ZusammenfassungDer heutige Arbeitsalltag im medizinischen Betrieb ist durch verschiedene Belastungsfaktoren gekennzeichnet: 1) die Tempobeschleunigung und die Komplexitätssteigerung der medizinischen Entwicklung allgemein sowie 2) eine zunehmende moralische Verunsicherung des Personals in Bezug auf das Verhältnis von Möglichkeiten und Notwendigkeiten bestimmter therapeutischer Verfahren. Die in diesem Aufsatz vorgelegten Beobachtungen, die aus einem Projekt am Lehrstuhl für Ethik der Georg-August-Universität Göttingen resultieren, machen noch einen weiteren Punkt geltend, so dass 3) bereits die unterschiedliche Einschätzung rein sachlicher Fragen zu einem Dissens führen kann, der (...) als moralischer empfunden wird. Aus diesen drei Momenten erwächst ein allgemeiner Bedarf an ethischer Handlungsorientierung. Allerdings ist die Entlastung, die durch ethische Kommunikation, beispielsweise in klinischen Ethik-Komitees, erreicht wird, anderer Art als zunächst in der Regel erwartet. Denn die Leistung liegt nicht so sehr in der Lösung von Problemen als vielmehr in deren Beschreibung. (shrink)

ZusammenfassungDie Beschäftigung mit der ethischen Dimension des ärztlichen Handelns beruht auf der freiwilligen Einsicht in deren Notwendigkeit. Es stellte sich die Frage, ob die Anwesenheit von Studierenden, die nur durch den Zwang des Stundenplans Ethikseminare besuchen, die Qualität der Veranstaltungen messbar negativ beeinflusst. In einer über 2 Jahre umfassenden Umfrage zu Lernzielen, Unterrichtsatmosphäre, Moderation und Fächerwichtigkeiten wurden die Ethikseminare an der Universität Ulm evaluiert. Hierzu bekamen wir Fragebögen von 192 freiwillig Teilnehmenden des Jahrgangs 2001/2002 und von 293 Pflichtteilnehmern des Jahrgangs (...) 2002/2003 zurück. Überraschenderweise gab es bei keiner relevanten Frage oder Bewertung einen statistisch signifikanten Unterschied zwischen freiwilligen und Pflichtteilnehmern. Zum Teil deutliche Unterschiede zeigten sich zwischen männlichen und weiblichen Studierenden. Diese Unterschiede müssen aufgrund ihrer didaktischen und konzeptionellen Bedeutung weiterverfolgt werden. Das Umfrageergebnis lässt hoffen, dass das Unterrichtskonzept der fallorientierten Kleingruppenseminare die Lernziele bei allen Studierenden verwirklichen kann. (shrink)

Patientenselbstbestimmung und Patientenverfügungen haben zunehmende Bedeutung und Beachtung erfahren. In der vorliegenden qualitativen Studie wurden 15 Patientinnen und Patienten mit amyotropher Lateralsklerose —einer unheilbaren, chronisch-degenerativen Erkrankung mit vorhersehbarer Symptomatik—interviewt, um zu erfahren, welche Werte und Kriterien sie bei prospektiven Entscheidungen am Lebensende und bei der Abfassung von PV zugrunde legen. Die Auswertung erfolgte nach der Methode der „grounded theory“. Die befragten Patientinnen und Patienten befürworteten einen Verzicht auf lebenserhaltende Behandlungen, wenn sie keine hinreichenden Lebensmöglichkeiten mehr sahen, d. h. wenn sie (...) die aktuelle Lebensqualität für unzureichend erachteten und die Chance auf Besserung als gering einschätzten. Dem Patientenwillen sprachen sie bei der Entscheidungsfindung ein Vetorecht zu. Patientenverfügungen fassten sie erst ab, als sie keine Hoffnung mehr auf Besserung ihrer Erkrankung hatten. Sie verstanden diese als Instrumente zur vorsorglichen Erklärung ihres Wunsches, auf lebensverlängernde Maßnahmen zu verzichten, wenn die LM inakzeptabel geworden sind. Damit wollten sie sich gegenüber dem Arzt absichern, den sie in der Rolle eines Anwalts des Lebens sahen und mit dem sie daher ihre Behandlungswünsche nicht besprochen haben. Trotz vorhersehbarer Symptomatik legten sie in ihren PV keine spezifischen Behandlungswünsche nieder, sondern verwendeten allgemeine Formularmuster ohne konkreten Bezug zu ihrer Erkrankung. Daher bestehen auch bei dieser Patientengruppe Zweifel, ob die PV in einer konkreten Behandlungssituation hilfreich sind. (shrink)

