Increasing prevalence of depression poses a huge challenge to the healthcare systems, and the success rates of current standard therapies are limited. While 30% of treated patients do not experience a full remission after treatment, more than 75% of patients suffer from recurrent depressive episodes. Eye Movement Desensitization and Reprocessing therapy represents an emerging treatment option of depression, and preliminary studies show promising effects with a probably higher remission rate when compared to control-therapies such as cognitive behavioral therapy. In the (...) present study, 49 patients with severe depression were treated with an integrated systemic treatment approach including EMDR therapy that followed a specific protocol with a treatment algorithm for depression in a naturalistic hospital setting. Following their discharge from the hospital, the patients were followed up by a structured telephone interview after 3 and 12 months. 27 of the 49 patients fulfilled the Beck’s depression criteria of a full remission when they were discharged. At the follow-up interview, 12 months after discharge, 7 of the 27 patients reported a relapse, while the remaining 20 patients had stayed relapse-free. The findings of our observational study confirm reports of earlier studies in patients with depression, showing that EMDR therapy leads to a high rate of remission, and is associated with a decreased number of relapses. Patients with depression receiving EMDR treatment may be more resilient to stressors. (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)

Recent theoretical and empirical work in cognitive science and neuroscience is brought into contact with the concept of the flow experience. After a brief exposition of brain function, the explicit–implicit distinction is applied to the effortless information processing that is so characteristic of the flow state. The explicit system is associated with the higher cognitive functions of the frontal lobe and medial temporal lobe structures and has evolved to increase cognitive flexibility. In contrast, the implicit system is associated with the (...) skill-based knowledge supported primarily by the basal ganglia and has the advantage of being more efficient. From the analysis of this flexibility/efficiency trade-off emerges a thesis that identifies the flow state as a period during which a highly practiced skill that is represented in the implicit system’s knowledge base is implemented without interference from the explicit system. It is proposed that a necessary prerequisite to the experience of flow is a state of transient hypofrontality that enables the temporary suppression of the analytical and meta-conscious capacities of the explicit system. Examining sensory-motor integration skills that seem to typify flow such as athletic performance, writing, and free-jazz improvisation, the new framework clarifies how this concept relates to creativity and opens new avenues of research. (shrink)

Contrary to assumptions that changes in brain networks are possible only during crucial periods of development, research in the past decade has supported the idea of a permanently plastic brain. Novel experience, altered afferent input due to environmental changes and learning new skills are now recognized as modulators of brain function and underlying neuroanatomic circuitry. Given findings in experiments with animals and the recent discovery of increases in gray and white matter in the adult human brain as a result of (...) learning, the old concept of cognitive reserve, that is the ability to reinforce brain volume in crucial areas and thus provide a greater threshold for age-dependent deficits, has been reinforced. The challenge we face is to unravel the exact nature of the dynamic structural alterations and, ultimately, to be able to use this knowledge for disease management. Understanding normative changes in brain structure that occur as a result of environmental changes and demands is pivotal to understanding the characteristic ability of the brain to adapt. (shrink)

When the social relevance of robotic applications is addressed today, the use of assistive technology in care settings is almost always the first example. So-called care robots are presented as a solution to the nursing crisis, despite doubts about their technological readiness and the lack of concrete usage scenarios in everyday nursing practice. We inquire into this interconnection of social robotics and care. We show how both are made available for each other in three arenas: innovation policy, care organization, and (...) robotic engineering. First, we analyze the discursive “logics” of care robotics within European innovation policy, second, we disclose how care robotics is encountering a historically grown conflict within health care organization, and third we show how care scenarios are being used in robotic engineering. From this diagnosis, we derive a threefold critique of robotics in healthcare, which calls attention to the politics, historicity, and social situatedness of care robotics in elderly care. (shrink)

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)

_In Perception, Empathy, and Judgment_ Arne Johan Vetlesen focuses on the indispensable role of emotion, especially the faculty of empathy, in morality. He contends that moral conduct is severely threatened once empathy is prevented from taking part in an interplay with cognitive faculties in acts of moral perception and judgment. Drawing on developmental psychology, especially British "object relations" theory, to illuminate the nature and functioning of empathy, Vetlesen shows how moral performance is constituted by a sequence involving perception, judgment, (...) and action, with an interplay between the agent's emotional and cognitive faculties occurring at each stage. In the powerful tradition from Kant to present-day theorists such as Kohlberg, Rawls, and Habermas, reason is privileged over feeling and judgment over perception, in such a way that basic philosophical questions remain unasked. Vetlesen focuses our attention on these questions and challenges the long-standing assertion that emotions are damaging to moral response. In the final chapter he relates his argument to recent feminist critiques that have also castigated moral theorists in the Kantian tradition for their refusal to recognize a role for emotion in morality. While the book's argument is philosophical, its method and scope are interdisciplinary. In addition to critiques of such philosophers as Arendt, MacIntyre, and Habermas, it contains discussions of specific historical, ideological, and sociological factors that may cause "numbing"—selective or broad-ranging, pathological insensitivity—in humans. The Nazis' mass killing of Jews is studied to illuminate these and other relevant empirical aspects of large-scale immoral action. (shrink)

