Im Transit ist eine subjektorientierte Analyse von Transnationalisierungsprozessen in der Wissenschaft.In dieser exploariven Studie werden das Lehr- und Lernsetting eines außergewöhnlichen Rahmen-Experiments zur Transnationalisierung der ...

Context: Philosophical and - more recently - empirical approaches to the study of mind have recognized the research of lived experience as crucial for the understanding of their subject matter. Such research is faced with self-referentiality: every attempt at examining the experience seems to change the experience in question. This so-called “excavation fallacy” has been taken by many to undermine the possibility of first-person inquiry as a form of scientific practice. Problem: What is the epistemic character and value of reflectively (...) acquired phenomenological data? Can the study of experience, despite the excavation fallacy, rely on the act of reflection on lived experience and make sense and use of its results? Method: Through a philosophical discourse, informed by empirical first-person inquiry, we explore the experiential structure of the act of reflection and the formation of the corresponding belief about past experience. Results: We present a provisional first-person model of the experiential dynamics of retrospective reflection, in which the reflective act is characterized as enaction of belief about past experience that co-determines - rather than distorts - its results. From a constructivist perspective on the inevitable interdependence between the act of observing and the observed, the excavation “fallacy” is recognized as an intrinsic characteristic of reflection. Reflection is described as an iterative, self-referential process, guided by a context- and subject-specific horizon of expectations. Implications: Knowing the characteristics of the formation of beliefs about experience is essential for understanding first-person data and for the possibility of their acquisition and use in scientific practice, particularly in the context of second-person approaches to the study of experience. Constructivist content: We relate the proposed understanding of reflection to constructivist epistemology and argue that constructivism provides an epistemological foundation for the empirical study of experience more suitable than the traditional epistemological objectivism of cognitive science. We suggest that the constructive nature of the process of reflection calls for a collaboration between the fields of constructivism, phenomenology, and first-person research, and points towards the potential for their mutual enrichment. (shrink)

Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a (...) qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient. (shrink)

The article critically responds to "A Planetary Health Pledge for Health Professionals in the Anthropocene" which was published by Wabnitz et al. in The Lancet in November 2020. It focuses on the different roles and responsibilities of a physician. The pledge is criticised because it neglects the different roles, gives no answers in case of conflicting goals, and contains numerous inconsistencies. The relationship between the Planetary Health Pledge and the Declaration of Geneva is examined. It is argued that the Planetary (...) Health Pledge should have supplemented the Declaration of Geneva instead of changing it. (shrink)

The Hippocratic Oath and the Declaration of Geneva of the World Medical Association are compared in terms of content and origin. Their relevance for current medical practice is investigated. The status which is ascribed to these documents will be shown and the status which they can reasonably claim to have will be explored. Arguments in favor of the Hippocratic Oath that rely on historical stability or historical origin are being examined. It is demonstrated that they get caught up in paradoxes. (...) Should doctors swear the Hippocratic Oath or the Declaration of Geneva? The Hippocratic Oath is a remarkable historic document, which contains important elements still relevant for medical ethics today. Its interpretation as a timeless, still valid medical code is unfounded. The historical arguments, that should justify its validity, are untenable. The Declaration of Geneva, and not the Hippocratic Oath, can legitimately claim to come close to representing the most important principles of professional medical conduct in today’s globalised world. (shrink)

Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long (...) tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question “art or science” are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an ‘empirical healing art’ to a ‘rational, molecular science’ is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable. (shrink)

The article presents the judgment of the German Federal Constitutional Court from 26 February 2020 on assisted suicide. The statements regarding human dignity, human rights and the relationship between citizens and the state are examined. Furthermore, the consequences resulting from this interpretation of human dignity for states that are pluralistic and based on human rights will be laid out. The court’s judgment limits the power of parliaments and poses a challenge to many laws in states that see themselves as pluralistic, (...) human rights-based states. There are no data in this work. (shrink)

