The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

The distinquished American philosopher and historian of ideas, George H. Sabine, once remarked that the two great social ideals of liberty and equality, the subjects of this essay, are in effect but “shorthand for redressing quite definite grievances or bringing about quite definite results.” He went on to suggest that the social philosophies embodying these ideals are in large measure “occasional performances” which flourish in periods of social unrest where the “cake of custom” is broken and must be adjusted (...) to new contexts and problems. Sabine also suggested that for this reason history is an indispensable tool of analysis for most of the issues in social philosophy. (shrink)

It is a commonplace in both the popular imagination and the philosophical literature that hope has a special kind of motivational force. This commonplace underwrites the conviction that hope alone is capable of bolstering us in despairinducing circumstances, as well as the strategy of appealing to hope in the political realm. In section 1, I argue that, to the contrary, hope’s motivational essence is not special or unique—it is simply that of an endorsed desire. The commonplace is not entirely mistaken, (...) however, because standard ways of expressing hope do have motivational influence that is different in kind from that of desire. In sections 2 through 4, I examine one of these ways of expressing hope, fantasizing, and argue that fantasies can present us with reasons to modify our goals and projects in multiple ways. (shrink)

How do we encourage patients to be hopeful without exploiting their hope? A medical researcher or a pharmaceutical company can take unfair advantage of someone's hope by much subtler means than simply giving misinformation. Hope shapes deliberation, and therefore can make deliberation better or worse, by the deliberator's own standards of deliberation.

Appreciation and gratitude get good press: They are central virtues in many religious and secular ethical frameworks, core in positive psychology research, and they come highly recommended by the self‐improvement set. Generally, appreciation and gratitude feature as good things, in popular consciousness. Of course, on an Aristotelian model, the belief that these are virtues implies they are something people can get right or wrong. This paper examines bad appreciation and bad gratitude, characterizing forms of appreciation and gratitude at the center (...) of some major social norms and practices, and demonstrating that they mask familiar oppressive expectations and power relations. (shrink)

Something in the world tears away, jumps out, approaches... A world that approaches is a world that is alive and vivid. This applies not only to the existing natural world, but also to what humans create, which, in form the form of artifacts - from the hand-held ax to linguistic theory - also approaches design in terms of both object and challenge.

This essay provides a systematic as well as chronological account of Schiller's concepts of freedom and autonomy. Its main thesis is that the duality of Schiller's moral/aesthetic ideal in the Letters on the Aesthetic Education of Man - of beauty and the sublime, of play and the moral law - is a result of his use of conflicting concepts of autonomy. While it is widely accepted that Schiller took over Kant's concept of autonomy, I argue that he simultaneously employed another (...) concept of autonomy, that of the contemporary philosopher Karl Leonhard Reinhold, whose criticism of Kant's concept of free will and alternative formulation of the concept of a neutral will influenced Schiller. (shrink)

The study of Islamic philosophy has entered a new and exciting phase in the last few years. Both the received canon of Islamic philosophers and the narrative of the course of Islamic philosophy are in the process of being radically questioned and revised. Most twentieth-century Western scholarship on Arabic or Islamic philosophy has focused on the period from the ninth century to the twelfth. It is a measure of the transformation that is currently underway in the field that, unlike other (...) reference works, the Oxford Handbook has striven to give roughly equal weight to every century, from the ninth to the twentieth. The Handbook is also unique in that its 30 chapters are work-centered rather than person- or theme-centered, in particular taking advantage of recent new editions and translations that have renewed interest and debate around the Islamic philosophical canon. The Oxford Handbook of Islamic Philosophy gives both the advanced student and active scholar in Islamic philosophy, theology, and intellectual history, a strong sense of what a work in Islamic philosophy looks like and a deep view of the issues, concepts, and arguments that are at stake. Most importantly, it provides an up-to-date portrait of contemporary scholarship on Islamic philosophy. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

Political Correctness ist nicht nur Reizthema und Schlagwort medialer Debatten, sondern auch in Alltagskommunikation oft Ausloser hitziger Debatten um sprachliche Diskriminierung. Doch wie positionieren sich eigentlich Sprachprofis zu diesem Thema, was rat das Worterbuch? Der Einfluss von Diskursen auf Worterbucher ist zwar in der Forschung unstrittig; eine umfassende Untersuchung zur Wirkung eines bestimmten zeitgenossischen Phanomens auf einen abgeschlossenen Wortschatzbereich existierte jedoch bislang nicht. Dieser Lucke widmet sich die Autorin, die den uber eine Korpusanalyse gewonnenen Wortschatz der Political Correctness aus den (...) ersten zehn Jahren (1990-2000) des Diskurses in den ersten sechs Auflagen (1983-2006) des Duden - Universalworterbuchs untersucht. Erstmals wird hier die Diskurslexik der Political Correctness der 1990er Jahre greifbar gemacht. Daruber hinaus werden vorhandene lexikographische Strategien beschrieben sowie deren Defizite im Umgang mit problematischer Lexik aufgedeckt. Die Arbeit zeigt, dass das Ringen um einen angemessenen Sprachgebrauch, die Vermeidung von Pejorisierung feste Bestandteile des Sprachhandelns darstellen, dem sich Worterbucher mit deskriptivem oder normativem Anspruch zu stellen haben. (shrink)

2021 jährte sich zum zwanzigsten Mal die Einführung des Lebenspartnerschaftsgesetzes und damit der Eingetragenen Lebenspartnerschaft als das erste Rechtsinstitut für gleichgeschlechtliche Paare. 2017 löste die Ehe die Lebenspartnerschaft ab, allerdings nicht mit allen Rechten einer Ehe wie zwischen heterosexuellen Personen. Der Aushandlungsprozess zur sogenannten Ehe für alle ist insbesondere für religionswissenschaftliche Fragestellungen erkenntnisreich. Am Beispiel des Diskurses um die Einführung der gleichgeschlechtliche Ehe in Deutschland 2015 und dem Referendum in Irland als diskursivem Ereignis zeigt die Autorin, wie politische Akteur*innen in (...) einem zeitgenössischen Deutungskampf um die Bedeutung von Ehe wetteifern und dabei mit der Diskursprämisse einer angenommenen Moderne die Dichotomie von religiös vs. säkular sowie weitere Narrative von und über Religion(en) zur Selbst- und Fremdpositionierungen sowie für ihre Koalitions- und Oppositionsbildungen einsetzen. Die Analyse verwendet einen zeit-, akteurs- und arenaspezifischen Ansatz und verknüpft methodologisch die Wissenssoziologische Diskursanalyse (WDA) mit einem religionswissenschaftlichen Erkenntnisinteresse. (shrink)