English summary: Rochus Leonhardt discusses the relationship between Protestantism and scepticism in a critical analysis of the philosophical approach used by Odo Marquard. He shows that the most important goal of Marquard's philosophy was to establish a pluralism in hermeneutics. In view of this fact, the author questions the extent to which such a pluralism is related to the Protestant emphasis on the Scriptures. German description: Rochus Leonhardt diskutiert das Verhaltnis von Protestantismus und Skeptizismus anhand einer kritischen Analyse (...) des philosophischen Ansatzes von Odo Marquard. Als Pointe des Marquardschen Skeptizismus stellt er die Forderung nach einer pluralisierenden Hermeneutik heraus und konfrontiert diese Forderung mit dem protestantischen Schriftprinzip. Dessen originare Gestalt, Luthers Betonung der uneingeschrankten Schriftautoritat ( sola scriptura ), schliesst zwar einen hermeneutischen Pluralismus kategorisch aus, aber die immer drangendere eKrise des Schriftprinzips' macht die Problematik dieser esingularisierenden Hermeneutik' deutlich. Im Gesprach mit wichtigen Vertretern der zeitgenossischen evangelischen Theologie pladiert der Autor daher fur eine Integration der in der Literaturwissenschaft langst etablierten pluralisierenden Hermeneutik in die Bibelauslegung - und damit fur eine Ubernahme des hermeneutischen Skeptizismus in die Theologie. (shrink)

Die Einführung der kostenkalkulierten und landesweit einheitlich bepreisten DRGs hat die Möglichkeiten gewinnorientierter Krankenhausträger, ehemals kommunale, defizitäre Krankenhäuser in die Gewinnzone zu führen, erschwert. Diese reagieren darauf mit dem Einsatz bisher nicht gekannter Werkzeuge wie beispielsweise der Steuerung von Patientenströmen, Anreizsystemen, Gründung von Privatkliniken sowie erlösorientierten Therapien und Abrechnungen. Mittlerweile bedienen sich auch andere Trägergruppen dieser Instrumente, so dass sich die Frage stellt, ob angesichts der Wettbewerbssituation nicht gewinnorientierte Träger eines besonderen wirtschaftlichen Schutzes bedürfen, damit die bisher im Krankenhaus gültigen (...) ethischen Prinzipien auch weiterhin Anwendung finden können. (shrink)

It is common to hear talk of the aim of belief and to find philosophers appealing to that aim for numerous explanatory purposes. What belief 's aim explains depends, of course, on what that aim is. Many hold that it is somehow related to truth, but there are various ways in which one might specify belief 's aim using the notion of truth. In this article, by considering whether they can account for belief 's standard of correctness and the epistemic (...) norms governing belief, I argue against certain prominent specifications of belief 's aim given in terms of truth, and advance a neglected alternative. (shrink)

The _Physics_ is a foundational work of western philosophy, and the crucial one for understanding Aristotle's views on matter, form, essence, causation, movement, space, and time. This richly annotated, scrupulously accurate, and consistent translation makes it available to a contemporary English reader as no other does—in part because it fits together seamlessly with other closely associated works in the New Hackett Aristotle series, such as the _Metaphysics_, _De Anima_, and forthcoming _De Caelo_ and _On Coming to Be and Passing Away_. (...) Eventually the series will include all of Aristotle's works. Sequentially numbered endnotes provide the information most needed at each juncture, while a detailed Index of Terms indicates places where focused discussion of key notions occurs. An illuminating general Introduction describes the book that lies ahead, explaining what sort of work it is and what sorts of evidence it relies on. (shrink)

In _Buddhists, Brahmins, and Belief_, Dan Arnold examines how the Brahmanical tradition of Purva Mimamsa and the writings of the seventh-century Buddhist Madhyamika philosopher Candrakirti challenged dominant Indian Buddhist views of epistemology. Arnold retrieves these two very different but equally important voices of philosophical dissent, showing them to have developed highly sophisticated and cogent critiques of influential Buddhist epistemologists such as Dignaga and Dharmakirti. His analysis--developed in conversation with modern Western philosophers like William Alston and J. L. Austin--offers an innovative (...) reinterpretation of the Indian philosophical tradition, while suggesting that pre-modern Indian thinkers have much to contribute to contemporary philosophical debates. In logically distinct ways, Purva Mimamsa and Candrakirti's Madhyamaka opposed the influential Buddhist school of thought that emphasized the foundational character of perception. Arnold argues that Mimamsaka arguments concerning the "intrinsic validity" of the earliest Vedic scriptures are best understood as a critique of the tradition of Buddhist philosophy stemming from Dignaga. Though often dismissed as antithetical to "real philosophy," Mimamsaka thought has affinities with the reformed epistemology that has recently influenced contemporary philosophy of religion. Candrakirti's arguments, in contrast, amount to a principled refusal of epistemology. Arnold contends that Candrakirti marshals against Buddhist foundationalism an approach that resembles twentieth-century ordinary language philosophy--and does so by employing what are finally best understood as transcendental arguments. The conclusion that Candrakirti's arguments thus support a metaphysical claim represents a bold new understanding of Madhyamaka. (shrink)

