Algorithms used in the public sector, e.g., for allocating social benefits or predicting fraud, often require involvement from multiple stakeholders at various phases of the algorithm’s life-cycle. This paper focuses on the communication issues between diverse stakeholders that can lead to misinterpretation and misuse of algorithmic systems. Ethnographic research was conducted via 11 semi-structured interviews with practitioners working on algorithmic systems in the Dutch public sector, at local and national levels. With qualitative coding analysis, we identify key elements of the (...) communication processes that underlie fairness-related human decisions. More specifically, we analyze the division of roles and tasks, the required skills, and the challenges perceived by diverse stakeholders. Three general patterns emerge from the coding analysis: (1) Policymakers, civil servants, and domain experts are less involved compared to developers throughout a system’s life-cycle. This leads to developers taking on the role of decision-maker and policy advisor, while they potentially miss the required skills. (2) End-users and policy-makers often lack the technical skills to interpret a system’s output, and rely on actors having a developer role for making decisions concerning fairness issues. (3) Citizens are structurally absent throughout a system’s life-cycle. This may lead to unbalanced fairness assessments that do not include key input from relevant stakeholders. We formalize the underlying communication issues within such networks of stakeholders and introduce the phase-actor-role-task-skill (PARTS) model. PARTS can both (i) represent the communication patterns identified in the interviews, and (ii) explicitly outline missing elements in communication patterns such as actors who miss skills or collaborators for their tasks, or tasks that miss qualified actors. The PARTS model can be extended to other use cases and used to analyze and design the human organizations responsible for assessing fairness in algorithmic systems. It can be further extended to explore communication issues in other use cases, design potential solutions, and organize accountability with a common vocabulary. (shrink)

Should a debate of the choice between metaphorical investigation and epistemological realism in organizational research be prioritized as Willy McCourt called for in Organization Studies? We argue here against doing any such thing — a ‘realism’ debate in organizational theory would merely be a ‘red herring’. Theoretical investigation from Ricoeur to Derrida has liberated us from the need to re-visit the theme, but examination of Gareth Morgan's intellectual development, as begun by McCourt, is of interest because it reveals two very (...) different ‘realisms’. What is of interest about ‘realism’ is not an eitherlor of either ‘realism’ or ‘constructivism’, but a polyphony of the many voices of research. (shrink)

The paper reacts against the strict separation between dialectical and rhetorical approaches to argumentation and argues that argumentative discourse can be analyzed and evaluated more adequately if the two are systematically combined. Such an integrated approach makes it possible to show how the opportunities available in each of the dialectical stages of a critical discussion have been used strategically to further the rhetorical aims of the speaker or writer. The approach is illustrated with the help of an analysis of an (...) `advertorial' published by R. J. Reynolds Tobacco Company. (shrink)

This is the first extensive study of ecological virtue ethics and the new rhetoric of environmentalists. Based on a wide-ranging survey of environmental literature, Louke van Wensveen offers an overview of current "green" virtue language and proposes the basic elements of a matching ecological virtue theory, dubbed "dirty virtues" by ecological philosophers.Environmental ethics is not exhausted by debates about the need to preserve rivers, our duties to bioregions, and the intrinsic value of nonhuman nature; rather, ecoliterature also contains a rich (...) virtue language. Highlighting the integrity, diversity, internal tensions, dynamism, and visionary character of this ecological virtue language, the author shows both its historical roots and innovative features. Van Wensveen illustrates a widespread awareness of attitudes and habits that help or harm our relations with the nonhuman world. She includes a unique catalog of 189 virtues and 174 vices that mark the vision and praxis of people committed to ecological flourishing.The second part of Dirty Virtues presents carefully crafted criteria to help discern genuine virtue and vice in an ecological age. Her arguments are distinguished by a critical balance of moral sources, including Aristotelian virtue theory, Christian tradition, women's experiences, psychological theory, and metaphorical representations of nonhuman nature.Methodologically innovative and boldly interdisciplinary, Dirty Virtues will challenge and inspire virtue theorists, as well as environmental ethicists and theologians. (shrink)

