Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations (...) that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)

Applying an evolutionary framework, we investigate how a reputation mechanism and a buyer insurance (as used on Internet market platforms such as eBay) interact to promote trustworthiness and trust in markets with moral hazard problems. Our analysis suggests that the costs involved in giving reliable feedback determine the gains from trade that can be obtained in equilibrium. Buyer insurance, on the other hand, can affect the trading dynamics and equilibrium selection. We find that, under reasonable conditions, buyer insurance crowds out (...) trust, and trustworthiness. (shrink)

PurposeScarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.Materials and methodsA prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.Results8 (25%) physicians and 24 (75%) nurses participated in (...) the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.ConclusionsOur findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals. (shrink)

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians in the ghettos (...) and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice. (shrink)

Only recently have historians explored in depth the role of the medical profession in Nazi Germany. Several recent works reveal that physicians joined the Nazi party in disproportionate numbers and lent both their efforts and their authority to Nazi eugenic and racist programs. While the crimes of the physician Mengele and a few others are well known, recent research points to a much broader involvement by the profession, even in its everyday clinical work. Analogous activities existed in the German legal (...) and industrial communities; disruption of the medical ethic thus sprang from the broader social contexts of Nazi Germany. The new United States Holocaust Memorial Museum, now opening on the Mall in Washington, D.C, will have an opportunity to educate the public about both the great crimes at Auschwitz and other camps, and the gradual but thorough degradation of ethics in the German medical profession. From this presentation, contemporary bioethics can ponder the proper use of the Nazi analogy in bioethical debate. (shrink)

This work offers a new theory of what it means to be a legal person and suggests that it is best understood as a cluster property. The book explores the origins of legal personhood, the issues afflicting a traditional understanding of the concept, and the numerous debates surrounding the topic.

Talking Politics is a philosophical examination of some of the basic concepts of political discourse. Its primary focus is on the ordinary ; on what is said by politicians, in newspapers and by people in pubs, rather than on the works of political theorists. This is a work of , but not on political theory. Talking Politics is: * Invaluable as a source of reference for students, and contains a detailed index * Arranged thematically, around topics such as `Nation'. Each (...) entry has copious cross-references and suggestions for further reading A. W. Sparkes is uniquely qualified to write such a book, combining some thirty years' teaching as a philosopher with wide experience of, and a life-long fascination with, politics. His attitude is that of a critical, but uncynical, observer. (shrink)

In this article, we present results from a literature review of intrinsic, instrumental, and relational values of nature conducted for the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, as part of the Methodological Assessment of the Diverse Values and Valuations of Nature. We identify the most frequently recurring meanings in the heterogeneous use of different value types and their association with worldviews and other key concepts. From frequent uses, we determine a core meaning for each value type, which is (...) sufficiently inclusive to serve as an umbrella over different understandings in the literature and specific enough to help highlight its difference from the other types of values. Finally, we discuss convergences, overlapping areas, and fuzzy boundaries between different value types to facilitate dialogue, reduce misunderstandings, and improve the methods for valuation of nature's contributions to people, including ecosystem services, to inform policy and direct future research. © 2023 The Author(s). Published by Oxford University Press on behalf of the American Institute of Biological Sciences. (shrink)

Multilingual dictionary of philosophical terms.

Upshot: All my commentators have focused, with varying emphasis, on issues related to: (a) cognitive vs. non-cognitive knowledge, (b) the role of the social environment, and (c) ethical responsibility. These issues are addressed in this response.

Context: On 12 November 2010, Ernst von Glasersfeld passed away. He was one of the most important, if not the most important, proponents of constructivist philosophy. Problem: In his life Ernst influenced many other scientists and philosophers. By whom was he himself influenced; who shaped his intellectual development? By collecting contributions from those who knew him closely or have an excellent understanding of radical constructvism we aim at presenting a cartography of the past and current state of affairs of radical (...) constructivism. These contributions should also shed light on the question of the legacy that Ernst leaves behind. Method: Some 25 authors accepted our invitation to contribute to this commemorative issue. Some texts are reminiscence essays expressing their friendship with Ernst, others are academic papers that investigate Ernst’s influence in various disciplines. Two contributions Ernst von Glasersfeld authored himself. Results: Ernst von Glasersfeld is described as an intellectual mentor for many of his students. His legacy is alive in many disciplines ranging from education science to linguistics. Implications: Ernst’s impact on mathematics education is described in some detail in these articles. However, his impact on science education has also been extensive. Constructivism is a foundation stone in the thinking behind the curriculum in many countries and this collection of papers should be useful to practitioners and researchers in education. We think that the work on conceptual analysis could be used more fully as a tool for modelling emerging concepts and hope that the articles here will facilitate interest in this aspect of Ernst’s work. (shrink)

Of all the arguments for the existence of God, the argument from design is in many respects the most impressive, as everyone remarks that Kant remarked. Certainly it is an argument which seems to have appealed to the popular imagination and even today does not lack philosophical proponents. The purpose of the present paper is to examine a recent formulation of the argument. In particular I shall be concerned to bring into the open its dualist assumptions and to show how (...) these militate against its general plausibility. (shrink)

It is commonly accepted by those who consider macroevolution as a process decoupled from microevolution that its apparent jerkiness (and, hence, incompatibility with principles of population genetics) results from the structural complexity of epigenetic systems, since all complex cybernetic systems are expected to behave discontinuously. To analyse the validity of this assumption, the process of self-improvement has been analysed in a complex cybernetic system by means of computer simulations. It turns out that the investigated system tends to develop by accumulation (...) of as small structural changes as possible, while larger changes are likely to result in the collapse of the system rather than in its persistence or improvement. This implies that cybernetic considerations alone cannot justify the claim that the very nature of epigenetic systems induces evolution by discrete steps rather than by gradual accumulation of small changes. (shrink)

The paper is devoted to the subject status of the discipline “Philosophy of Sociology”. Philosophy of sociology is an interdisciplinary direction focusing on the main preconditions of sociological knowledge development as well as cognitive value of sociological facts, theories and conceptions. Its subject can be divided into “philosophical foundations of sociology” and “philosophical problems of sociology”. “Sociologism” as the concept of substitution of social philosophy by sociology as a science which is better empirically oriented and is able to give more (...) exact and proved picture of social reality also poses danger to social philosophy. “Sociologism” presents a positivist attack on social philosophy. Indeed, sociology is no less speculative science than social philosophy is, which is well illustrated by a lot of divergences among its theoretical constructions and empirical data. The main functions of philosophy of sociology in the world of contemporary social-humanitarian knowledge are critical function, integrative function and axiological function. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

On fundamentals of Vedanta and science; a study.

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.