analysis of the role of ethics consultants in the context of a clinical ethical case consultation services can account for the existing challenges by linking empirically measurable endpoints with normative theory. Finally, we discuss practical implications of our model for evaluation research. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to evaluate (...) clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)

In their national follow-up study on ethics consultation in the U.S., Fox et al. report the worrying finding of a decline in efforts to evaluate ECs. Compared to the findings of Fox et...

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

Zusammenfassung Hintergrund Advance Care Planning (ACP) wird auch in Deutschland zunehmend praktiziert. Aus klinisch-ethischer Perspektive bietet ACP eine Möglichkeit, Vorausverfügungen zu konkretisieren und auf diese Weise die Entscheidungsfindung bei fehlender Selbstbestimmungsfähigkeit von Patient:innen zu unterstützen. Während es für Gesprächsangebote im Sinne des ACP in Pflegeeinrichtungen und Einrichtungen der Eingliederungshilfe seit 2015 Finanzierungsmöglichkeiten gibt und erste Studien zu Angeboten veröffentlich wurden, fehlt es in Deutschland bisher an publizierten Evaluationsstudien zu ACP-Angeboten im Krankenhaus. Intervention und Methoden Im vorliegenden Beitrag erfolgt die strukturierte (...) Darstellung von ACP als ein Element des klinisch-ethischen Unterstützungsangebotes am Universitätsklinikum Halle (Saale) (UKH). Es erfolgte eine quantitative Inhaltsanalyse der schriftlichen Dokumentation von durchgeführten ACP-Gesprächsprozessen für den Zeitraum der Pilotphase von 01/2020 bis 08/2021 (20 Monate). Ergebnisse Im Zeitraum wurden 93 ACP-Gespräche angefragt. Mit 79 Patient:innen konnten 110 Gespräche geführt werden. 46 % der Anfragen kamen von Palliative Care betreuten Patient:innen. Im Durchschnitt dauerten die Beratungen 45 min. Der Gesprächsprozess zur Erstellung einer Patientenverfügung benötigte durchschnittlich 122 min und 2,5 Gespräche. Bei 23 % der Patient:innen endete der ACP-Prozess nach dem Erstgespräch. Die Inhalte der ACP-Prozesse tangierten verschiedene Bereiche anderer Professionen im Krankenhaus, insbesondere die Entscheidungsfindung über aktuelle Diagnostik und Therapie zwischen Ärzt:innen und Patient:innen. Diskussion Die Einführung eines ACP-Angebotes im Krankenhaus zeigt neben einer Vielzahl an Chancen auch Herausforderungen auf, welche es im gemeinsamen Diskurs zu bewältigen gilt. Bei der Einbettung eines ACP-Angebots im Krankenhaus müssen die Besonderheiten der Klinik und insbesondere die Abgrenzung von ACP zu anderen Arbeitsfeldern der Ethikberatung, wie beispielsweise die Ethikfallberatung, bedacht werden. (shrink)

De se attitudes seem to play a special role in action and cognition. This raises a challenge to the traditional way in which mental attitudes have been understood. In this chapter, we review the case for thinking that de se attitudes require special theoretical treatment and discuss various ways in which the traditional theory can be modified to accommodate de se attitudes.

This chapter provides a critical overview of various influential accounts of de se attitudes including those proposed by Frege, Lewis and Perry. It also addresses the charge that there is nothing distinctive about de se attitudes. The second half outlines a widely accepted and influential model of communication and various complications that arise in applying this model to the communication of de se thoughts. The final section provides an overview of the papers in this volume.

Just like humans, animals experience pleasure and pain. Animals can be intelligent, curious, and social, but they can't speak for themselves. So, activists speak out for those that lack basic necessities and suffer mistreatment.

