This article raises the question of whether bioethics qualifies as a discipline. According to a standard definition of discipline as “a field of study following specific and well-established methodological rules” bioethics is not a specific discipline as there are no explicit “well-established methodological rules.” The article investigates whether the methodological rules can be implicit, and whether bioethics can follow specific methodological rules within subdisciplines or for specific tasks. As this does not appear to be the case, the article examines whether (...) bioethics’ adherence to specific quality criteria (instead of methodological rules) or pursuing of a common goal can make it qualify as a discipline. Unfortunately, the result is negative. Then, the article scrutinizes whether referring to bioethics institutions and professional qualifications can ascertain bioethics as a discipline. However, this makes the definition of bioethics circular. The article ends by admitting that bioethics can qualify as a discipline according to broader definitions of discipline, for example, as an “area of knowledge, research and education.” However, this would reduce bioethics’ potential for demarcation and identity-building. Thus, to consolidate the discipline of bioethics and increase its impact, we should explicate and elaborate on its methodology. (shrink)

Kairos has been a key concept in medicine for millennia and is frequently understood as “the right time” in relation to treatment. In this study we scrutinize kairos in the context of diagnostics. This has become highly topical as technological developments have caused diagnostics to be performed ever earlier in the disease development. Detecting risk factors, precursors, and predictors of disease (in biomarkers, pre-disease, and pre-pre-disease) has resulted in too early diagnoses, i.e., overdiagnoses. Nonetheless, despite vast advances in science and (...) technology, diagnoses also come too late. Accordingly, timing diagnostics right is crucial. In this article we start with giving a brief overview of the etymology and general use of the concepts of kairos and diagnosis. Then we delimit kairos in diagnostics by analysing “too early” and “too late” diagnosis and by scrutinizing various phases of diagnostics. This leads us to define kairos of diagnostics as the time when there is potential for sufficient information for making a diagnosis that is most helpful for the person. It allows us to conclude that kairos is as important in diagnostics as in therapeutics. (shrink)

Fred Dretske’s account of mental causation, developed in Explaining Behavior and defended in numerous articles, is generally regarded as one of the most interesting and most ambitious approaches in the field. According to Dretske, meaning facts, construed historically as facts about the indicator functions of internal states, are the structuring causes of behavior. In this article, we argue that Dretske’s view is untenable: On closer examination, the real structuring causes of behavior turn out to be markedly different from Dretske’s meaning (...) facts. Our argument proceeds in three steps. First, we set forth the problem of meaning individuation: We argue that the proposal that meaning facts are structuring causes of behavior commits Dretske to a very fine-grained individuation of meanings that is deeply counterintuitive. In a second step, we show that even these finely individuated meaning facts cannot do the job that they are supposed to do, since information facts—which are constitutive of, but distinct from Dretske’s meaning facts—are better candidates for the role of structuring causes. Finally, we argue that it is not even information facts, but facts of co-instantiation which are the real structuring causes of behavior. In concluding, we briefly consider the options that are left for Dretske if our arguments succeed. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Excerpt from Empfindung und Vorstellung: Ein Beitrag zur Klarung Psychologischer Grundbegriffe Vor kurzem erschien eine Abhandlung von Carl Stumpf uber Empfindung und Vorstellung, welche auf Grund feinfuhliger Selbstbeobachtungen und unter Berucksichtigung der grossen einschlagigen Literatur in die vielen Winkel und Dunkelheiten dieses Problems der deskriptiven Psychologie hineinleuchtet. Unter sorgfaltiger Analyse der von den verschiedenen Beobachtern gegebenen Beschreibungen und scharfsinniger Untersuchung der logischen Durchfuhrbarkeit jeder einzelnen der bisher ausgesprochenen Auffassungen versucht diese Abhandlung die Frage zu klaren, worin der wesentliche Unterschied beider (...) Erlebnisarten besteht. Als Ergebnis gelangt Stumpf in der Hauptsache zu einer Rechtfertigung der altuberlieferten Auffassung, nach der ein "spezifischer" Unterschied zwischen Empfindung und Vorstellung nicht vorliegt, sich die Vorstellungen vielmehr vor allem durch ihre geringere Intensitat von den Empfindungen unter-scheiden. Ausser an Intensitat fehlt es den Vorstellungen im Gegensatz zu den Empfindungen an Fulle und Bestandigkeit, ferner sind sie dadurch charakterisiert, dass sie willkurlich leichter modifizierbar sind, dass ihnen gegenuber der Glaube an die Realitat fur das erlebende Bewusstsein einer Rechtfertigung bedarf, und dass sie durchschnittlich schwachere Gefuhlswirkungen mit sich fuhren. Vorstellungen stellen sich so den Empfindungen gegenuber als "Erscheinungen zweiter Ordnung" dar: in dem Inhalt der Erlebnisse, nicht in den Akten des Erlebens, ist ihre Verschiedenheit zu suchen. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.". (shrink)

The essays in Powerful Arguments reconstruct the standards of validity underlying argumentative practices in a wide array of late imperial Chinese discourses, from the Song through the Qing dynasties. The fourteen case studies analyze concrete arguments defended or contested in areas ranging from historiography, philosophy, law, and religion to natural studies, literature, and the civil examination system. By examining uses of evidence, habits of inference, and the criteria by which some arguments were judged to be more persuasive than others, the (...) contributions recreate distinct cultures of reasoning. Together, they lay the foundations for a history of argumentative practice in one of the richest scholarly traditions outside of Europe and add a chapter to the as yet elusive global history of rationality. (shrink)

In April 2017, scientists took to the streets in a historically unprecedented Global March for Science. The event was seen as symbolic of a crisis in the relationship of science and society. This book considers the Global March for Science from a postcolonial perspective to inquire into the toolkit that the academic field of Science & Technology Studies (STS) has to offer. It argues that new concepts and analytical approaches are necessary to investigate current global dynamics in science, technology and (...) society, so as to deliver insights that the recent expansion of STS scholars beyond Western Europe and North America alone is unlikely to provide. The book presents a Programme in Science Studies Elsewhere (SSE) to demonstrate the urgent need to carry postcolonial issues right into the centre of STS's intellectual programme. (shrink)

The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

Human actions have diverse consequences. Some consequences are intended, others are considered side effects, although they too, such as climate-damaging CO2 emissions, can be ethically relevant. Ethically speaking, considering consequences in a differentiated way is therefore clearly unavoidable. After discussing the influential concepts of utilitarianism and moral theology, the author presents his own approach to considering consequences.