The present article discusses shared epistemological characteristics of two distinct areas of research: the field of first-person inquiry and the field of quantum mechanics. We outline certain philosophical challenges that arise in each of the two lines of inquiry, and point towards the central similarity of their observational situation: the impossibility of disregarding the interrelatedness of the observed phenomena with the act of observation. We argue that this observational feature delineates a specific category of research that we call the non-trivial (...) domain. Unlike the trivial domain, non-trivial research cannot assume the view from nowhere on which the observed phenomena could be regarded as existing independently of the process of observation. Presenting first-person inquiry and quantum mechanics as two of its examples, we show that non-trivial research violates several fundamental observational presuppositions of the trivial domain, exemplified in the principles of classical physics. Drawing on Niels Bohr’s philosophy of quantum mechanics and the constructivist notion of enaction, we stress the constructive, participatory, and irreversible nature of observation in the non-trivial domain. We discuss the possibility of developing a non-representationalist epistemology of the non-trivial, and consider the implications of our discussion for research in the non-trivial domain, as well as for the general understanding of the scientific inquiry. (shrink)

Die Frage, ob sie eine Kunst oder eine Wissenschaft sei, begleitet die Medizin seit der Antike. Die vorliegende Arbeit untersucht die Frage insbesondere im Hinblick auf den Einfluss Kants, Fichtes und Schellings auf das Selbstverstandnis der Medizin. Sie zeichnet die geschichtlichen Linien nach, die zum Verstandnis der gegenwartigen Situation fuhren und liefert wichtige Argumente zu einem zeitgemassen Selbstverstandnis der Medizin, das fur die wissenschaftstheoretische und ethische Diskussion in der Medizin von heute unverzichtbar ist. Since antiquity, the question has been whether (...) medicine is an art or a science. This work explores the question, in particular in view of Kants, Fichtes and Schellings influence on the self-conception of medicine. It traces the historical timelines which help to understand the current situation and provides important arguments for a timely self-conception of medicine which is indispensable for the discussion of scientific theory and ethics in todays medicine. (shrink)

ZusammenfassungDer Artikel untersucht die Frage, ob es sinnvoll ist, Doping im Sport unter ärztlicher Kontrolle freizugeben. Dazu werden die Auswirkungen einer Freigabe untersucht, die stets nur eine begrenzte Freigabe wäre, allein wegen der Risiken. Die unangenehmen Begleiterscheinungen der Dopingkontrollen würden nicht entfallen. Die Auswirkungen einer Freigabe von Doping im Wettkampfsport wären entweder unsinnig oder aber mit Nachteilen behaftet. Es ist nicht notwendig, die Frage zu klären, was die „Idee des Sportes“ ausmacht und ob sie verändert werden darf. Allein unter praktischen (...) Aspekten zeigt sich, dass dem Sport mit einer Freigabe des Dopings keine Vorteile, aber viele Nachteile erwachsen. (shrink)

Fifteen original essays open up a novel area of inquiry: the distinctively ethical dimensions of women's experiences of and in aging. Contributors distinguished in the fields of feminist ethics and the ethics of aging explore assumptions, experiences, practices, and public policies that affect women's well-being and dignity in later life. The book brings to the study of women's aging a reflective dimension missing from the empirical work that has predominated to date. Ethical studies of aging have so far failed to (...) emphasize gender. And feminist ethics has neglected older women, even when emphasizing other dimensions of 'difference.' Finally work on aging in all fields has focused on the elderly, while this volume sees aging as an extended process of negotiating personal and social change. (shrink)

