The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves (...) two problems for psychiatric diseases: experimenter’s regress and arbitrariness. (shrink)

This paper compares the ethical decisions and attitudes of business students and practitioners. Recent unpublished data from a national study of over 1600 students are contrasted with information reported previously. Students are found consistently to make less ethical choices than practitioners, and there is some indication that students are making less ethical choices in the 1980s than in the 1960s. In addition, both students and practitioners agree that buyers should beware, view the role of business more narrowly, and find fewer (...) incentives to behave ethically over time. Codes of ethics appear to be less influential than the individual''s strong personal value system and one''s superiors behaving ethically; support for codes is declining. The paper concludes with observations about the limitations and possibilities for survey research in this area drawing on other studies that used the same instrument utilized for this paper. Some implications for future research are suggested. (shrink)

In psychiatry, many scientists desire to move from a classification system based on symptoms toward a system based on biological causes. The idea is that psychiatric diseases should be redefined such that each disease would be associated with specific biological causes. This desire is intelligible because causal disease models often facilitate understanding and identification of new ways to intervene in disease processes. In its attempt to move from syndromal to specific etiological definitions, psychiatry follows the trend of general medicine.Current psychiatric...

Direct-to-consumer advertising of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians but DTCA is an increasing part of global promotional spending for prescription drugs. Latest estimates suggest that DTCA now represents (...) an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion's share is going to the 20 most prescribed pharmaceuticals. (shrink)

ABSTRACT Temporal dynamists argue that we should believe that there exists temporal passage because there being passage is the best explanation for the presence of our temporal phenomenology. Presentists argue that presentism is the best version of temporal dynamism. Therefore, conditional on us accepting temporal dynamism, we should accept presentism. In this paper it is argued that if we understand temporal passage as the presentist does, such an argument can succeed only if dualism is true. Thus, we conclude, either presentists (...) should embrace dualism, or they should reject any argument for presentism that proceeds via any such argument for temporal passage that proceeds via considerations of what best explains our temporal phenomenology. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

This paper argues that the definition of food justice must be defined in more participatory terms. Current accounts of food justice tend to emphasize distributional inequalities. However, there is broad recognition that these distributional inequalities are the result of participative inequalities and that the participation of marginalized groups in advocacy plays an important role in creating just food systems. In addition, thinking of food justice in more participative terms also suggests a more well-rounded and comprehensive approach to dealing with inequalities (...) within the food system. One manner in which the concept of food justice can be redefined to better capture the importance of participative justice is by considering what is required for informed consent. (shrink)

This study investigated the relationship between dream lucidity, i.e., a dreamer’s insight to the ongoing dream, and attention by considering lucidity as a trait. We examined the ways in which lucidity correlates with the orienting, alerting, and conflict components of the attentional network. A total of 77 participants rated the lucidity of their dreams over 7 consecutive days with the LuCiD scale and then completed the attentional network task. A negative correlation between trait lucidity and the conflict score of the (...) ANT was found for 49 participants whose responses were faster when an alerting signal was presented. This result suggested that, with a prerequisite that the presence of cues facilitates subsequent information processing, the greater a person’s trait lucidity, the more efficiently he or she is capable of resolving conflicts. (shrink)

Der Klimawandel ist die globale Krise unserer Gegenwart. Mit Blick auf die sich hieraus ergebenen Handlungsoptionen und -zwänge stellt der verantwortliche Umgang mit Energie sicher einen der zentralen Bereiche dar. Unsere ethische Verantwortung betrifft dabei beides: Erzeugung und Verbrauch von Energie gleichermaßen. Der vorliegende Band verfolgt zwei Ziele: Erstens soll ein interdisziplinärer Dialog ermöglicht und die dafür notwendigen fachlichen Reflexionen angestoßen werden. Keine Einzeldisziplin kann auf die komplexen Probleme des Klimawandels oder die mit dem Terminus Energieverantwortung angezeigten Herausforderungen alleine eine (...) plausible Antwort geben. Vielmehr müssen die Wissenschaften ein gemeinsames Verständnis der Probleme entwickeln, um auch interdisziplinär geteilte Antworten bereitstellen zu können. Zweitens soll dies in transdisziplinärer Perspektive erfolgen. Das bedeutet, die von der Gesellschaft an die Wissenschaft herangetragenen Fragen und Problemstellungen ernst zu nehmen, aufzugreifen und Antworten zu formulieren, die auch außerhalb der wissenschaftlichen Diskurse als Antworten auf diese Fragen und Problemstellungen verstanden werden können. (shrink)