This paper describes the development of pragma-dialectics as a theory of argumentative discourse. First the development of the pragma-dialectical model of a critical discussion is explained, with the rules that are to be complied with in order to avoid fallacies from occurring. Then the integration is discussed of rhetorical insight in the dialectical framework. In this endeavour, the concept of strategic manoeuvring is explained that allows for a more refined and more profoundly justified analysis of argumentative discourse and a better (...) identification of fallacies. The paper ends with a brief overview of current research projects. (shrink)

Minimal predicates P satisfying a given first-order description φ(P) occur widely in mathematical logic and computer science. We give an explicit first-order syntax for special first-order ‘PIA conditions’ φ(P) which guarantees unique existence of such minimal predicates. Our main technical result is a preservation theorem showing PIA-conditions to be expressively complete for all those first-order formulas that are preserved under a natural model-theoretic operation of ‘predicate intersection’. Next, we show how iterated predicate minimization on PIA-conditions yields a language MIN(FO) equal (...) in expressive power to LFP(FO), first-order logic closed under smallest fixed-points for monotone operations. As a concrete illustration of these notions, we show how our sort of predicate minimization extends the usual frame correspondence theory of modal logic, leading to a proper hierarchy of modal axioms: first-order-definable, first-order fixed-point definable, and beyond. (shrink)

People who work and live in a certain moral practice usually possess a specific form of moral wisdom. If we manage to incorporate their moral intuitions in ethical reasoning, we can arrive at judgements and theories that grasp a moral experience that generally cannot be found outside the said practice. To achieve this goal, we need a legitimate way to balance moral intuitions, ethical principles and general theories. In the present contribution, we describe a version of the model of Reflective (...) Equilibrium, which we call the Normative-Empirical Reflective Equilibrium . RE provides a framework for ethical thinking that includes both moral experience and normative theory.After an outline of the model, we focus on the role of empirical research and illustrate how empirical data on moral intuitions can add to the comprehensiveness of the set of moral beliefs in NE-RE. Subsequently, we describe how coherence among the elements of an NE-RE can be understood and measured. Finally, we address an important question for any method of moral reasoning: what is the status of the outcome of the reasoning process? This is a matter of justification. We argue for a so-called good reasoning-justified outcome strategy in NE-RE. This strategy is built on a reasoning process in which the reason-giving force of each element is tested and weighed. The thinker has to work towards a coherent view in which only the elements with sufficient justificatory power are retained. If the thinker decides that the elements fit together into a coherent view, a reflective equilibrium is reached. NE-RE is an attempt to describe a model for moral reasoning that can profit from the moral wisdom present among experienced agents through the use of empirical research. (shrink)

Here we explore whether mental training in the form of meditation can help to overcome age-related attentional decline. We compared performance on the attentional blink task between three populations: A group of long-term meditation practitioners within an older population, a control group of age-matched participants and a control group of young participants. Members of both control groups had never practiced meditation. Our results show that long-term meditation practice leads to a reduction of the attentional blink. Meditation practitioners taken from an (...) older population showed a reduction in blink as compared to a control group taken from a younger population, whereas, the control group age-matched to the meditators’ group revealed a blink that was comparatively larger and broader. Our results support the hypothesis that meditation practice can: alter the efficiency with which attentional resources are distributed and help to overcome age-related attentional deficits in the temporal domain. (shrink)

This paper is on the update semantics for might of Veltman. Threeconsequence relations are introduced and studied in an abstract setting.Next we present sequent-style systems for each of the consequence relations.We show the logics to be complete and decidable. The paper ends with asyntactic cut elimination result.

