If our sense of the past is inevitably shaped by the explanatory logic of narrative, then the stories that we create in turn reveal the inescapable presence and ...

Référence de la pensée critique contemporaine et de la lutte contre les discriminations sexuelles et « culturelles », Judith Butler passe pour une grande philosophe. En prise sur notre actualité, ce livre, dont le titre fait allusion à l'autorité usurpée des Jésuites moqués par Pascal dans Les Provinciales, questionne cette évidence, par une critique sévère et argumentée de la « pensée Butler ».

We all know what a voluntary action is - we all think we know when an action is voluntary, and when it is not. Yet, performing and action and defining it are different matters. What counts as an action? When does it begin? Does the conscious desire to perform an action always precede the act? If not, is it really a voluntary action? This is a debate that crosses the boundaries of Philosophy, Neuroscience, Psychology, and Social Science. This book brings (...) together some to the leading thinkers from these disciplines to consider this deep and often puzzling topic. The result is a fascinating and stimulating debate that will challenge our fundamental assumptions about our sense of free-will. (shrink)

The doctor patient relationship starts with a story. Doctors' notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The "practice" of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.

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)

Across two studies, a wide age range of participants was interviewed about the nature of death. All participants were living in rural Madagascar in a community where ancestral beliefs and practices are widespread. In Study 1, children (8–17 years) and adults (19–71 years) were asked whether bodily and mental processes continue after death. The death in question was presented in the context of a narrative that focused either on the corpse or on the ancestral practices associated with the afterlife. Participants (...) aged 8 years and older claimed that death brings an end to most bodily and mental processes. Nevertheless, particularly in the context of the religious narrative, they claimed that certain mental processes continue even after death. This assertion of an afterlife was more evident among adults than children, especially with respect to cognitive processes, such as knowing and remembering. In Study 2, 5‐ and 7‐year‐olds were asked similar questions in connection with the death of a bird and a person. Seven‐year‐olds consistently claimed that bodily and mental processes cease at death, whereas 5‐year‐olds were unsystematic in their replies. Together, the two studies replicate and extend findings obtained with Western children showing that, in the course of development, different conceptions of death are elaborated—a biological conception in which death terminates living processes and a religious conception in which death marks the beginning of a new form of spiritual existence. (shrink)

'A comprehensive and important collection that includes essays by some of the leading figures in the field....Essential reading for anyone interested in risk assessment.' Professor Kristin Shrader-Frechette, University of Notre Dame 'The editors are to be congratulated for bringing together a distinguished international group of theorists to reflect on the issues. This volume will be sure to raise the level of debate while at the same time showing the importance of philosophical reflection in approaches to the problems of the age.' (...) Professor Jonathan Wolff, University College London This volume brings together top authors from the fields of risk, philosophy, social sciences and psychology to address the issue of how we should decide how far technological risks are morally acceptable or not. The underlying principles are examined, along with methodological challenges, public involvement and instruments for democratization. A strong theoretical basis is complemented by a range of case studies from some of the most contentious areas, including medical ethics and GM crops. This book is a vital new resource for researchers, students and anyone concerned that traditional approaches to risk management don't adequately address ethical considerations. (shrink)

The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in (...) as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas’s understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas’s theory of modern society and the concept of the system’s colonization of the life world. (shrink)

Steblin's fully updated reference focuses on musical key characteristics during the baroque, classical, and romantic periods. (Music).

“Acceptable Risk” – On the Rationality of Emotional Evaluations of Risk What is “acceptable risk”? That question is appropriate in a number of different contexts, political, social, ethical, and scienti c. Thus the question might be whether the voting public will support a risky proposal or project, whether people will buy or accept a risky product, whether it is morally permissible to pursue this or that potentially harmful venture, or whether it is wise or prudent to test or try out (...) some possibly dangerous hypothesis or product. But complicating all of these queries, the “sand in the machinery” of rational decision-making, are the emotions. It is often noted that voters are swayed by their passions at least as much as they are convinced by rational arguments. And it is obvious to advertisers and retailers that people are seduced by all sorts of appeals to their vanities, their fears, their extravagant hopes, their insecurities. At least one major thread of ethical discourse, the one following Kant, minimizes the importance of the emotions in favor of an emphatically rational decision-making process, and it is worth mulling over the fact that many of those who do not accept Kant’s ethical views more or less applaud his rejection of the “moral sentiment theory” of the time, promoted by such luminary philosophers as David Hume and Adam Smith. (shrink)

Anthropology combines two quite different enterprises: the ethnographic study of particular people in particular places and the theorizing about the human species. As such, anthropology is part of cognitive science in that it contributes to the unitary theoretical aim of understanding and explaining the behavior of the animal species Homo sapiens. This article draws on our own research experience to illustrate that cooperation between anthropology and the other sub-disciplines of cognitive science is possible and fruitful, but it must proceed from (...) the recognition of anthropology’s unique epistemology and methodology. (shrink)

As everyone knows, physicists have proved that free will doesn’t exist. That’s because we are made of tiny particles which follow strict laws, and human behavior is really just a consequence of these particles’ laws. At least that’s what I used to think. But some years ago I stumbled over a gap in this argument. In this essay I want to tell you what made me rethink and why you should rethink, too.