Three studies test eight hypotheses about (1) how judgment differs between people who ascribe greater vs. less moral relevance to choices, (2) how moral judgment is subject to task constraints that shift evaluative focus (to moral rules vs. to consequences), and (3) how differences in the propensity to rely on intuitive reactions affect judgment. In Study 1, judgments were affected by rated agreement with moral rules proscribing harm, whether the dilemma under consideration made moral rules versus consequences of choice salient, (...) and by thinking styles (intuitive vs. deliberative). In Studies 2 and 3, participants evaluated policy decisions to knowingly do harm to a resource to mitigate greater harm or to merely allow the greater harm to happen. When evaluated in isolation, approval for decisions to harm was affected by endorsement of moral rules and by thinking style. When both choices were evaluated simultaneously, total harm -- but not the do/allow distinction -- influenced rated approval. These studies suggest that moral rules play an important, but context-sensitive role in moral cognition, and offer an account of when emotional reactions to perceived moral violations receive less weight than consideration of costs and benefits in moral judgment and decision making. (shrink)

The revitalization of Indigenous ways of knowing and being with land is central to addressing the devastating impacts of climate change. This article contributes to growing research in Indigenous Climate Change Studies by focusing on connections between ecology, sexuality, and gender. To track the histories of gendered violence for Two Spirit peoples is to also follow the marked wounds of land dispossession, excavation, and exploitation. Conversely, Two Spirit futures are deeply imbricated in not only surviving but also flourishing among post-apocalyptic (...) conditions. Through socio-linguistic analyses of western animacy hierarchies and a historical analysis of colonial fables which casted the racialized-gendered other as monstrous, this article critiques popularized end-of-the-world discourses on climate change narratives. Alternatively, the article concludes by offering a reading of Indigiqueer speculative science fiction, gleaning methods of not only survival and resistance but also resilience amongst post-apocalyptic conditions. Ultimately, this paper argues that the revitalization of Indigenous genders is in-part linked to the present revitalization and protection of ecological life-worlds, centering Two Spirit knowledge at what settlers may fear to be “the end of the world.”. (shrink)

Many have criticized liberalism for being too individualistic, but few have offered an alternative that goes beyond a vague affirmation of the need for community. In this entertaining book, written in dialogue form, Daniel Bell fills this gap, presenting and defending a distinctively communitarian theory against the objections of a liberal critic. Drawing on the works of such thinkers as Charles Taylor, Michael Sandel, and Alasdair MacIntyre, Bell attacks liberalism's individualistic view of the person by pointing to our social (...) embeddedness. He develops Michael Walzer's idea that political thinking involves the interpretation of shared meanings emerging from the political life of a community, and intelligently rebuts criticism that this approach damages his case by being conservative and relativistic. Communitarianism and Its Critics is a provocative defense of a distinctly communitarian theory which will stimulate interest and debate among scholars and students of political theory as well as those approaching the subject for the first time. (shrink)

Premodern Buddhists are sometimes characterized as veritable "mind scientists" whose insights anticipate modern research on the brain and mind. Aiming to complicate this story, Dan Arnold confronts a significant obstacle to popular attempts at harmonizing classical Buddhist and modern scientific thought: since most Indian Buddhists held that the mental continuum is uninterrupted by death, they would have no truck with the idea that everything about the mental can be explained in terms of brain events. Nevertheless, a predominant stream of Indian (...) Buddhist thought, associated with the seventh-century thinker Dharmakirti, turns out to be vulnerable to arguments modern philosophers have leveled against physicalism. By characterizing the philosophical problems commonly faced by Dharmakirti and contemporary philosophers such as Jerry Fodor and Daniel Dennett, Arnold seeks to advance an understanding of both first-millennium Indian arguments and contemporary debates on the philosophy of mind. The issues center on what modern philosophers have called _intentionality_--the fact that the mind can be about other things. Tracing an account of intentionality through Kant, Wilfrid Sellars, and John McDowell, Arnold argues that intentionality cannot, in principle, be explained in causal terms. Elaborating some of Dharmakirti's central commitments, Arnold shows that despite his concern to refute physicalism, Dharmakirti's causal explanations of the mental mean that modern arguments from intentionality cut as much against his project as they do against physicalist philosophies of mind. This is evident in the arguments of some of Dharmakirti's contemporaneous Indian critics, whose critiques exemplify the same logic as modern arguments from intentionality. Elaborating these various strands of thought, Arnold shows that seemingly arcane arguments among first-millennium Indian thinkers can illuminate matters still very much at the heart of contemporary philosophy. (shrink)

