There is an ongoing expert debate with regard to financial incentives in order to increase organ supply. However, there is a lacuna of empirical studies on whether citizens would actually support financial incentives for organ donation.

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps (...) with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

In this article, we offer a systematic description of intermedia relations across music, literature, the visual arts, and film. Beginning with some general reflections on materiality and medium in these diverse fields of art, we then offer various examples consisting of two media (e.g. music film, song, images in writing). We pursue the question if, and how, one of the two media may take priority over the other. In our conclusion, we deal with „intermedia relations in monomediality“. This section focuses (...) on artistic representations made in one medium, but based on reflections on another medium. For instance, this is the case when a novelist writes about a picture without having this picture reprinted in the text. (shrink)

In depicting five “spheres of morality” occupied by physicians Doernberg and Troug provide an impressive analysis on physicians’ various commitments and role conflicts which are excellently illustr...

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 ».

The normative force of evidence can seem puzzling. It seems that having conclusive evidence for a proposition does not, by itself, make it true that one ought to believe the proposition. But spelling out the condition that evidence must meet in order to provide us with genuine normative reasons for belief seems to lead us into a dilemma: the condition either fails to explain the normative significance of epistemic reasons or it renders the content of epistemic norms practical. The first (...) aim of this paper is to spell out this challenge for the normativity of evidence. I argue that the challenge rests on a plausible assumption about the conceptual connection between normative reasons and blameworthiness. The second aim of the paper is to show how we can meet the challenge by spelling out a concept of epistemic blameworthiness. Drawing on recent accounts of doxastic responsibility and epistemic blame, I suggest that the normativity of evidence is revealed in our practice of suspending epistemic trust in response to impaired epistemic relationships. Recognizing suspension of trust as a form of epistemic blame allows us to make sense of a purely epistemic kind of normativity the existence of which has recently been called into doubt by certain versions of pragmatism and instrumentalism. (shrink)

It is often argued that there are no practical reasons for belief because we could not believe for such reasons. A recent reply by pragmatists is that we can often believe for practical reasons because we can often cause our beliefs for practical reasons. This paper reveals the limits of this recently popular strategy for defending pragmatism, and thereby reshapes the dialectical options for pragmatism. I argue that the strategy presupposes that reasons for being in non-intentional states are not reducible (...) to reasons to act. Pragmatists who want to preserve a motivational constraint on reasons therefore have exactly two options: either arguing that there are irreducible reasons for being in non-intentional states ; or arguing that we can believe directly for practical reasons. I argue that the prospects for the former option are dim because irreducible reasons to be in states are hard to square with the motivational constraint on reasons. Returning to the more traditional route of arguing for pragmatism by defending a version of doxastic voluntarism therefore seems to be the more promising way for pragmatists to go. (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)

The semeiotic of Charles Sanders Peirce is irreducibly triadic, positing that a sign mediates between the object that determines it and the interpretant that it determines. He eventually holds that each sign has two objects and three interpretants, standardizing quickly on immediate and dynamical for the objects but experimenting with a variety of names for the interpretants. The two most prominent terminologies are immediate/dynamical/final and emotional/energetic/logical, and scholars have long debated how they are related to each other. This paper seeks (...) to shed new light on the matter by reviewing the numerous manuscript drafts where Peirce develops the latter nomenclature while attempting to introduce his pragmatism to a general audience. It then goes on to examine an additional set of interpretants, intentional/effectual/communicational, and shows that the three different trichotomies can be understood as complementary, rather than redundant or conflicting. (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)

Das Buch beschreibt die Transformation des Diskurses der Kulturwissenschaft, der seit seinem Entstehen um die Jahrhundertwende auch die deutsch-jüdische Interkulturalität retten sollte, in einem Diskurs der politischen Theologie (Carl Schmitt und Gerschom Scholem), über den sich der katastrophale Trennungsprozess beider Kulturen vollstreckt.