Zusammenfassung Die Forschungs- und Regulierungsebene bei datenintensiver Forschung in der Medizin liegen auseinander. Ein heterogenes Feld aus regulierenden Institutionen mit regional ungleichen Regelungen, sowohl hinsichtlich der Dichte als auch der Restriktivität von Regelungen, steht einer globalen Entwicklung der Technologien entgegen. Trotz oder gerade wegen mangelnder global-gültiger Regulierungen können auch unverbindliche oder nur bedingt verbindliche normative Vorgaben der Orientierung dienen. Doch wie soll eine solche normative Regulierung angesichts datenintensiver Forschung in der Medizin ausgestaltet werden und woran soll sie sich orientieren? Die (...) Frage, wie konkret und detailliert man eine solche Forschung regulieren sollte, lässt sich nur im Einzelfall für bestimmte Situationen und Institutionen beantworten. Ob dabei neue Normen oder Gewichtungen von Normen vorgenommen werden sollen, oder ob die Normen und deren Gewichtung weiterhin bestehen bleiben sollen, lässt sich nur mit Verweis auf starke normative Argumente beantworten. An zwingenden Argumenten für neue Normen angesichts der datenintensiven medizinischen Forschung mangelt es bisher. Dennoch ist eine Umsetzungsarbeit von Normen, egal ob neue oder alte, und deren Anwendung auf eine neue Methode oder Technologie allemal zu erbringen. Es bedarf daher – wie schon bisher – beider: sowohl etablierter und transparent kommunizierter Normen als auch des unabhängigen Urteils zur Anwendung dieser Normen. Angesichts der besonderen Eignung für diese Aufgabe sollten auch weiterhin Ethik-Kommissionen als prozedurale Instanz bei der Bewilligung von datenintensiver Forschung in der Medizin gefordert und befähigt werden, die als unabhängige Institution ein Urteil im Einzelfall anhand vorgegebener Normen fällen. Nichtsdestotrotz können sich die veränderten Praktiken datenintensiver Forschungsprojekte auch in neuen Anforderungen an Ethik-Kommissionen niederschlagen, denen mit Reformen der Arbeitsweise begegnet werden sollte. (shrink)

The article tries to clarify the relation between history of medicine and medical ethics. Therefore it distinguishes between the double meaning of the german word Geschichte , which means both: development of events and story . For the first option no systematic relation between history and ethics can be reconstructed. In the second sense historical knowledge can be a readable and worth reading text for the ethical debate. Therefore the methodological professionality of the historian is required.

Theranostics or theragnostics are new terms which start to appear occasionally in publications from 2001 onwards, with a marked increase in references from 2011. In the last few years more than 1100 articles using this term were published each year. In 2011 the journal Theranostics was founded. This paper addresses the question of whether this new term is appropriate. The etymology of the term is analysed. A literature search for definitions of “theranostics” is carried out and the definitions examined as (...) to whether they give grounds for justifying the use of a new term. The differences between diagnostics and therapy are explored. A broad and a narrow definition are found. According to the broad definition theranostics provides a closer relationship between diagnostics and therapy. According to the narrow definition diagnostics and therapy become a single intervention. On closer examination it turns out that in the narrow definition the diagnostics capacities are limited to monitoring. Neither the broad nor the narrow definition actually demonstrate a new concept in medicine. Rather, they describe the well-known practice of medical decision making. In this respect, the new term cannot be justified. The level of diagnostics is new but not the relationship between diagnostics and therapy. The term theranostics is misleading as it obscures the existing differences between diagnostics and therapy and wrongly insinuates that steps between diagnostics and therapy could be omitted. (shrink)

