Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired (...) of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. Results The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64–74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. Conclusions An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously. (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

We provide a retrospective of 25 years of the International Conference on AI and Law, which was first held in 1987. Fifty papers have been selected from the thirteen conferences and each of them is described in a short subsection individually written by one of the 24 authors. These subsections attempt to place the paper discussed in the context of the development of AI and Law, while often offering some personal reactions and reflections. As a whole, the subsections build into (...) a history of the last quarter century of the field, and provide some insights into where it has come from, where it is now, and where it might go. (shrink)

Pretheoretically we hold that we cannot gain justification or knowledge through an epistemically circular reasoning process. Epistemically circular reasoning occurs when a subject forms the belief that p on the basis of an argument A, where at least one of the premises of A already presupposes the truth of p. It has often been argued that process reliabilism does not rule out that this kind of reasoning leads to justification or knowledge. For some philosophers, this is a reason to reject (...) reliabilism. Those who try to defend reliabilism have two basic options: (I) accept that reliabilism does not rule out circular reasoning, but argue that this kind of reasoning is not as epistemically “bad” as it seems, or (II) hold on to the view that circular reasoning is epistemically “bad”, but deny that reliabilism really allows this kind of reasoning. Option (I) has been spelled out in several ways, all of which have found to be problematic. Option (II) has not been discussed very widely. Vogel considers and quickly dismisses it on the basis of three reasons. Weisberg has shown in detail that one of these reasons is unconvincing. In this paper I argue that the other two reasons are unconvincing as well and that therefore option (II) might in fact be a more promising starting point to defend reliabilism than option (I). (shrink)

"Heideggers Interpretation des Neuplatonismus und damit seine Konstruktion der Seinsgeschichte wurden außer von Stimmen aus der Heidegger-Forschung vor allem von Vertretern der Neuplatonismus-Forschung in Frage gestellt. Die Kritikpunkte lauten zumeist: Heidegger hat den Neuplatonismus zu wenig beachtet (Neuplatonismus-Vergessenheit), ein Vorwurf, der durch die geringe Zahl und die Kürze seiner Äußerungen zum Neuplatonismus begünstigt wurde. Auch könne gerade bei dieser Philosophie von Seinsvergessenheit keine Rede sein. Schlüters Arbeit ist eine ausführliche Auseinandersetzung mit dieser Kritik."--P. [4] of cover.

Social anxiety disorders (SAD) are among the most prevalent mental disorders (lifetime prevalence: 7–12%), with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy (ISFT) for SAD, and evaluated its feasibility in a pilot randomized controlled trial (RCT). The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused (...) language, social network diagnostics, and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD (ICD F40.1; Liebowitz Social Anxiety Scale, LSAS-SR > 30): 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy (CBT; age:M = 36 years,SD = 14). Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety (LSAS-SR; ISFT:d = 1.67; CBT:d = 1.04), while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT (d = 0.81). Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory (Structured Clinical Interview, SCID; 78% in ST, 45% in CBT,p = 0.083); this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

Objectives:Social isolation is increasing in aging societies and several studies have shown a relation with worse cognition in old age. However, less is known about the association in the oldest-old (85+); the group that is at highest risk for both social isolation and dementia. Methods:Analyses were based on follow-up 5 to 9 of the longitudinal German study on aging, cognition, and dementia in primary care patients (AgeCoDe) and the study on needs, health service use, costs, and health-related quality of life (...) in a large sample of oldest-old primary care patients (AgeQualiDe), a multi-center population-based prospective cohort study. Measurements included the Lubben Social Network Scale (LSNS-6), with a score below 12 indicating social isolation, as well as the Mini-Mental Status Examination (MMSE) as an indicator of cognitive function. Results:Dementia-free study participants (n = 942) were M = 86.4 (SD = 3.0) years old at observation onset, 68.2% were women. One third (32.3%) of them were socially isolated. Adjusted linear hybrid mixed effects models revealed significantly lower cognitive function in individuals with smaller social networks (β = 0.5, 95% CI = 0.3-0.7, p <.001). Moreover, changes in an individual's social network size were significantly associated with cognitive changes over time (β = 0.2, 95% CI = 0.1-0.4, p =.003), indicating worse cognitive function with shrinking social networks. Conclusion:Social isolation is highly prevalent among oldest-old individuals, being a risk factor for decreases in cognitive function. Consequently, it is important to maintain a socially active lifestyle into very old age. Likewise, this calls for effective ways to prevent social isolation. (shrink)