In a seminal article in the Journal of Medical Ethics, Søren Holm and Tuja Takala analysed two protechnology arguments in bioethics: the hopeful principle and the automatic escalator. They showed how these arguments relate to problematic arguments such as the precautionary principle and the empirical slippery slope argument, and argued that they should be used with great caution. The present article investigates the recent debate on proton beam therapy, where the hopeful principle and the automatic escalator are identified. However, the (...) debate reveals a series of other arguments that deserve similar caution. An analysis of these arguments indicates that the roots of their fallacies are to be found in the ignorance of the uncertainties about risks and benefits and an overly optimistic attitude towards technology and progress. The point is not to argue against proton therapy, but rather to point out that flawed arguments for new technologies, such as proton therapy, can actually hamper their implementation instead of promoting it. Patients deserve the best technology available, not only on the basis of the best available evidence, but also on the basis of the best arguments. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

Many consumers implicitly associate sustainability with lower product strength. This so-called ethical = less strong intuition (ELSI) poses a major threat for the success of sustainable products. This article explores this pervasive lay theory and examines whether it is a key barrier for sustainable consumption patterns. Even more importantly, little is known about the underlying mechanisms that might operate differently at the implicit and explicit levels of the consumer’s decision-making. To fill this gap, three studies examine how the implicit judgments (...) that consumers activate automatically shape their consumption behaviors, in concert with their more controlled explicit beliefs about sustainable products. The Main Study investigates the ELSI’s imprint on actual shopping patterns and disentangles the implicit and explicit mechanisms of the lay theory. This paper also asks how this negative influence can be attenuated by examining whether the consumer’s interest in sustainable consumption reduces reliance on the ELSI. Two follow-up studies confirm the robustness from different methodological and practical perspectives. Implications for companies and policy makers are derived. (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)

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)

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.

Evil is a poorly understood phenomenon. In this provocative 2005 book, Professor Vetlesen argues that to do evil is to intentionally inflict pain on another human being, against his or her will, and causing serious and foreseeable harm. Vetlesen investigates why and in what sort of circumstances such a desire arises, and how it is channeled, or exploited, into collective evildoing. He argues that such evildoing, pitting whole groups against each other, springs from a combination of character, situation, and social (...) structure. By combining a philosophical approach inspired by Hannah Arendt, a psychological approach inspired by C. Fred Alford and a sociological approach inspired by Zygmunt Bauman, and bringing these to bear on the Holocaust and ethnic cleansing in the former Yugoslavia, Vetlesen shows how closely perpetrators, victims, and bystanders interact, and how aspects of human agency are recognized, denied, and projected by different agents. (shrink)

--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.

Excessive fear generalisation is a feature characteristic of clinical anxiety and has been linked to its aetiology. Previous animal studies have shown that the mere passage of time increases fear generalisation and that brief exposure to training cues prior to long-term testing reverses this effect. The current study examined these phenomena in humans. Healthy participants learned the relationship between the presentation of a picture of a neutral male face and the delivery of a mild shock. One group was immediately tested (...) with a novel picture of a somewhat different male face (generalisation test). Another group was tested one week later. A third group was also tested one week later and was additionally exposed to the training picture prior to testing. During picture presentations, shock-expectancy ratings were obtained as a measure of fear. Fear generalisation increased from the immediate test to the 1-week follow-up test. This result could not be attributed to level of neuroticism or a general increase in fear (incubation). Furthermore, the time-dependent increase in fear generalisation vanished following brief exposure to the training picture. Results indicate that human fear generalisation is a temporally dynamic process and that memory for stimulus details can be re-established following a reminder treatment. (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?