For valid informed consent, it is crucial that patients or research participants fully understand all that their consent entails. Testing and revising informed consent documents with the assistance of their addressees can improve their understandability. In this study we aimed at further developing a method for testing and improving informed consent documents with regard to readability and test-readers’ understanding and reactions. We tested, revised, and retested template informed consent documents for biobank research by means of 11 focus group interviews with (...) members from the documents’ target population. For the analysis of focus group excerpts we used qualitative content analysis. Revisions were made based on focus group feedback in an iterative process. Focus group participants gave substantial feedback on the original and on the revised version of the tested documents. Revisions included adding and clarifying explanations, including an info-box summarizing the main points of the text and an illustrative graphic. Our results indicate positive effects on the tested and revised informed consent documents in regard to general readability and test-readers’ understanding and reactions. Participatory methods for improving informed consent should be more often applied and further evaluated for both, medical interventions and clinical research. Particular conceptual and methodological challenges need to be addressed in the future. (shrink)

ZusammenfassungDie Einführung der Fallpauschalen-basierten Finanzierung der Krankenhäuser ist ein erneuter Versuch, die Kosten in diesem Bereich zu reduzieren. Folge dieses Anreizsystems ist u. a. eine deutliche Verkürzung der Verweildauer der Patienten im Krankenhaus. Das wiederum führt zu durchschnittlich kränkeren Patienten und einer deutlichen Arbeitsverdichtung für alle. Vor diesem Hintergrund wird anhand empirischer Daten die Situation der Pflege mit drastischen Einschränkungen beschrieben und es werden Hypothesen zur Begründung aufgestellt. Daran knüpft sich die Frage, welche Art der Versorgung die Patienten mit kürzer (...) werdender Verweildauer und immer häufiger auftretenden chronischen Krankheiten neben der ärztlichen Therapie benötigen. Dies baut auf der Theorie der Aufgaben zur Krankheitsbewältigung auf, die Patienten befähigen sollen, mit Krankheiten in ihrem eigenen Sinne umgehen zu können. Die Kernaufgaben der Pflege werden hier mit dem Ziel der forcierten Förderung der Entlassungsfähigkeit verbunden mit einem Empowerment der Patienten verknüpft. Organisatorisch bietet sich als Lösung der Einsatz von Primary Nurses an. Die derzeitige Situation in der Pflege widerspricht den genannten Sollvorstellungen diametral. Im Sinne einer sicheren und effektiven Versorgung von Patienten im Krankenhaus muss der Pflegedienst inhaltlich völlig anders aufgestellt und mit weiteren Kompetenzen ausgestattet werden. (shrink)

Not all countries do their fair share in the effort of preventing dangerous climate change. This presents those who are willing to do their part with the question whether they should 'take up the slack' and try to compensate for the non-compliers' failure to reduce emissions. There is a pro tanto reason for doing so given the human rights violations associated with dangerous climate change. The article focuses on fending off two objections against a duty to take up the slack: (...) that it is unfair and ineffective. We grant that it is unfair if some have to step in for others but argue that this does not amount to a decisive objection under conditions of partial compliance. With regard to the charge of emission reductions being ineffective, we argue that the empirical case for this claim is missing and that even if it were not, there still remains the option of taking up the slack in other forms. (shrink)

Using the example of architecture, this article defends the thesis that designing should not be regarded as a kind of experimenting. This is in contrast to a widespread methodological claim that design processes are equivalent to experimentation processes. The contrary thesis can be proven by focusing on actual practices, techniques and design strategies. Closely connected with the thesis is an even more important epistemological claim, which contends that designing serves not only to develop artefacts but is also a means of (...) acquiring genuine knowledge. When the epistemic relevance of said practices, techniques and strategies is reassessed, designing emerges clearly as an independent epistemic praxis. To defend the thesis, the present article draws on and analyses empirical material from an ethnographic field study in order to back up the conceptual analysis. (shrink)

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

In written and spoken communications, metaphors are often used as an aid to help convey abstract or less tangible concepts. However, the benefits of using visual metaphors in visualization have so far been inconclusive. In this work, we report an empirical study to evaluate hypotheses that visual metaphors may aid memorization, visual search and concept comprehension. One major departure from previous metaphor-related experiments in the literature is that we make use of a dual-task methodology in our experiment. This design offers (...) an abstraction of typical situations where viewers do not have their full attention focused on visualization (e.g., in meetings and classes). The use of the secondary task introduces “divided attention”, and makes the effects of visual metaphors more observable. In addition, it also serves as additional masking in memory-based trials. The results of this study show that visual metaphors can help participants better remember the information depicted in visualization. On the other hand, visual metaphors can have a negative impact on the speed of visual search. The results also show a complex pattern as to the benefits of visual metaphors in helping participants grasp key concepts from visualization. (shrink)