Wissenschaftsreflexion: eine neue interdisziplinäre Perspektive auf die Geschichte, Theorie und Ethik der Wissenschaften sowie auf die praktischen Auswirkungen von wissenschaftlicher Forschung und Erkenntnis. Die Wissenschaften sehen sich gegenwärtig mit Blick auf ihre Geltungs- und Wahrheitsansprüche, ihre Vertrauenswürdigkeit und ihre Rolle in der Gesellschaft vor grundlegende Herausforderungen gestellt. Die Diskussionen betreffen dabei so unterschiedliche Themen wie Unsicherheit, Scheitern oder "Fake News" in den Wissenschaften, Klimawandel, Gentechnik, Impfungen und Alternativmedizin oder Evolutionstheorien. Nur eine interdisziplinär angelegte Reflexion über die Rolle der Wissenschaften, ihren (...) Erkenntnisanspruch und ihre Methoden wird diesen neuen Herausforderungen gerecht. Mit dem vorliegenden Band wird erstmals der Begriff der Wissenschaftsreflexion differenziert eingeführt und interdisziplinär diskutiert. Der Band umfasst vielfältige Beiträge zu Grundlagen- und Anwendungsfragen aus unterschiedlichen Disziplinen, die gemeinsam eine pluralistische Perspektive eröffnen und konkrete Lösungsmöglichkeiten aufzeigen. (shrink)

ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean age 69 years] (...) who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome MeasureQuantitative: exercise capacity, cardiovascular risk. Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean power in maximal ergometry 165 vs. 151, p < 0.001; submaximal ergometer training 99 vs. 97, p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 said they had been unable to maintain their exercise levels, and 15 felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward. (shrink)

Good chefs know the importance of maintaining sharp knives in the kitchen. What’s their secret? A well-worn Taoist allegory offers some advice. The king asks about his butcher’s impressive knifework. “Ordinary butchers,” he replied “hack their way through the animal. Thus their knife always needs sharpening. My father taught me the Taoist way. I merely lay the knife by the natural openings and let it find its own way through. Thus it never needs sharpening” (Kahn 1995, vii; see also Watson (...) 2003, 46). Plato famously employed this image as an analogy for the reality of his Forms (Phaedrus, 265e). Just like an animal, the world comes pre-divided for us. Ideally, our best theories will be those which “carve nature at its joints”. While Plato employed the “carving” metaphor to convey his views about the reality of his celebrated Forms, its most common contemporary use involves the success of science -- particularly, its success in identifying distinct kinds of things. Scientists often report discovering new kinds of things -- a new species of mammal or novel kind of fundamental particle, for example -- or uncovering more information about already familiar kinds. Moreover, we often notice considerable overlap in different approaches to classification. As Ernst Mayr put it: No naturalist would question the reality of the species he may find in his garden, whether it is a catbird, chickadee, robin, or starling. And the same is true for trees or flowering plants. Species at a given locality are almost invariably separated from each other by a distinct gap. Nothing convinced me so fully of the reality of species as the observation . . . that the Stone Age natives in the mountains of New Guinea recognize as species exactly the same entities of nature as a western scientist. (Mayr 1987, 146) Such agreement is certainly suggestive. It suggests that taxonomies are discoveries rather than mere inventions. Couple this with their utility in scientific inference and explanation and we have compelling reason for accepting the objective, independent reality of many different natural kinds of things.. (shrink)

Background: As a non–European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. Aim: The aim of this study is to investigate nurse’s knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. Research design: The study was conducted using an inductive and qualitative (...) design, utilizing a focused ethnographic approach, based on Roper and Shapira’s framework. Method: Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring’s qualitative content analysis. Ethical consideration: The approval for the study was obtained from UMIT—The Health and Life Sciences University, Austria. Findings: The findings of the study fell into the following main categories: “Everyday care issues,” “End-of-life issues,” “Legal issues,” and “Ethical-legal education and conflicts.” Discussion: The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. Conclusion: This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family. (shrink)

Background In nursing homes, residents’ relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. Research objectives The present analysis aimed at elaborating a typology of nurses’ experience of ethical support and challenges in their interaction with relatives in emergency situations. Research design Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring’s (...) method of qualitative content analysis. Participants and research context Participants were licensed nurses working in nursing homes. Ethical considerations Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. Findings/results In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives’ demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives’ demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. Conclusions Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors. (shrink)