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the (...) spiritual condition of the patient. (shrink)

Confucius is one of the most influential figures--as historical individual and as symbol--in world history; and the Analects, the sayings attributed to Confucius and his disciples, is a classic of world literature. Nonetheless, how to understand both figure and text is constantly under dispute. Surprisingly, this volume is the first and only anthology on these topics in English. Here, contributors apply a variety of different methodologies (including philosophical, philological, and religious) and address a number of important topics, from Confucius and (...) Western "virtue ethics" to Confucius' attitude toward women to the historical composition of the text of the Analects. Scholars will appreciate the rigor of these essays, while students and beginners will find them accessible and engaging. (shrink)

To understand pre-Fregean theories of judgment and proposition, such as those found in Locke and the Port-Royal logic, it is important to distinguish between propositions in the modern sense and propositions in the pre-Fregean sense. By making this distinction it becomes clear that these pre-Fregean theories cannot be meant to solve the propositional attitude problem. Notwithstanding this fact, Locke and Arnauld are able to make a distinction between asserted and unasserted propositions (in their sense). The way Locke makes this distinction (...) turns out to be very different from the way it is made by Arnauld. (shrink)

We give in this paper a sufficient condition, cast in semantic terms, for Hallden-completeness in normal modal logics, a modal logic being said to be Hallden-complete (or Ήallden-reasonable') just in case for any disjunctive formula provable in the logic, where the disjuncts have no propositional variables in common, one or other of those disjuncts is provable in the logic.

Recent research suggests that one can have the feeling of being the cause of an action’s outcome, even in the absence of a prior intention to act. That is, experienced self-agency over behavior increases when outcome representations are primed outside of awareness, prior to executing the action and observing the resulting outcome. Based on the notion that behavior can be represented at different levels, we propose that priming outcome representations is more likely to augment self-agency experiences when the primed representation (...) corresponds with a person’s behavior representation level. Three experiments, using different priming and self-agency tasks, both measuring and manipulating the level of behavior representation, confirmed this idea. Priming high level outcome representations enhanced experienced self-agency over behavior more strongly when behavior was represented at a higher level, rather than a lower level. Thus, priming effects on self-agency experiences critically depend on behavior representation level. (shrink)

Sound and complete axiomatizations are provided for a number of different logics involving modalities for the knowledge of multiple agents and operators for branching time, extending previous work of Halpern, van der Meyden and Vardi [to appear, SIAM Journal on Computing] for logics of knowledge and linear time. The paper considers the system constraints of synchrony, perfect recall and unique initial states, which give rise to interaction axioms. The language is based on the temporal logic CTL*, interpreted with respect to (...) a version of the bundle semantics. (shrink)

A recurrent issue in the vast amount of literature on reasoning models in ethics is the role and nature of moral intuitions. In this paper, we start from the view that people who work and live in a certain moral practice usually possess specific moral wisdom. If we manage to incorporate their moral intuitions in ethical reasoning, we can arrive at judgements and (modest) theories that grasp a moral experience that generally cannot be found outside the practice. Reflective equilibrium (RE) (...) provides a framework for balancing moral intuitions, ethical principles and general theories. Nevertheless, persisting problems associated with the use of intuitions need to be addressed. One is the objection that moral intuitions lack the credibility necessary to guide moral reasoning. Ethicists have tried to solve this problem by formulating criteria to separate the “bad” intuitions from the “good” ones at the beginning of the reasoning process. We call this the credible input-justified outcome strategy. An example is the appeal to the common morality by Beauchamp and Childress. We think this approach is unsuccessful. As an alternative, we outline the good reasoning-justified outcome strategy. It connects to a variant of RE in which intuitions from different sources are incorporated. We argue that the elements of RE have different levels of justificatory power at the start of reasoning. In our strategy, each element can gain or lose justificatory power when it is tested in a reasoning process that meets several criteria. (shrink)

In this paper we examine the questions “What does it mean to be a surrogate mother?” and “What would be an appropriate perspective for a surrogate mother to have on her pregnancy?” In response to the objection that such contracts are alienating or dehumanising since they require women to suppress their evolving perspective on their pregnancies, liberal supporters of surrogate motherhood argue that the freedom to contract includes the freedom to enter a contract to bear a child for an infertile (...) couple. After entering the contract the surrogate may not be free to interpret her pregnancy as that of a non-surrogate mother, but there is more than one appropriate way of interpreting one's pregnancy. To restrict or ban surrogacy contracts would be to prohibit women from making other particular interpretations of their pregnancies they may wish to make, requiring them to live up to a culturally constituted image of ideal motherhood. We examine three interpretations of a “surrogate pregnancy” that are implicit in the views and arguments put forward by ethicists, surrogacy agencies, and surrogate mothers themselves. We hope to show that our concern in this regard goes beyond the view that surrogacy contracts deny or suppress the natural, instinctive or conventional interpretation of pregnancy. (shrink)