This paper centers on a case study of CSR performativity during the COVID-19 pandemic. In the extant CSR literature, CSR performativity has focused on “walking the talk” and/or “talking the walk,” wherein narrative and action around CSR are typically treated as two different things with their relationships questioned. We focus on what has been called “t(w)alking” wherein speech is understood to be performative and wherein speech acts and CSR are merged, becoming one and the same thing. Performativity then entails what (...) is (and what is not) said, whereby CSR involves taking responsibility for speech and/or silences. Our thesis is that the COVID-19 pandemic led to the “presenting” of CSR as performativity, in the presence of Levinas' Other, as noble (speech) acts. We examine what became of CSR performativity in a for-profit medical services provider when the COVID-19 pandemic turned fatal for its main client group: the infirm elderly. The performativity of the statement: “The elderly and their carers must be protected” turned out to be crucial and set the stage for the provider's emergency action. Following on insights derived from Nietzsche and Levinas, and more specifically from their views on the particularity of ethical action, we find that CSR morphed into ethical performativity in the case study at hand. Against the backdrop of the views of these thinkers, the research potential of the performativity of “t(w)alking” in future CSR studies emerges and is critically discussed. (shrink)

Der Band widmet sich der Frage, wer verantwortlich ist für einen ethisch angemessenen Umgang mit Energie. Dazu sollen zunächst im ersten Teil die normativen Grundlagen von Energieverantwortung skizziert werden. Im zweiten Teil werden mögliche Spannungsfelder identifiziert, die in verschiedenen gesellschaftlichen, wirtschaftlichen und politischen Dimensionen bestehen. Im abschließenden dritten Teil wird die Perspektive auf Probleme erweitert, die durch die Implementierung energieverantwortlicher Maßnahmen und Bestrebungen entstehen. So leistet der Band eine Ordnung der Fragen rund um Energieverantwortung sowie die Darstellung, Bewertung und Lösung (...) konkreter Handlungsprobleme im Feld der Energie-Nachhaltigkeit. (shrink)

Drawing on a scene in J.M.G. Le Clézio's novel Terra Amata, which tells the story of the instincts of a small boy, the minute sensoria of some bugs and a cosmic catastrophe, this essay demonstrates the ambivalence around insects in animal studies, their contingent location in psychoanalysis and the conundrums they place in ethical philosophy. By reading Le Clézio's tale through Uexküll, Freud, Dodds and Stengers we argue for more nuanced, imbricated and critical connections between ethology, psychoanalysis and ethics. These (...) connections become imperatives in the face of the current environmental crisis, where we urgently need to attend to co-affecting relations that are too distant or proximate, tiny or vast to register as familiar sentient states or ethical feelings. In the process we demonstrate the performative dimensions of what we call the entomological imagination – present in the strange proximity of child and bugs, the powerful unthinking god, the indifference of the insects to human commands, and the infinitesimal catastrophe in Le Clézio's story – that facilitates an epistemic fluidity required for a contemporary understanding of ecologies. (shrink)

This chapter provides a broad overview of the relationship between climate change and environmental justice. It provides (1) a brief review of the concept of environmental justice, (2) discussion about how environmental justice applies to climate change, and (3) several examples of how environmental justice has been integrated into climate governance.

There is currently a gap between assessment and intervention in the literature concerned with climate change and food. While intervention is local and context dependent, current assessments are usually global and abstract. Available assessments are useful for understanding the scale of the effects of climate change and they are ideal for motivating arguments in favor of mitigation and adaptation. However, adaptation projects need assessments that can provide data to support their efforts. This requires the adoption of a more local and (...) context-sensitive approach to assessments. I suggest that Community-Based Participatory Research has the potential to be a tool for such an approach. (shrink)

Dorion Sagan observes that pioneering ethologist Jakob von Uexküll tends to be read in contrasting ways, as a “humble naturalist” pre-empting current research in biosemiotics, animal perception and agency; and as a “biologist-shaman,” gesturing to a transcendental realm where the life-worlds of animals interconnect in a vast symphony of nature. In both cases the tools of the laboratory are thought to generate complete pictures of the invertebrates that Uexküll studies, in unity with their environments. As Giorgio Agamben points out, these (...) experiments form part of an abstract mechanism that produces the human, by isolating instinctual life as an object for study and management from social and ethical modes of existence. What these readings neglect to consider is that Uexküll imagines his experiments through a Picture Book frame. We argue that for Uexküll there is always something fabulous and child-like about the enterprise of reconstructing the subjective environments of the small animals he works with. Drawing on Bernard Stiegler, we propose the Picture Book as a particular technics, or tertiary memory, that cultivates modes of attention that are associated with childhood and are open to the emergence of partial objects and relations. Considered through the Picture Book frame, the Umwelten of insects and other small animals are no longer fixed but are drawn and redrawn in partial expressive ways, through the uncanny picturing – or what Brian Massumi would call “semblances” – of different configurations of animal, technology, human relations. By considering the Picture Book as a technic for ecological thought and imagination, our paper will explore how the small creatures that Uexküll describes might enable the emergence of new ethical sensibilities and relations. (shrink)