Recent decades have seen a development of a variety of approaches for examining lived experience in the context of cognitive science. However, the field of first-person research has yet to develop a pragmatic epistemological framework that would enable researchers to compare and integrate – as well as understand the epistemic status of – different methods and their findings. In this article, we present the foundation of such a framework, grounded in an epistemological investigation of gestures involved in acquiring data on (...) experience. We examine the acts of turning towards one’s experiential field and attending to experience within the process of reflection. We describe what we call the _horizon of attending to experience_ by analogy to the “experimental arrangement” in quantum observation: this horizon, we argue, co-defines experiential phenomena that end up being observed and reported; at the same time, it itself forms an element of experience and is therefore amenable to phenomenological investigation. Drawing on the constructivist notion of enaction, we show that acknowledging the inherently constructive nature of attending to experience and accepting one’s lack of epistemic access to the “original”, observation-independent pre-reflective experience is not a dead end for first-person research when situated in a constructivist (but not relativist) understanding of the reflective act and its results. Expanding the notion of the horizon to encompass all epistemic acts involved in producing phenomenological data and final results of a first-person study (i.e., _horizon of the method_), we suggest some lines of inquiry that would allow researchers to identify and articulate horizons of particular methods, opening a way towards integrating past and future findings of different complementary first-person approaches into a comprehensive map of lived experience. (shrink)

The article is devoted to the question of how the moral integrity of the physician's role can be maintained under the pressure of economic and social interests. First, the moral basis of the doctor's role is discussed and areas of conflict are systematized. Second, a preference for cases of conflict is recommended and allocational decisions are examined. The primary question of whether the doctor's role in its current moral orientation should be maintained is answered clearly in the affirmative under reference (...) to history, to the patient's self-determination and to undesirable results that are to be feared. Der Aufsatz widmet sich der Frage, wie unter dem Druck ökonomischer und gesellschaftlicher Interessen die moralische Integrität der Arztrolle gewahrt bleiben kann. Zunächst wird die moralische Grundlegung der Arztrolle dargestellt; anschließend werden Konfliktfelder systematisiert. Danach wird eine Präferenz in Konfliktfällen vorgeschlagen und ein Blick auf Allokationsentscheidungen geworfen. Die vorgängige Frage, ob die Arztrolle in ihrer jetzigen moralischen Ausrichtung bestehen bleiben soll, wird mit Verweis auf die Geschichte, auf die Selbstbestimmung der Patienten und auf zu befürchtende unerwünschte Erscheinungen eindeutig bejaht. (shrink)

When the 15-year-old Auguste Böhmer, daughter of Caroline Schlegel and stepdaughter of August Wilhelm Schlegel, died on 12th July 1800, Friedrich Wilhelm Joseph Schelling was accused of being responsible for this tragic event, because he tried to treat her according to the medical system of John Brown. The ensuing scandal became a symbol for the danger of every progressive movement of that time: the Romantic literature, the natural philosophy of Schelling and Brownianism in its German version, represented by Andreas Röschlaub. (...) An attempt is made to analyse the social and political background of the scandal and to argue the historical meaning as a fight against a fundamental reform of medicine. (shrink)

Nanomedicine promises unprecedented innovations for diagnosis and therapy as well as for predicting and preventing diseases. On the other hand it raises fears linked to new and unknown characteristics of nanoscale materials. Both, promises and fears, are closely linked to the realm of uncertainty. To a large extent it is currently not known which expectations could become reality and which suspected adverse events might come true. Medicine is quite familiar with decision-making under uncertainty. Rules and regulations for clinical research have (...) been developed to reduce possible harm for research participants without abandoning necessary investigations. Here we examine whether clinical research trials of nanomedicine need new regulations and conclude that the established rules should suffice. (shrink)

Michel Bitbol offers a well-thought-out system of metaphysical coordinates. Despite the elegance and soundness of the proposed system, I nevertheless have concerns about the very need for a tailor-….