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)

Il ne subsiste aucun vestige de la charpente du temple d’Apollon construit à Delphes durant le ive s. av. J.‑C., ni de bloc comportant des réservations pour l’appui des poutres. En revanche, de nombreux passages des comptes de construction mentionnent des pièces en bois et font état de travaux sur les parties hautes du monument. Nous présentons ici un commentaire de ces inscriptions qui s’articule autour de trois objectifs principaux : déterminer la destination et la fonction des pièces de bois (...) ; analyser le vocabulaire technique ; établir la chronologie des travaux dans les parties hautes du temple. Au‑delà d’une étude centrée sur l’architecture delphique, le corpus mobilisé contribue à la caractérisation des techniques de charpente et à la connaissance du déroulement des chantiers d’architecture monumentale en Grèce ancienne. (shrink)

​Nach der Auffassung Thomas S. Kuhns ist in einer wissenschaftlichen Disziplin, die einen bestimmten Reifegrad erreicht hat, stets genau ein Paradigma vorherrschend, welches die normalwissenschaftliche Entwicklung bestimmt. In diesem Sammelband wird untersucht, ob im Widerspruch zu Kuhn Paradigmenkonstellationen existieren, in denen mehrere Paradigmen über einen langen Zeitraum parallel existieren und unterschiedliche, sich z.T. widersprechende Erklärungsmuster für dieselben Gegenstandsbereiche bereitstellen. Zu diesem Zweck haben die Herausgeber Wissenschaftlerinnen und Wissenschaftler der Soziologie, Physik, Musikpädagogik, Erziehungs-, Politik-, Sprach-, Kultur- und Sportwissenschaft eingeladen, die Paradigmenstrukturen (...) ihrer Wissenschaften anhand eines einheitlichen Begriffsapparates zu analysieren. Es stellt sich heraus, dass sich Kuhns Position als nicht adäquat erweist und durch ein differenzierteres Wissenschaftsverständnis abgelöst werden muss. (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 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.

What happens when competing assertions of validity collide? This question stands at the center of 22 projects being undertaken in various fields as part of the interdisciplinary research project "Transcendence and Shared Meaning." Drawing on empirical examples, the contributions show how transcendence is founded or, alternatively, challenged.

In recent years, the significance of industrial heritage has seemed to become a growing trend in international heritage studies. Concerning their attributed values and the crucial needs for urban development, this branch of cultural heritage has been considered the important grid of cities. This has caused a great acceptance of adaptive reuse practices especially among developing countries which is a smart response to an ongoing debate to reach sustainable development. The flexibility of these buildings and sites seems an important criterion, (...) which can be improved through adaptive reuse practice. Therefore, this research aims to introduce the concept of flexibility in industrial heritage sites, evaluate its criteria among adaptive reuse practices, and make a comprehensive flexibility model for it. Indeed, the final goal is to determine the condition that based on the flexibility model, the adaptive reuse practice would be a proper way of encountering these sites. A historical-interpretation research method, analytical-description techniques, and questionnaire-based interviews are applied in this research. Results indicate that flexibility has genuinely been considered in this practice. Analysing flexibility techniques, this paper suggests a valuable framework to achieve the flexibility of industrial heritage as the presupposition of successful adaptive reuse in these sites. (shrink)

In this paper, I seek to challenge two prevailing views about religious accommodation. The first maintains that religious practices deserve accommodation only if they are regarded as something unchosen on a par with the involuntary circumstances of life people must face. The other view maintains that religious practices are nothing more than preferences but questions the necessity of their accommodation. Against these views, I argue that religious conducts, even on the assumption that they represent voluntary behaviours, deserve in certain circumstances (...) certain kinds of accommodation. They must be understood as one possible expression, along with nonreligious or secular beliefs, of a person's convictions of conscience, which are strong ethical commitments upon which depends the moral integrity of those having such convictions. I demonstrate that the main ground for religious accommodation is the need to protect fairly, through such rights as religious freedom and freedom of conscience, the ethical commitments and conscientious beliefs of all citizens. Finally, against the objection that such a view risks leading to the proliferation of demands for accommodation, I maintain that a deliberative approach to religious accommodation is in a good position to put serious hurdles in the path of unreasonable demands. (shrink)

