Entscheidungen am Lebensende rechtzeitig zu thematisieren und eine Vorausverfügung festzulegen, beispielsweise im Rahmen von Advance Care Planning, kann Patientenautonomie bei medizinischen Entscheidungen ermöglichen, wenn Patient*innen nicht mehr einwilligungsfähig sind. Davon profitieren nicht nur Patient*innen, sondern auch ihre Angehörigen und die behandelnden Ärzt*innen. In der klinischen Realität finden entsprechende Gespräche dennoch häufig nicht statt.In dieser Arbeit wird anhand einer prinzipienethisch geleiteten Analyse unter Einbezug eines Konzepts von personaler Autonomie nach Quante untersucht, ob die Initiierung bzw. das Führen eines Gespräches über Entscheidungen (...) am Lebensende eine verbindliche Aufgabe von Ärzt*innen ist.Im Ergebnis besteht eine prima facie Pflicht für Ärzt*innen, ihren Patient*innen mit einer eingeschränkten Lebenserwartung Gespräche über Entscheidungen am Lebensende anzubieten. Eine Verpflichtung zur tatsächlichen Durchführung dieser Gespräche wird durch die Patientenselbstbestimmung begrenzt. Mit Patient*innen, die angeben, über Entscheidungen am Lebensende nicht sprechen zu wollen, sollten die Verzichtsentscheidung gemeinsam kritisch reflektiert werden, Vertrauensangebote aufgegriffen und das Angebot zum Gespräch regelmäßig wiederholt werden. (shrink)

Surveys of the German public have revealed a high acceptance of social freezing, i.e. oocyte conservation without medical indication. Up to now, there are no investigations available on the experiences and attitudes of health professionals towards social freezing. Between August 2015 and January 2016, we surveyed gynecologists Germany-wide on the topic social freezing. Five gynecologists specialized in reproductive medicine and five office-based gynecologists in standard care were chosen for the survey. The survey was conducted with an explorative, qualitative research design. (...) The demand for social freezing in Germany is low. With regard to their fertility age, most women attend consultations too late, they have only little previous knowledge and false expectations. The gynecologists consider it the duty of society and politics to provide for the compatibility of family and work. They relate late parenthood to disadvantages primarily for the children. A majority of the gynecologists interviewed tend to advise natural reproduction. Social freezing is often mistaken as a kind of fertility insurance. Thus, it is necessary that physicians inform women early about the possibilities and limitations of social freezing. In the first place, social freezing is not a medical or medical-ethical topic. Women consider the method as a possibility to ensure the compatibility of family and work. This compatibility should be mostly perceived as a political topic. It cannot be a medical task to solve this issue. In fact, a debate in society as a whole is necessary that includes all relevant actors. (shrink)

This volume draws on an expanded field of bioethical, sociological and anthropological research, to set a new agenda for discussing the ethics of disclosing prognostic genetic information.

The book examines disabled figures in Harriet Beecher Stowe's Uncle Tom's Cabin and Rebecca Harding Davis's Life in the Iron Mills, in African-American novels by Toni Morrison and Audre Lorde, and in the popular cultural ritual of the freak ...

Excerpt from Wissen, Glaube und Ahndung Ich habe an; einem andern Orte, reinhold Fichte und Schelling 1, ]i den; f_unt'e1{s chied des arbeit Ma1en platonisehen'nogrnatisrnugx und deanfleiesigen; Kriticiemus 511159in hier - mu ichbemmv. 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)

Objective: To examine current research payment practices and to inform development of clearer guidelines for researchers and ethics committees.Design: Exploratory email based questionnaire study of current research participant reimbursement practices. A diverse sample of organisations and individuals were targeted.Setting: Australia.Participants: Contacts in 84 key research organisations and select electronic listservers across Australia. A total of 100 completed questionnaires were received with representations from a variety of research areas .Main measurements: Open-ended and fixed alternative questions about type of research agency; type (...) of research; type of population under study; whether payment is standard; amounts and mechanisms of payment; factors taken into account when deciding on payment practices; and whether payment policies exist.Results: Reimbursement practice is highly variable. Where it occurs it is largely monetary and is for time and out-of-pocket expenses. Ethics committees were reported to be often involved in decision making around reimbursement.Conclusions: Research subject payment practices vary in Australia. Researchers who do provide payments to research participants generally do so without written policy and procedures. Ethics committees have an important role in developing guidelines in this area. Specific guidelines are needed considering existing local policies and procedures; payment models and their application in diverse settings; case study examples of types and levels of reimbursement; applied definitions of incentive and inducement; and the rationale for diverse payment practices in different settings. (shrink)