Alle Kulturleistungen des Menschen bilden sich in oder als Traditionen, seien es einfache Rituale und Bräuche oder komplexe Wissenssysteme wie Religion, Kunst, Wissenschaft und Philosophie. Thomas Arne Winter legt erstmals eine systematische Traditionstheorie vor, die das Wesen hinter den vielfältigen Erscheinungsformen von Tradition ergründet. In kritischer Auseinandersetzung mit Heidegger und Gadamer entwickelt er einen neuen Ansatz, der phänomenologische, hermeneutische und strukturanalytische Verfahren zusammenführt. Genaue Analysen der Grundbegriffe Weitergabe, Wiederholung, Muster, Verstehen und Sinn erarbeiten eine Ontologie des traditionalen Phänomens. Sie (...) zeigt, wie hermeneutische Muster die kollektive Sinngebung des menschlichen Lebens ermöglichen. Dabei geht es nicht darum, traditionalen Sinn zu verfechten, sondern über seine Generierungsprozesse aufzuklären. So wird in anthropologischer Hinsicht eine Universalgrammatik menschlicher Lebensformen entworfen. (shrink)

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)

Die Gesundheitsreformen der vergangenen Jahrzehnte haben die Organisation Krankenhaus einem grundlegenden Wandel unterzogen. Neben offenkundig notwendigen und sinnvollen Veränderungen hat es aber auch solche gegeben, die die Frage aufwerfen, welchen gesellschaftlichen Aufgaben das Krankenhaus in Zukunft dienen soll. Pointiert gefragt: Welcher Effektivität soll die seit Jahren betriebene Effizienzsteigerung in der Organisation Krankenhaus dienen außer der Begrenzung eines allgemeinen Kostenanstiegs? Es ergibt sich ein paradoxer Befund: Der Wandel der Organisation Krankenhaus scheint sich maßgeblich der Ökonomisierung zu verdanken, die zugleich das Mittel (...) darstellt, mit dem der Wandel bewältigt werden soll. In diesem Beitrag werden organisations- und institutionstheoretische Entwicklungen auf den Prozess der Ökonomisierung abgebildet und aus einer ethischen Perspektive reflektiert. (shrink)

Taking the individual human being as a point of reference, this paper examines the sustainability of oneself as a contribution to human society and the biosphere in an evolving world. The proactive role as inquirer/researcher alias designer leads to active inquiry and design of one's life with influential consequences on the lives of other human beings and planetary life forms. To sustain a tenable position between the constructive and destructive forces of contemporary existence, a conscientious and ethical stance becomes central (...) in one's self?understanding of life fulfillment and the pragmatic nature of one's actions in the world. (shrink)

Die menschliche Begeisterung fur Garten reicht historisch weit zuruck und ist bis in die Gegenwart ungebrochen. Dieser Band versammelt Beitrage zu einem bisher jedoch wenig beachteten Themenfeld. Der Begriff des Gartens war immer auch ein zentraler Bestandteil philosophischer und theologischer Diskurse und Kristallisationspunkt von Selbstverstandigungen des Menschen uber die Bedingungen gluckenden Lebens und uber zentrale Inhalte religiosen Glaubens. Die Beitrage des Bandes untersuchen derartige Gartendiskurse mit verschiedenen historischen Schwerpunkten, die von biblischer Zeit bis in die Gegenwart reichen. Erganzt wird dies (...) durch zwei exemplarische Untersuchungen uber die mediale Transformation, in der philosophische und theologische Gartendiskurse in Literatur und Musik eingegangen sind.". (shrink)

Big Data and biopolitics are two major issues currently attracting attention in public health discourse, but also in sociology of knowledge, STS Studies as well as in philosophy of science and bioethics. The paper considers big data to be a new form and instrument of biopolitics which addresses both the categories of body and space. It is expected to fundamentally transform health care systems, domestic environments and practices of self-observation and reflection. Accordingly the paper points out some problems and pitfalls (...) as well as open questions that have emerged in the field of AAL, which merit more attention in future public and academic debate. (shrink)

Michael S. Gazzaniga, a pioneer and world leader in cognitive neuroscience, has made an initial attempt to develop neuroethics into a brain-based philosophy of life that he hopes will replace the irrational religious and political belief-systems that still partly govern modern societies. This article critically examines Gazzaniga’s proposal and shows that his actual moral arguments have little to do with neuroscience. Instead, they are based on unexamined political, cultural and moral conceptions, narratives and values. A more promising way of interpreting (...) the belief-forming system of the brain is to say that we cannot avoid thinking in terms of wider frameworks and narratives that are socially embedded and historically developed; consequently, any moral discussion has to be in terms of these frameworks and narratives. (shrink)