Recent decades have seen a development of a variety of approaches for examining lived experience in the context of cognitive science. However, the field of first-person research has yet to develop a pragmatic epistemological framework that would enable researchers to compare and integrate – as well as understand the epistemic status of – different methods and their findings. In this article, we present the foundation of such a framework, grounded in an epistemological investigation of gestures involved in acquiring data on (...) experience. We examine the acts of turning towards one’s experiential field and attending to experience within the process of reflection. We describe what we call the horizon of attending to experience by analogy to the “experimental arrangement” in quantum observation: this horizon, we argue, co-defines experiential phenomena that end up being observed and reported; at the same time, it itself forms an element of experience and is therefore amenable to phenomenological investigation. Drawing on the constructivist notion of enaction, we show that acknowledging the inherently constructive nature of attending to experience and accepting one’s lack of epistemic access to the “original”, observation-independent pre-reflective experience is not a dead end for first-person research when situated in a constructivist (but not relativist) understanding of the reflective act and its results. Expanding the notion of the horizon to encompass all epistemic acts involved in producing phenomenological data and final results of a first-person study (i.e., horizon of the method), we suggest some lines of inquiry that would allow researchers to identify and articulate horizons of particular methods, opening a way towards integrating past and future findings of different complementary first-person approaches into a comprehensive map of lived experience. (shrink)

The article discusses some of the consequences of choosing the radical constructivist epistemological point of view (as proposed by Glasersfeld and von Foerster). What happens when the role of the observer (author, philosopher, or scientist) is not ignored? What happens when observation is taken as interaction instead of one-directional copying? By explicating his answers to fundamental (or—according to von Foerster—“unanswerable”) questions, the author makes an attempt at outlining the changes that science of the mind should adopt if the constructivist concept (...) of interactional nature of observation is accepted in its entirety. (shrink)

I critically examine possible advantages of the introduction of a “naturalistic” setting to empirical phenomenological inquiry. As an alternative, I suggest taking the sum of factors ….

Moral Repair examines the ethics and moral psychology of responses to wrongdoing. Explaining the emotional bonds and normative expectations that keep human beings responsive to moral standards and responsible to each other, Margaret Urban Walker uses realistic examples of both personal betrayal and political violence to analyze how moral bonds are damaged by serious wrongs and what must be done to repair the damage. Focusing on victims of wrong, their right to validation, and their sense of justice, Walker presents (...) a unified and detailed philosophical account of hope, trust, resentment, forgiveness, and making amends - the emotions and practices that sustain moral relations. Moral Repair joins a multidisciplinary literature concerned with transitional and restorative justice, reparations, and restoring individual dignity and mutual trust in the wake of serious wrongs. (shrink)

BackgroundIndividuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues. The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial -design and methods. The main hypothesis is that participants receiving PIPCI will increase their (...) psychological flexibility compared to participants in the active control group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health compared to participants in the active control group and the waiting list control group.Materials and MethodsThis three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group, an active control group or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers and health care costs. Assessments will be performed at pre- and post-intervention, as well as at a 6-month follow-up.DiscussionThe development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia.Clinical Trial RegistrationClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 253-276.

Der Beitrag untersucht die ethischen Konflikte, die einer Regelung der Arbeitszeit von Ärzten zugrunde liegen. Als oberstes ethisches Prinzip ist die Vermeidung von Schäden zu beachten, die durch Überarbeitung der Ärzte sowie durch übermäßige Aufteilung der Arbeit entstehen. Zudem sind andere ethische Prinzipien zu berücksichtigen, insbesondere die Schadensvermeidung und Nutzenmehrung für zukünftige Patienten sowie für die Ärzte. Der Beitrag begründet Präferenzen bei konfligierenden ethischen Prinzipien und untersucht überdies die strukturellen Schwierigkeiten, die unvermeidlich bei der Regelung einer komplexen Tätigkeit, wie der (...) ärztlichen, anfallen. (shrink)

ABSTRACT Definition of the problem: The regulation of residents' work hours involves several ethical conflicts which need to be systematically analysed and evaluated. Arguments and conclusion: The most important ethical principle when regulating work hours is to avoid the harm resulting from the over‐work of physicians and from an excessive division of labour. Additionally, other ethical principles have to be taken into account, in particular the principles of nonmaleficence and beneficence for future patients and for physicians. The article presents arguments (...) for balancing the relevant ethical principles and analyses the structural difficulties that occur unavoidably in any regulation of the complex activities of physicians. (shrink)