This very short introduction will first outline how ontological investigations and questions of practice go together. The second section will bring in the next pole of this entire book, history of mathematics. How do ontology, practice, and history go together? Is this a forced marriage or one born in true love? That is, do these three belong together in some very basic way? One chapter in the section argues that the philosophy of mathematical practice intersects with the history of mathematics (...) essentially. If the first section of this introduction is persuasive that will also show that the history of mathematics intersects with ontological questions as well, specifically, that historical questions are very much about the ontological commitments of past mathematicians. The last section will take up what might seem a very different theme, namely, how these things matter to mathematics education. This section is connected closely to the second section since mathematics education has taken an interest in the role of history of mathematics in mathematics education, and much insight can be gained by seeing the issues in relation to the ontology-practice-history triad. The question of education is also important since teachers must consider what it is exactly that they are teaching, or, to adapt the title of Reuben Hersh’s well-known book, “What is mathematics really about?” And the “aboutness” of mathematics is really the ontological question. (shrink)

Last year, the Joint Commission on Accreditation of Healthcare Organizations for the first time included provisions in its Hospital Accreditation Manual requiring institutions to have mechanisms in place to consider ethical issues arising in the care of patients and to educate care givers and patients on bioethical issues. This new requirement is notably vague. There is no indication of what type of mechanisms would be appropriate or how those involved in considering ethical issues should conduct themselves. This vagueness is by (...) no means accidental, but it reflects a recognition that clinical bioethics is still in its formative stages and that there are currently almost as many different mechanisms for dealing with bioethical issues in the healthcare setting as there are institutions that have such mechanisms. The Joint Commission's action, however, also implies that the time for experimentation will soon be over. (shrink)

This book reminds us that “in inwardness I am in myself. ” It defines our experience in terms of subjectivity, private self-awareness, and complex relationships between interiority and outwardness. The book shows that our inwardness need not confine us to narcissistic self-absorption, but may expand our capacity for richer, more sympathetic relations with others.

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

In 2004, drug user representatives lobbied against the now stalled $17.5m Australian government Retractable Needle and Syringe Technology Initiative due to concerns about inadequate consultation and potential health risks to participants.1 Some drug user organisations have also recently withdrawn support for the Australian Illicit Drug Reporting System , ….

Despite recent increasing support for the brain disease model of alcohol and drug addiction, the extent to which the model may clinically impact addiction treatment and client behaviour remains unclear. This qualitative study explored the views of community-based clinicians in Australia and examined: whether Australian community-based clinicians support the BDM of addiction; their attitudes on the impact the model may have on clinical treatment; and their views on how framing addiction as a brain disease may impact addicted clients’ behaviour. Six (...) Australian community-based clinicians participated in semi-structured in-depth interviews that were analysed using thematic analysis. Whilst the BDM was not fully supported by this purposive sample of Australian community-based clinicians, there was acceptance that addiction neuroscience formed a key part of a wider addiction framework. Participants believed the BDM ignored key social, psychological and environmental factors important for successful treatment. The BDM was seen as potentially irrelevant for certain client types, however the model was believed to integrate with particular therapies. Participants believed that for clients viewing their addiction in terms of a brain disease, there were potential positive and negative impacts on client behaviour. Implications for addiction treatment practice and public health policy are discussed. (shrink)

The identification of molecules controlling embryonic patterning and their functional analysis has revolutionized the fields of Developmental and Cell Biology. The use of new sequence information and modern bioinformatics tools has enriched the list of proteins that could potentially play a role in regulating cell behavior and function during early development. The recent application of efficient methods for gene knockout in zebrafish has accelerated the functional analysis of many proteins, some of which have been overlooked due to their small size. (...) Two recent publications report on the identification of one such protein and its role in zebrafish embryogenesis. The protein, currently designated Apela, was shown to act as a secreted protein whose absence adversely affected various early developmental processes. Additional signaling proteins that have been identified in one of the studies are likely to open the way to unraveling hitherto unknown developmental pathways and have the potential to provide a more comprehensive understanding of known developmental processes. (shrink)