This chapter explores how LEGO compare to the metaphysics of the real, actual world—our universe. LEGO worlds and real worlds at least differ in how many there are: there are many LEGO worlds, but only one real world. According to David Lewis, there are worlds in which people were saved from entering the dark ages. There are worlds where they have a billion bricks at their disposal. But there are also worlds where LEGO has never been invented. On Lewis's view, (...) other worlds are just as real as the actual world. Lewis's plausible thesis of Humean supervenience need not be combined with his extravagant claim that there is a real world for any possible arrangement of the fundamental building blocks. A pervasive and obvious phenomenon of our world, is absent in a LEGO world. Things change—cars move, babies grow, coffee goes cold, leaves turn brown. (shrink)

Qu'est-ce qu'une structure?- Remarques sur la notion de potentialité.- De quelques mots clefs de la philosophie.

Unlike many other early modern philosophers, Spinoza was not particularly troubled by scepticism. Spinoza's disdain for skeptics is backed up by remarkable epistemic confidence. Spinoza is thus concerned with at least three kinds of skeptics: with the methodological skeptic; the philosophical skeptic; with the fideist who gives epistemic priority to scripture or revelation over reason. The skeptic's recommendation to suspend one's judgment relies on a flawed metaphysical view of the thinking subject and its ideas. Spinoza has epistemological concerns about methodological (...) skepticism. Descartes's strategy of employing methodological skepticism in order to convince his readers of the existence of certain truths is risky. Spinoza's dismissal of the skeptics is bolstered by a demanding notion of ideas as acts of understanding, which presuppose and explain the existence of their objects. (shrink)

Local sustainable food systems have captured the popular imagination as a progressive, if not radical, pillar of a sustainable food future. Yet these grassroots innovations are embedded in a dominant food regime that reflects productivist, industrial, and neoliberal policies and institutions. Understanding the relationship between these emerging grassroots efforts and the dominant food regime is of central importance in any transition to a more sustainable food system. In this study, we examine the encounters of direct farm marketers with food safety (...) regulations and other government policies and the role of this interface in shaping the potential of local food in a wider transition to sustainable agri-food systems. This mixed methods research involved interview and survey data with farmers and ranchers in both the USA and Canada and an in-depth case study in the province of Manitoba. We identified four distinct types of interactions between government and farmers: containing, coopting, contesting, and collaborating. The inconsistent enforcement of food safety regulations is found to contain progressive efforts to change food systems. While government support programs for local food were helpful in some regards, they were often considered to be inadequate or inappropriate and thus served to coopt discourse and practice by primarily supporting initiatives that conform to more mainstream approaches. Farmers and other grassroots actors contested these food safety regulations and inadequate government support programs through both individual and collective action. Finally, farmers found ways to collaborate with governments to work towards mutually defined solutions. While containing and coopting reflect technologies of governmentality that reinforce the status quo, both collaborating and contesting reflect opportunities to affect or even transform the dominant regime by engaging in alternative economic activities as part of the ‘politics of possibility’. Developing a better understanding of the nature of these interactions will help grassroots movements to create effective strategies for achieving more sustainable and just food systems. (shrink)

This book addresses an essential need felt by many who seek to promote best business practices in China and East Asia - namely the need for culturally appropriate instructional materials (basic information, case studies and ethical perspectives) that will allow managers and entrepreneurs to understand and embrace the challenge of moral leadership in business. In an era characterized by globalization and the increasing importance of the economies of China, India, Japan, and SE Asia, international business ethics must reflect the concerns (...) of the people living and working in this area, the moral and spiritual traditions that have nurtured them, and their specific contributions to sustainable development. This book presents twenty important case studies, taken from newsworthy events of the past few years, in which Asians and others have attempted to respond to this challenge. Each case study has been selected and shaped in order to highlight various aspects of doing business in Asia, starting with basic principles and moving on to the specific responsibilities that businesses have towards their various stakeholders. The authors contend that the best way to appreciate the relevance of Asian moral and spiritual traditions is to determine their specific contribution to virtue ethics, where the ancient traditions of both East and West converge in their focus on the qualities of moral leadership that form the basis of best business practice. Exploring the case studies will enable readers to appreciate the continued relevance of these ethical perspectives in Asian business. Best business practice clearly involves learning to do business and playing the game according to the rules; but the necessity of playing by the rules is not likely to become clear until one takes up the path that leads to a virtuous life in business, developing a moral character chiefly based on integrity. (shrink)