This book offers a comprehensive account of vitalism and the Romantic philosophy of nature. The author explores the rise of biology as a unified science in Germany by reconstructing the history of the notion of “vital force,” starting from the mid-eighteenth through the early nineteenth century. Further, he argues that Romantic Naturphilosophie played a crucial role in the rise of biology in Germany, especially thanks to its treatment of teleology. In fact, both post-Kantian philosophers and naturalists were guided by teleological (...) principles in defining the object of biological research. The book begins by considering the problem of generation, focusing on the debate over the notion of “formative force.” Readers are invited to engage with the epistemological status of this formative force, i.e. the question of the principle behind organization. The second chapter provides a reconstruction of the physiology of vital forces as it was elaborated in the mid- to late-eighteenth century by the group of physicians and naturalists known as the “Göttingen School.” Readers are shown how these authors developed an understanding of the animal kingdom as a graded series of organisms with increasing functional complexity. Chapter three tracks the development of such framework in Romantic Naturphilosophie. The author introduces the reader to the problem of classification, showing how Romantic philosophers of nature regarded classification as articulated by a unified plan that connects all living forms with one another, relying on the idea of living nature as a universal organism. In the closing chapter, this analysis shows how the three instances of pre-biological discourse on living beings – theory of generation, physiology and natural history – converged to form the consolidated disciplinary matrix of a general biology. The book offers an insightful read for all scholars interested in classical German philosophy, especially those researching the philosophy of nature, as well as the history and philosophy of biology. (shrink)

Masked priming experiments occasionally revealed surprising effects: Participants responded slower for congruent compared to incongruent primes. This negative congruency effect was ascribed to inhibition of prime-induced activation [Eimer, M., & Schlaghecken, F. . Response faciliation and inhibition in subliminal priming. Biological Psychology, 64, 7–26.] that sets in if the prime activation is sufficiently strong. The current study tests this assumption by implementing manipulations designed to vary the amount of prime-induced activation in three experiments. In Experiments 1 and 3, NCEs were (...) observed despite reduced prime-induced activation. Experiment 2 revealed no NCE with at least similar prime strength. Thus, the amount of prime activation did not predict whether or not NCEs occurred. The findings are discussed with regard to the inhibition account and the recently proposed account of mask-induced activation [cf. Lleras, A., & Enns, J. T. . Negative compatibility or object updating? A cautionary tale of mask-dependent priming. Journal of Experimental Psychology: General, 133, 475–493; Verleger, R., Jaskowski, P., Aydemir, A., van der Lubbe, R. H. J., & Groen, M. . Qualitative differences between conscious and nonconscious processing? On inverse priming induced by masked arrows. Journal of Experimental Psychology: General, 133, 494–515]. (shrink)

The essay discusses Donald Davidson’s concept of anomalous monism in the framework of Husserlian phenomenology. It develops in four stages. Section 1 is devoted to a critical presentation of the argument for anomalous monism. Section 2 succinctly examines those Husserlian notions that best provide the ground for a discussion parallel to Davidson’s. In Sect. 3, the aporetic status of “mental causation” is analyzed by providing a genetic-phenomenological account of efficient causation. Section 4 draws some general conclusions concerning the kind of (...) efficaciousness that must be attributed to consciousness and discusses the sense in which anomalous monism can be defended in a phenomenological framework, but not in a naturalistic one. (shrink)

As Dieter Lohmar (Citation2002; Citation2012) has shown, in the Logical Investigation Husserl sketches a peculiar type of reduction, the so-called “Reduktion auf den reellen Bestand.” Husserl does not explicitly put this kind of reduction forward, though, and he does definitely not clarify how it works, and what its elements properly are. Lohmar proposes to understand it as a kind of empiricist reduction to mere sense-data. On the contrary, I believe that it should be considered as entailing also the apprehensional forms (...) of sense-data, though not the so-called apprehensional senses. In this article, I will offer some arguments and textual evidence in favour of this claim, and I will conclude by proposing that, despite Husserl’s unclarity on the issue, the reduction to the real components of experience, rather than being simply an ancestor of the transcendental-phenomenological reduction, should be seen as the regulative model of all later forms of reduction. (shrink)