Interest in spirituality in the workplace and in leaders’ spirituality has grown in the last two decades, paralleled by the emergence of spiritual leadership theories and research. Despite evidence that spirituality is important to many leaders, the literature fails to adequately address the intersections of spiritual, leader, and moral development. A whole person and integrated approach to these three types of development seems beneficial to individual leaders, businesses, and society. In this article we first review spiritual, moral, and leader development (...) literature. Then, drawing on the theory of being-centered leadership, we present a framework which addresses the parallel and intertwined nature of spiritual, leader, and moral development. Our proposed framework includes markers of the three types of development and is inclusive of multiple spiritual development traditions. Four practices and processes of spiritual development are also explored and related to leader and moral development processes. Implications for theory, research, and practice are presented. (shrink)

This paper attempts to signal the potential relevance of A Test of the News, written by Lippmann and Merz, for Critical Discourse Analysis. It seems that the study is overlooked by CDA’s experts as a pioneering work in press analysis. In order to demonstrate links between CDA and the research, in the first part, the work of Lippmann and Merz is situated within a wider picture of the theoretical and historical background as well as common views on politics and the (...) role of the press. Then, the reasons for the choice of the Times as a medium of research and the Russian Revolution as a topic are stated. The authors’ methodological assumptions are discussed in brief. The second part begins with an attempt to define the concept of CDA. The next section presents a theoretical framework of CDA in order to indicate that Lippmann’s and Merz’s analysis demonstrates a similar theoretical approach. Additionally, the tools used by authors are compared with those used in CDA. The parallel between the central role of the media discourse in CDA and the concern of the authors of the role of the press is also discussed. Since the active role of the reader and the hearer in constructing the meaning of the text corresponds with the views of the authors on the discrepancy between the real world and its representation, the next section is devoted to this issue. Finally, readers’ abilities, discussed by Lippmann and Merz, are viewed in relation to the significance of reader’s experiences in constructing the meaning of a text. (shrink)

Artykuł stanowi próbę pokazania zagadnienia społecznej odpowiedzialności przedsiębiorstw z filozoficznej perspektywy obecnej w pismach Waltera Lippmanna. Krótko omówione zostały istotne w tym kontekście elementy biografii autora powiązane z jego twórczością. Następnie przedstawione zostało samo pojęcie społecznej odpowiedzialności i jego ewolucja w okresie, w którym powstawały pisma Lippmanna, z naciskiem na amerykański kontekst kulturowo-historyczny. W kolejnej części pokazane zostay dwa różne ujęcia problematyki charakterystycznej dla opisywanego zagadnienia, które odnaleźć można w pismach autora. Pierwsze odnosi się do postulowanej przez autora teorii ekonomii (...) społecznej, drugie powiązane jest ze specyficznym sposobem definiowania społeczeństwa. Wskazane zostały także źródła potencjalnych inspiracji we współczesnych Lippmannowi teoriach ekonomicznych, filozoficznych i społecznych. Niektóre propozycje autora są typowe dla epoki, inne zdają się nosić znamiona innowacyjności. (shrink)

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was (...) disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

Cognitive functions like perception, memory, language, or consciousness are based on highly parallel and distributed information processing by the brain. One of the major unresolved questions is how information can be integrated and how coherent representational states can be established in the distributed neuronal systems subserving these functions. It has been suggested that this so-called ''binding problem'' may be solved in the temporal domain. The hypothesis is that synchronization of neuronal discharges can serve for the integration of distributed neurons into (...) cell assemblies and that this process may underlie the selection of perceptually and behaviorally relevant information. As we intend to show here, this temporal binding hypothesis has implications for the search of the neural correlate of consciousness. We review experimental results, mainly obtained in the visual system, which support the notion of temporal binding. In particular, we discuss recent experiments on the neural mechanisms of binocular rivalry which suggest that appropriate synchronization among cortical neurons may be one of the necessary conditions for the buildup of perceptual states and awareness of sensory stimuli. (shrink)

The history of maternal-fetal therapy is a complex and compelling one. It can be argued that the science and ethics underpinning this field evolved together, with emerging technology spurring on th...

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)