The introductory chapter places creativity in a historical context. It shows how objectivist and subjectivist research philosophies have emerged and how they relate to technical, practical and emancipatory knowledge interests which inform the study of organizational creativity. Based on a sensitizing concept of organizational creativity the chapter then suggests context, process and practice as the conceptual framing for the subsequent arguments of the book.

Can we trade in the truths we discover? We show that any public work of truth requires the assistance of three collaborators that we call the Inscriber, the Thinker and the Truthmaker. We then show that if the Inscriber can legitimately trade in his inscriptions, the Thinker should not be authorized to trade in those of his thoughts which are true: because he is not the author of their truth.

When Carl Friedrich Gethmann announced Poiesis & Praxis in 2001—“A new journal is launched”— this notification came along with high expectations of the addressees with respect to meaning and quality of the content of the newborn journal. The initiative for an “International Journal of Ethics of Science and Technology Assessment” followed the supposed demand for a periodic forum for the rational reflection of the consequences of scientific and technological advance for the individual and social life of the human and its (...) environment—also beyond national perspectives. In the meantime, this broad spectrum was indeed covered with mostly professional articles, which reflected upon the quite different methods of technology assessment and scientific policy advice.Eleven years, nine volumes, and 36 issues later, the world has changed and with it the journal as well: It came up with new topics and challenges of the scientific-technological civilization but also with new perception modes and read. (shrink)

Professor H. L. Van Breda had hoped to write this preface, but his recent, unexpected and untimely death has left that task in my hands. Although my remarks will not be as eloquent and insightful as his surely would have been, some few words are clearly in order here; for the phenomenological community has not only lost the leadership of Fr. Van Breda these last years, but also the scholarship and leadership of Aron Gurwitsch and Alden Fisher - both contributors (...) to this volume - as well as that of Dorion Cairns and John Wild. Our leaders are fewer now but Herbert Spiegelberg is still very obviously one of them. This volume thus presents the work of some of the past and presently recognized leaders in phenomenology - e. g. Gurwitsch, Straus, and Fisher - but, more important perhaps, it also presents the work of some of those who are sure to be future leaders of our community of phenomenological philosophers, if in fact they have not already achieved this status. Most, if not all, of the contribu tors to this volume are in some way or another indebted to Herbert Spiegelberg and his work in phenomenology. (shrink)

Ethische Grundfragen der Medizin gehoren zu den zentralen Themen der Theologischen Ethik. Einen Schwerpunkt bilden dabei die brisanten Fragen nach einem verantwortlichen Umgang mit den medizinischen Moglichkeiten am Anfang und Ende des menschlichen Lebens, z. B. Pranatal- und Praimplantationsdiagnostik, Genome Editing, Schwangerschaftsabbruch, Sterbehilfe und Assistierter Suizid. Stephan Ernst bietet hier kompetente Handlungsorientierung. Er greift das Prinzip der Verhaltnismassigkeit als zentrales Kriterium ethischer Entscheidungen auf, das in der Praxis verantwortlichen Handelns von Arzten und Pflegern immer schon leitend ist. So wird (...) es moglich, Entscheidungen in der Medizin zu treffen, die starre prinzipielle Verbote aufbrechen und den realen Situationen und Menschen in ihrer Vielfalt und Individualitat gerecht werden, ohne in eine kriterienlose Beliebigkeit zu verfallen. (shrink)