According to the pragma-dialectical ideal of reasonableness, in case of a difference of opinion the protagonist and the antagonist of a standpoint should attempt to find out by means of a critical discussion whether the protagonist's standpoint is capable of withstanding the antagonist's criticism. In this paper, the authors formulate the latest version of their basic rules for the performance of speech acts in the various stages that can beanalytically distinguished in a critical discussion that can lead to the resolution (...) of a single and non-mixed difference opinion. (shrink)

What renders some mentally disordered patients incapable of informed consent to medical interventions? It is argued that a patient is incapable of giving informed consent owing to mental disorder, if a mental disorder prevents a patient from understanding what s/he consents to; if a mental disorder prevents a patient from choosing decisively; if a mental disorder prevents a patient from communicating his/her consent; or if a mental disorder prevents a patient from accepting the need for a medical intervention. This paper (...) holds that a patient's capacity to give informed consent should be assessed clinically by using these conditions necessary for informed consent, and should be assessed specifically for each intervention and specifically at the time when the consent has to be given. The paper considers patients' incapacity to give informed consent to treatment, to give informed consent to be examined clinically, and to give informed consent to participate in research. (shrink)

Despite its basically syllogistic character, Richard Whately's Elements of logic presents the subject in a modern theoretical setting. Whately, for instance, regarded logic as an abstract science, and defined the syllogism as a purely formal device to be used as a means of determining the validity of all arguments. In this paper, I argue that such instances of abstractive ascent place Whately's theory in closer proximity to later 19th-century developments than to the work of his 17th-century predecessors. In addition to (...) discussing the theory itself, other sections deal with its historical setting, and various reactions to it. (shrink)

Objectives: There are indications that institutional review board members do not find it easy to assess the risks and benefits in medical experiments, although this is their principal duty. This study examined how IRB members assessed the risk/benefit ratio of a specific phase II breast cancer clinical trial.Participants and methods: The trial was evaluated by means of a questionnaire administered to 43 members of IRBs at six academic hospitals and specialised cancer centres in the Netherlands. The questionnaire addressed: identification and (...) estimation of inconvenience, toxicity, psychosocial distress, and benefits of trial participation to patients; identification and estimation of benefits to future patients and medical science; assessment of the trial’s RBR; and assessment of its ethical acceptability.Results: Most IRB members expected trial participation to involve fairly or very serious inconvenience, fairly severe to sometimes life-threatening toxicity, and serious psychological and social consequences. Conversely, the perceived likelihood of benefits to patients was modest. Most regarded the study as important, and the balance between risks and benefits to be favourable, and believed that the protocol should be approved. The IRB members’ final judgement on the trial’s ethical acceptability was significantly correlated with their RBR assessment of the protocol.Conclusions: Because most patients who participate in clinical trials hope this will prolong their lives, it is suggested that patient information should better describe the anticipated benefits—for example, the likelihood of prolonging life. This would allow patients to make decisions regarding participation based on realistic expectations. (shrink)

The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. (...) Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld. (shrink)

It is frequently said that pain is incommunicable and even that it destroys language . This paper offers a phenomenological account of pain and then explores and critiques this view. It suggests not only that pain is communicable to an adequate degree for clinical purposes, but also that it is itself a form of communication through which the person in pain appeals to the empathy and ethical goodness of the clinician. To explain this latter idea and its ethical implications, reference (...) is made to the writings of Emmanuel Levinas. (shrink)

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)

Since the mid-1990s most EU Member States have established a national forensic DNA database. These mass repositories of DNA profiles enable the police to identify DNA stains which are found at crime scenes and are invaluable in criminal investigation. Governments have always brushed aside privacy objections by stressing that the stored DNA profiles do not contain sensitive genetic information on the included individuals and that they reside under the statutory privacy protection regulations. However, it has been generally overlooked that the (...) police also store the DNA samples from which the DNA profiles are derived. Although these DNA samples are actually a potential source of genetic information, they have so far scarcely been the subject of discussion. In this article we will show that both European and national regulations offer inadequate protection to completely prevent function creep, that is, the use of these forensic DNA samples for purposes beyond those envisaged at the time of collection. (shrink)