Objectives To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices. Design Cross-sectional postal survey. Setting Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument. Subjects All 1645 physician members of the German Society for Palliative Medicine. Main outcome measures Types (...) and frequencies of limitation of treatment and possible determinants. Results 901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death. Conclusion The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life. (shrink)

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60-77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric (...) Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients. (shrink)

New Blackfriars, Volume 102, Issue 1101, Page 677-693, September 2021.

table ronde du Centre national de la recherche scientifique, Paris, 27-29 mars 1979. Huygens et la France (Paris, Vrin, 1981, p. 99-114) CHRISTIAAN HUYGENS VU PAR LEIBNIZ par Albert HEINEKAMP (*) (Leibniz-Archiv, Hannover) Les ...

It would be difficult to name a more interesting scientific problem than that of knowledge of the brain, its overall mechanisms and its molecular nature. Rational management of the brain in the future and utilization of the principles of its functioning to construct various mechanisms to undergird present-day technological progress should follow as direct consequences of development of that sphere of knowledge.

Aron Gurwitsch claims that the field of consciousness is invariantly organized in a theme, thematic field, margin pattern. However, at least two perceptual presentations, chaos and boundlessness, are not ordered in accordance with this pattern. The question this study poses then is the following: given Gurwitsch's field-theory of experiential organization, what is the structure, status, and function of chaos and boundlessness in the field of consciousness? ;Using Gurwitsch's field-theory organization as a base, the structure of thematic chaos and then of (...) thematic boundlessness is articulated: the first by contrasting the field-theories of Gurwitsch and James, the second by contrasting Gurwitsch and Kant. It is concluded that in both cases no thematic Gestalt-coherence and no thematic field as relevant context is presented. ;In terms of status and function, chaos and boundlessness are interpreted as necessary limits. These "limit cases" are not "ideal limits" since they are possible perceptual presentations. Also, limit is taken to mean a two-edged presentation, one that is both an ending and a beginning. Interpreting Gurwitsch, we conclude that both cases are epistemological endings, since they represent a necessary end to the ordinary perception of things. Interpreting James, we conclude that it is possible that thematic chaos is also a metaphysical beginning in experience, since it is that experience in which reality is presented as underived and original. Interpreting Kant, we conclude that it is possible that boundlessness is also an ethical beginning in experience, since it is that experience in which the most original feeling of our sense of humanity is presented. ;We show that chaos and boundlessness each have their own unique field-organization, that they function as two-edged limits involving epistemological concerns on the one hand and metaphysical and ethical concerns respectively on the other, and that their structure and status as limits in the field of consciousness are not contingent but necessary. (shrink)

Ian Kennedy extols the virtues of self-determination by patients: they should make their own decisions about medical treatment after being given advice by their doctors; for doctors to make such decisions on their patients' behalf is authoritarian and unacceptable (I). I present a case where, despite thorough consultation and counselling, the decisions made by the patient and supported by her doctors were found to be consistently inappropriate to her changing lifestyle.

The present work investigates whether the hemispheric processing of both verbal and emotional stimuli, studied by means of a dichotic listening task, differs between normal high and low dissociators as assessed by the Dissociative Experiences Scale . Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735). Two groups of subjects , participated in the experiment. The task consisted in identifying both verbal and emotional stimulus-targets, respectively, on successive sessions. Reaction time and response accuracy (...) were registered and analysed using ANOVA . The interaction between stimuli , channel , and dissociation level reached statistical significance in terms of accuracy measures = 4.75; p < .05). Both high and low dissociators exhibited the expected right ear advantage on verbal targets. On the other hand, whereas low dissociators exhibited the expected left ear advantage on emotional targets, high dissociators failed to follow this typical pattern of hemispheric asymmetry: both hemispheres exhibited similar performances. These results confirm the hypothesis that dissociation is related to changes in hemispheric processing, specifically of emotional information. (shrink)