Different versions of the A-theory of time are traditionally defined in terms of whether everything is present, or whether there are also past and future things. In this paper I argue that the traditional way of defining A-theories should be abandoned. I focus on the traditional definition of presentism, according to which always, everything is present. First, I argue that there are good reasons to reject all the most plausible interpretations of the predicate ‘is present’ as it appears in the (...) traditional definition of presentism. It follows that there are also good reasons to reject the most plausible interpretations of the traditional definitions of the other A-theories. I then argue that there is a better way of defining the A-theories, in terms of the question of whether existence has a beginning and an end. Finally, I argue that what goes for the traditional definition of presentism goes for the traditional definition of its modal analogue actualism, according to which necessarily, everything is actual : there are good reasons to reject the traditional definition of actualism in favour of a definition in terms of contingent existence. (shrink)

Increasing farmers’ acceptance and adoption of environmentally beneficial farming practices is essential for mitigating negative impacts of agriculture. To support adoption through policy, it is necessary to understand which types of farms or farmers do or do not apply such practices. However, farmers are not a homogeneous group and their behavior is subject to a complex array of structural, socioeconomic, and socio-psychological influences. Reducing this complexity, farmer typologies or archetypes are useful tools for understanding differing motivations for the uptake of (...) sustainable farming practices. Previous investigations of the role of farmer archetypes in the adoption of such practices rely on either purely qualitative or purely quantitative methods in data collection, typology creation, and hypothesis testing. Our study combines both approaches by classifying survey respondents into farmer types based on a previous Q methodological study. We then use these types in a two-part regression model that aims to explain participation in agri-environmental schemes and the level of scheme participation. To control for farm structural factors, we additionally link our questionnaire data to secondary data from the farm accountancy data network. Results indicate that in Austria, AES are attractive to all types of farmers, but the level of participation in these schemes differs between archetypes: Profitability-oriented farmers participate less, and nature-oriented farmers participate more than other types. This suggests that monetary compensations for sustainable farming practices are not perceived as sufficient by certain groups of farmers, and policy makers need to consider additional kinds of incentives. (shrink)

Die überragende Bedeutung Martin Luthers für die Geschichte und Kultur der europäischen Neuzeit sowie des Protestantismus ist unbestritten. An der Frage, wie diese Bedeutung genauer zu beschreiben sei, scheiden sich jedoch die Geister. Dieser Umstand spiegelt sich in den höchst unterschiedlichen Bezugnahmen auf die Theologie des Reformators in der Theologie seit der Aufklärung. Während die einen die lutherische Reformation in einen engen Zusammenhang mit Autonomie und Neuzeit rücken, betonen andere die Differenz zwischen Luther und der modernen Welt. An dieser Ambivalenz (...) in der Beurteilung Luthers wird bereits deutlich, dass die Bedeutung des Wittenberger Reformators die Kategorie der Wirkungsgeschichte in gewisser Weise sprengt. Geschichte und Kultur des Protestantismus lassen sich zu einem guten Teil als Geschichte der Rezeption von Luthers Denken auffassen. Diese Einsicht bildet den Leitgedanken des vorliegenden Bandes. Die darin versammelten zehn Studien untersuchen die höchst differenzierte und komplexe Wirkung und Rezeption Martin Luthers von der Aufklärung bis zum 20. Jahrhundert. (shrink)

This book provides an overview of Martin Luther's (1483-1546) state thinking whose reformation of faith and church provoked important and controversial consequences concerning the understanding of the political order and power. Luther's main work in this field "Von weltlicher Obrigkeit" is imprinted completely in a modern translation. The analysis of his state thinking in the contemporary context of the 16th century is followed by a systematic interpretation as well as a historical sketch. In the different areas "Luther and Machiavelli", "Resistance" (...) and "Natural law" the contributors develop connections and comparisons to other concepts. The two concluding essays engage with the current topicality of Luther's understanding of state. (shrink)