Criticizing Gallagher’s view on direct perception, I develop a basic model of social perception. According to the Cartesians another person’s intentions are not directly accessible to an observer. According to the cognitivist Cartesians conscious processes are necessary for social understanding. According to the Anti-Cartesians social perception is direct. Since both of these latter approaches face serious problems, I will argue in favor of an alternative: anti-cognitivist Cartesianism. Distinguishing between an active- and a passive part of the perceptual system we can (...) describe the situation as follows: Some functionally individuated parts of our nervous system generate percepts that correspond to the properties that causally trigger the system, whilst others form percepts of properties that do not causally trigger the system. The model is basic in that it merely helps clarifying some of the fundamental concepts we need in order to describe empirical findings. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

Reproductive techniques and practices, ranging from ordinary birth-control measures and artificial insemination to embryo transfer and surrogate motherhood, have greatly enhanced our range of reproductive choices. As a consequence, they pose a number of difficult moral and legal questions with regard to the formation of a family and our conception of parenthood. A view that is becoming increasingly common is that parental rights and responsibilities should not be based on genetic relationships but should instead be seen as arising from agreements (...) or contracts between individuals. Accordingly, a man who consents to his wife's artificial insemination by donor (AID) and not the sperm donor, is the legal father of the child; in surrogacy agreements, the intending mother, and not the surrogate, has the right to raise the resulting child. While agreeing that biology should not form the basis for assigning legal parenthood, I argue that the theory of intentional parenthood, despite being put forward as a liberal theory, is geared toward or will have the function of protecting the nuclear family and inhibiting the formation of alternative family forms. (shrink)

. In my recent work I argued that the religion and sciencedialogue is most successful when done locally and contextually. However, I also argued against theology's epistemic isolation in a pluralist, postmodern world, and for a postfoundationalist notion of human rationality that reveals the interdisciplinary, public nature of all theological reflection. I now want to explore the possibility that, when we look at what the prehistory of thehuman mind reveals about the biological roots of all human rationality, some forms of (...) contemporary evolutionary epistemology may actually hold the key to understanding the kind of cognitive fluidity that enables true interdisciplinary reflection. Philosophically the religion and science dialogue benefits from this move when a postfoundationalist notion of rationality redescribes the dynamic interaction of our various disciplinary dialogues with one another as aform of transversal reasoning. Transversality in this sense justifies and urges an acknowledgment of multiple patterns of interpretation as one moves across the borders and boundaries of different disciplines. (shrink)

In this article, the pragma-dialectical model of a critical discussion is demonstrated to provide a useful instrument for discovering causes of an unsatisfactory development of problem-solving discussions. First a sketch is given of the development of a problem-solving discussion which, in the opinion of the participants themselves, developed in an unsatisfactory fashion. Then it is argued that this development can be traced back to flaws in the execution of the stages of a critical discussion.

As the title implies, this article asks what an adequate practical ethic is and what a hermeneutic of moral experience can mean for practical ethics. We will use some elements from Ricoeur’s work to examine our view critically and develop it further. We will ask how experience can be an object of hermeneutical study and how we can tie narrativity and normativity together.

Ernest Mandel theorised the capitalist world economy as an articulated system of capitalist, semi-capitalist and precapitalist relations of production, linked to each other by capitalist relations of exchange and domination by the capitalist world market. This seems to be an interesting starting point for an historically well-founded theory, building on and going beyond Marx's work, of the worldwide expansion of the capitalist mode of production from its origins to the present. In his attempt to formulate his theory, Mandel did not (...) succeed in resolving all difficulties, however. His main works – Marxist Economic Theory and Late Capitalism – show a number of dangling loose ends. The central question is whether these loose ends are merely technical difficulties or whether they reveal fatal flaws in the theory as a whole. In order to come a step closer to answering this question, a conference was organised in Amsterdam, November 2003. This introduction formulates the five, closely interrelated issues that were highlighted at this conference. (shrink)