Psychological continuity theories have been the dominant theories of personal identity over time, and the phenomenal approach has largely been neglected because of the bridge problem. I propose a hybrid account of the persistence of the self that draws on both psychological and phenomenal influences while avoiding the problems that both theories face in their 'pure' form. Such a hybrid theory retains the benefits of a phenomenal account of intra-streamal unity, and provides a better account of inter-streamal unity with the (...) use of a psychological-continuity theory. (shrink)

Unter ‚Akzeptabilität‘ versteht man einerseits „gerechtfertigte Akzeptanzfähigkeit“ und andererseits „intersubjektive Angemessenheit“; Letztere wird in diesem Beitrag als praktische Kohärenz und soziale Verhältnismäßigkeit gefasst. Damit stellt das Konzept ethischer Akzeptabilität ein Angebot der praktischen Philosophie für den gesellschaftlichen Diskurs zur Akzeptabilitätsüberprüfung bereit. Als kritische Reflexionsinstanz geht es der Philosophie dabei weder um Akzeptanzbeschaffung noch um die Ermittlung möglicher oder erwartbarer Akzeptanz. Philosophische Politikberatung fokussiert als Ethik auf die Qualität der Gründe von Handlungen oder Handlungszielen von politischen Institutionen oder Personen.

Echo phonology was originally proposed to account for obligatory coordination of manual and mouth articulations observed in several sign languages. However, previous research into the phenomenon lacks clear criteria for which components of movement can or must be copied when the articulators are so different. Nor is there discussion of which nonmanual articulators can echo manual movement. Given the prosodic properties of echoes (coordination of onset/offset and of dynamics such as speed) as well as general motoric coordination of various articulators (...) in the human body, we expect that the mouth is not the only nonmanual articulator involved in echo phonology. In this study, we look at a fixed set of lexical items across 36 sign languages and establish that the head can echo manual movement with respect to timing and to the axis/axes of manual movement. We propose that what matters in echo phonology is the visual percept of temporally coordinated movement that repeats a salient movement property in such a way as to give the visual impression of a copy. Our findings suggest that echoes are not obligatory motor couplings of two or more articulators but may enhance phonological distinctions that are otherwise difficult to see. (shrink)

Brooks convincingly makes the case that the current arguments for climate mitigation and adaptation fail. Each of the arguments discussed by Brooks appeals to end-state solutions that are some combination of poorly defined, inadequate, inappropriate, or are impossible. Thus, those arguments provide us with relatively limited guidance regarding what we should do about climate change. I hope to extend Brooks’ article by providing a rough sketch of how we might think about responding to climate change that does not depend upon (...) achieving a particular end state. (shrink)

Data about flow rate, fishing intensity, and expenditures made by anglers can be used to capture some of the recreational value of waterways in economic terms in a way that avoids a number of the weaknesses of the most commonly used tools such as the contingent valuation method. Furthermore, recreational fishing may spur more economic activity than competing uses of riverine flows such as agriculture. This suggests that potential opportunity cost in regards to recreation ought to be a factor considered (...) in management decisions. (shrink)

Business ethics has gained much attention over the past decade in both work and educational settings. This study used a version of Lysonski and Gaidis' ethical vignettes to examine by gender the ethical views of 165 Canadian undergraduate management students, to examine the psychometric properties and construct validity of the instrument, and to determine if the instrument is a useful tool for introducing undergraduates to the topic of ethics in management practice. Results showed that while the instrument is a useful (...) teaching tool, it has psychometric and validity inadequacies that need to be corrected. (shrink)

We think Hall (2013) is correct in arguing that the environmental movement needs a stronger narrative and believe that such a narrative requires significant nuance. Hall rightly recognizes the importance of appropriately framing the current narratives appealed to by the environmental movement. They are too simplistic and, as such, misleading. The optimistic frames tend to ignore the real losses people experience in trying to live greener lifestyles. The ‘doom and gloom’ frames are apt to foster a sense of hopelessness rather (...) than motivate change. However a stronger narrative, as we think Hall would agree, requires that the more qualitative, multifaceted, and mutable nature of value be considered. (shrink)

Society has already seen multiple potential futures of neurotechnologies through the multifaceted lens of science fiction. We do not know which of those futures we will come to live, but the strong force in society's evolutionary process will likely continue to be the insight and oversight developed by the bioethics community, pushing and being pushed by the advances of technology, improvements in medical care, and market competitiveness.