According to a classical causal account of perception, to perceive that object x is F is to fulfill the following conditions: (i) one has an experience as of x's being F, (ii) x is F, and (iii) one's experience of x's being F depends causally on x's being F. This is the core of Grice's causal theory of perception, and it is initially quite plausible (Grice 1961).

--2. Bd. Des Sokrates Apologie. Kriton. Euthydemos. Menexenos. Gorgias. Menon. Bearb. von H. Hofmann.--3. Bd. Phaidon. Das Gastmahl. Kratylos. Bearb. von D. Kurz.--4. Bd. Politeia. Der Staat. Bearb. von D. Kurz.--5. Bd. Phaidros. Parmenides. Briefe. Bearb. von D. Kurz.--6. Bd. Theaitetos. Der Sophist. Der Staatsmann. Bearb. von P. Staudacher.--7. Bd. Timaios, Kritias. Philebos. Bearb. von K. Widdra.--8. Bd. Nomōn. Gesetze. Bearb. von K. Schöpsdau. 2 v.

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or (...) neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

Like some ethical dilemmas, this question has an obvious answer that may not be right. On first reflection, it seems entirely unreasonable and inappropriate to expect staff members to withhold supportive care. Legally, a designated surrogate has the authority to refuse pain medication on the patient's behalf, but is it ethically defensible? A patient lacking decisionmaking capacity is crying out in pain; can we really imagine just closing the door? What do we say to other patients, visitors, and staff members, (...) such as physicians, nurses, housekeepers, and dietary workers, who might hear the patient? Do we place a sign on the door, one noting that the surrogate has refused, on behalf of the patient, to authorize the administration of pain medication and that the hospital or nursing home must comply with the surrogate's decision? (shrink)

The following description is based upon an actual case in which a patient initiated legal action after suffering a complication subsequent to an invasive diagnostic procedure performed by a senior fellow. Named as codefendants were the senior fellow, attending physician, and the hospital. Because any hospital with house staff is potentially vulnerable to similar litigation, Ethics Committees at Work is addressing the questions raised by this dilemma.

The belated but formal acknowledgment of medical errors and their impact has been well documented. Curiously, the topic of management or executive mistakes in healthcare is not raised in professional meetings nor, until recently, addressed by an article in health administration journals.

Our ethics committee is revising the organization's policy on forgoing life-sustaining treatment. The current policy now includes the statement, “When life-sustaining treatment is forgone, supportive care will be provided to relieve pain and ensure the patient's comfort, unless the patient or surrogate refuses those measures.” Is it reasonable, however, for the surrogate to have the authority to refuse consent for pain medication and/or other supportive care?

According to Ramsey and colleagues the main constituent psychological processes of innovation are response to novelty, exploration, and the ability to recognize a novel solution. I fully support this view but point out that novelty reactions are often context-specific. I will expand on this and discuss the possible consequences of context-specific novelty reactions on the emergence of innovations.

It is a commonly held belief among many psychological scientists that the more plausible a hypothesis, the better it is scientifically. It is also often believed that if there are two alternative theories which are equally strong in terms of explanatory power, one should choose the plausible theory over the implausible one. The goal of this article is to challenge these assumptions. Based on Popper's philosophical views, it will be argued that psychological scientists should be encouraged to formulate implausible hypotheses (...) and theories. Examples from other scientific disciplines will be presented to illustrate this argument. 2012 APA, all rights reserved). (shrink)

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

The late 18th century is characterized by two crucial events: the rise of Goethe as a dominating literary figure and the emergence of Kant’s critical philosophy and its productive reception not only in the philosophical but also literary discourse of the time. While the Tübingen School concreatively adopted Kant’s philosophy as a system of ideas, they also critically responded to its intellectualising impulse by positing the equiprimordiality of world and Self, of art and reason. Adhering to the self-critical impulse of (...) Kant’s philosophy by positing the equiprimordiality of both the empirical world and the intelligible subject, and trying to overcome the “chorismos” between them through the classicist model of aesthetic Bildung, they argued for the co-extensiveness of the reality of both philosophy and literature. The authors investigate how the latent antagonism between these divergent traditions of the so-called Goethezeit creates the thrust behind the intellectual firework of divergent literary and philosophical discourses from around 1800, throughout the 19th and into the 20th century. (shrink)

A widespread assumption in recent research on attitudes is that self-reported evaluations reflect conscious attitudes, whereas indirectly assessed evaluations reflect unconscious attitudes. The present article reviews the available evidence regarding unconscious features of indirectly assessed “implicit” attitudes. Distinguishing between three different aspects of attitudes, we conclude that people sometimes lack conscious awareness of the origin of their attitudes, but that lack of source awareness is not a distinguishing feature of indirectly assessed versus self-reported attitudes, there is no evidence that people (...) lack conscious awareness of indirectly assessed attitudes per se, and there is evidence showing that, under some conditions, indirectly assessed attitudes influence other psychological processes outside of conscious awareness. Implications for the concept of “implicit attitudes” are discussed. (shrink)