This chapter describes how philosophical theorizing about justice can be connected with empirical research in the social sciences. We begin by drawing on some received distinctions between ideal and non-ideal approaches to theorizing justice along several different dimensions, showing how non-ideal approaches are needed to address normative aspects of real-world problems and to provide practical guidance. We argue that there are advantages to a transitional approach to justice focusing on manifest injustices, including the fact that it enables us to set (...) aside some reasonable disagreements about justice. The ‘bottom-up’ approach we advocate, for which we borrow Wolff’s term ‘real-world political philosophy’, is an empirically-informed normative analysis that attends to specific, identifiable injustices, and thus is partial, though not isolationist. We illustrate our approach by considering how different models of the nature of disability suggest different kinds of remedy for injustices faced by persons living with disabilities. We reflect on the nature and significance of vulnerabilities, and we assess the role of public opinion in normative theorizing, suggesting a particular significance for the opinions and experiences of marginalized groups. We finally reflect on the relevance of European legal and institutional frameworks for theorizing justice in Europe. (shrink)

Objectives: To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process.Design: The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process.Participants: 727 doctors in three federal states and 469 judges dealing with guardianship matters all over Germany.Main measurements: Comparisons of means, analyses of (...) variance, pivot tables and factor analyses .Results: Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days.Conclusions: A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue. (shrink)

The purpose of this note is to observe a generalization of the concept "computable in..." to arbitrary partial combinatory algebras. For every partial combinatory algebra (pca) A and every partial endofunction on A, a pca A[f] is constructed such that in A[f], the function f is representable by an element; a universal property of the construction is formulated in terms of Longley's 2-category of pcas and decidable applicative morphisms. It is proved that there is always a geometric inclusion from the (...) realizability topos on A[f] into the one on A and that there is a meaningful preorder on the partial endofunctions on A which generalizes Turing reducibility. (shrink)

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients’ treatment refusals.Design of the study: Qualitative design with indepth interviews.Participants: The study sample included 30 patients with cancer and 16 physicians . All patients had refused a recommended oncological treatment.Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients’ treatment refusals. From a medical perspective, a patient’s treatment refusal based on personal values and experience (...) is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient’s refusal of these treatments. Thus, an important factor in the physician’s evaluation of a treatment refusal is whether the treatment refused is curative or non-curative.Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient’s decision being understood and accepted by the physician. The physician’s acceptance is crucial to his or her attitude towards the patient. It contributes to the patient’s feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. (shrink)

The aim of this article is to provide a preliminary ethical evaluation of the effect of telesurgery on patient care. In order to accomplish this task we give a broad description of the state of the art in telesurgery and analyse it using Joan Tronto’s articulation of care as a structured process. This structure illuminates the significance of the patient-physician relationship as the buttress for establishing and preserving practices of care in the healthcare context, with the ultimate goal of safeguarding (...) patient dignity. The process of care combined with the moral aim of medicine—to fulfil the good of the patient—provides the ethical foundation for assessing telesurgery. By exploring various telesurgical scenarios we may assess its potential role in augmenting or diminishing patient care within the frame of the patient-physician relationship. The significance of conducting this evaluation lies in the fact that the practice of telesurgery may very shortly become routine and an evaluation has not yet been attempted. (shrink)

There has been a time in my teaching career that I used to cite in my introductory classes ‘Moral Philosophy’ from Erica Jong's Fear of Flying . The situation leading up to the quote is that the main character, Isadora, is asked a sexual favour by her brother in law, Pierre. Her answer and the subsequent dialogue read then as follows: ‘I can't’ , I said. ‘Come on,’ Pierre said, ‘I'll teach you.’ ‘I didn't mean that … I meant that (...) I can't; morally , I can…’. (shrink)

The Human Genome Project showed that there is signifcant genetic variation within the population. Current research is accumulating large databases that may reveal genetic variations associated with disease or health risks, even if not intended as part of the study design. These incidental fnd-ings create legal, ethical, and fnancial challenges for researchers. Current federal and international guidelines are not adequate. Plans for dealing with incidental fndings need to be established in the study design and reviewed and approved by the Institutional (...) Review Board. (shrink)