Many of our attitudes are non-culpable: there was nothing that we should have done to avoid holding them. I argue that we can still be blameworthy for non-culpable attitudes: they can impair our relationships in ways that make our full practice of apology and forgiveness intelligible. My argument poses a new challenge to indirect voluntarists, who attempt to reduce all responsibility for attitudes to responsibility for prior actions and omissions. Rationalists, who instead explain attitudinal responsibility by appeal to reasons-responsiveness, can (...) make sense of blameworthiness for non-culpable attitudes. In response, voluntarists could propose a revision of our actual practices. This would lead us into a quite different debate. (shrink)

I present an explanatory argument for the reasons-first view: It is superior to knowledge-first views in particular in that it can both explain the specific epistemic role of perception and account for the shape and extent of epistemic justification.

Sartre pädagogisch lesen, dies ist bislang versäumt worden. Zu entdecken ist in seinem Denken eine deutliche Nähe zum Bildungsbegriff des frühen Nietzsche und damit auch eine Akzentuierung der Selbstverantwortlichkeit des Subjekts gegenüber allen situativen Einschränkungen seiner Freiheit. In Zeiten einer drohenden Selbstabdankung des Subjekts ist die Anknüpfung an Sartres Verständnis der Authentizität hilfreich für das Bemühen um die Neuformulierung eines tragfähigen Bildungsbegriffs. Die Sportpädagogik gewinnt über Sartres Analysen des Körpers eine bis heute unerschlossene phänomenologische Perspektive auf ihre anthropologischen Grundlagen.

“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)

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)

We set out longtermist political philosophy as a research field by exploring the case for, and the implications of, ‘institutional longtermism’: the view that, when evaluating institutions, we should give significant weight to their very long-term effects. We begin by arguing that the standard case for longtermism may be more robust when applied to institutions than to individual actions or policies, both because institutions have large, broad, and long-term effects, and because institutional longtermism can plausibly sidestep various objections to individual (...) longtermism. We then address points of contact between longtermism and some central values of mainstream political philosophy, focusing on justice, equality, freedom, legitimacy, and democracy. While each value initially seems to conflict with institutional longtermism, we find that these conflicts are less clear-cut upon closer inspection, and that some political values might even provide independent support for institutional longtermism. We end with a grab bag of related questions that we lack space to explore here. (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)

This volume provides a thorough investigation of the theological views of the Twelversh ite Ibn Ab Jumh r al-Ah s (d. after 906/1501) who combined traditional Mu tazilite thought with the philosophical tradition of Ibn S n, with the Illuminationist tradition and with speculative mysticism.

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)

Der Band gibt einen exemplarischen Überblick über die Geschichte feministischer Theorie in den Sozialwissenschaften. Er verfolgt eine doppelte Zielsetzung: Die vertiefende Einführung in feministisches Denken soll zugleich eine Einübung in eine kritische wissenschaftliche Praxis der Historisierung von Problemen, Objekten und Denkwerkzeugen in der sozialwissenschaftlichen Frauen- und Geschlechterforschung sein. Feministische Theorie entwickelte sich aus einer Reihe von kritischen Analysen und Haltungen gegenüber geschlechtlich organisierten sozialen Ungleichheiten und Ausschlüssen, dominanten Diskursen und Repräsentationen, aber auch in ständiger selbstkritischer Reflexion des eigenen Denkens. Es (...) ist dieser an Widersprüchen und Paradoxien geschulte Blick, der feministisches Denken im Kern ausmacht. (shrink)

Before we can answer what society owes the psychopaths, we have to know wherein society's putative sin against psychopaths might consist. Is the society really responsible for the development of so...

Das Buch diskutiert die Genese von Raum-Symbolen in Wissenschaft und Kunst. Dazu werden die Strukturen und Logiken von kollektiven und individuellen Gestaltungspraktiken von "Räumen" und ihren Konstrukteuren analysiert. Ein empirisch materialreicher Vergleich von urbaner Unterhaltungsliteratur mit Texten aus der Stadt- und Regionalsoziologie sowie der Raumplanung zeigt Gemeinsamkeiten undDifferenzen von Wissenschaft und Kunst.

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)