Citizen science models of public participation in scientific research represent a growing area of opportunity for health and biomedical research, as well as new impetus for more collaborative forms of engagement in large-scale research. However, this also surfaces a variety of ethical issues that both fall outside of and build upon the standard human subjects concerns in bioethics. This article provides background on citizen science, examples of current projects in the field, and discussion of established and emerging ethical issues for (...) citizen science in health and biomedical research. (shrink)

Logical form has always been a prime concern for philosophers belonging to the analytic tradition. For at least one century, the study of logical form has been widely adopted as a method of investigation, relying on its capacity to reveal the structure of thoughts or the constitution of facts. This book focuses on the very idea of logical form, which is directly relevant to any principled reflection on that method. Its central thesis is that there is no such thing as (...) a correct answer to the question of what is logical form: two significantly different notions of logical form are needed to fulfil two major theoretical roles that pertain respectively to logic and to semantics. This thesis has a negative and a positive side. The negative side is that a deeply rooted presumption about logical form turns out to be overly optimistic: there is no unique notion of logical form that can play both roles. The positive side is that the distinction between two notions of logical form, once properly spelled out, sheds light on some fundamental issues concerning the relation between logic and language. (shrink)

Concretism is the ontological thesis according to which possibilia are concrete entities. The paper first outlines concretism, arguing that its sole founding thesis is that individuals across possible worlds are individuated by similitude. Among other things, this means that there is no need to postulate that there is no overlap among worlds. The main virtues and vices of concretism are then reviewed, and a novel vice is put forward: a failure in the reduction of modality due to the modal character (...) of intrinsicness. (shrink)

Can genetic testing and manipulation be done ethically? -- Is the use of human embryos in stem cell research ethical? -- Chapter 3:is assisted reproductive technology ethical?

In our recent article ‘The Ethics of the Algorithmic Prediction of Goal of Care Preferences: From Theory to Practice’1, we aimed to ignite a critical discussion on why and how to design artificial intelligence (AI) systems assisting clinicians and next-of-kin by predicting goal of care preferences for incapacitated patients. Here, we would like to thank the commentators for their valuable responses to our work. We identified three core themes in their commentaries: (1) the risks of AI paternalism, (2) worries about (...) attacks to our humanity stemming from the use of AI and (3) the possibility of designing AI systems for more relevant use cases than the one we consider in our work. We shall focus on these themes, leaving aside some other interesting suggestions, given the limited space available for our response. Diaz Milian and Bhattacharyya discuss the risks of AI paternalism highlighting how the use of an AI to predict goal of care preferences may incentivise clinicians and surrogates to shift the burden of decision making to the machine.2 In particular, ‘[i]f the AI-generated response is given priority above the other agents’2 and the AI makes decisions autonomously, then ‘AI paternalism’ would emerge.2 Against this possibility, the authors suggest four safeguards to be implemented in the AI life-cycle.2 These are procedures that may improve the trustworthiness of the AI and human control over it.3 We agree that it is important …. (shrink)

Intellectual knowledge is omnipresent in human lives and decisions. We are constantly trying to make good and correct decisions. However, responsible decision-making is characterised by rather difficult epistemic conditions. It applies all the more during the pandemic when decisions require not only specialised knowledge in a number of disciplines, scientific consensus, and participants from different fields, but also responsibility and respect for moral principles in order to ensure that the human rights of all groups are observed. Pandemic measures are created (...) by politicians, healthcare policy-makers, and epidemiologists. However, what is the role of ethics as a moral philosophy and experts in ethics? Experts in ethics and philosophy are carefully scrutinising political decisions. Levy and Savulescu have claimed that Ethicists and philosophers are not epistemically arrogant if they question policy responses. They played an important role in the creation of a reliable consensus. This study analyses epistemic and moral responsibility, their similarities, analogies, and differences. Are they interconnected? What is their relationship and how can they be filled with actual content during the pandemic? (shrink)

This article, divided into two parts, traces and discusses two pairs of analogies invoked in Sanskrit literature to articulate the paradox of God’s oneness and multiplicity vis-à-vis the souls and the manifest world, reflecting the philosophical positions of pariṇāmavāda and vivartavāda. These are, respectively, the analogies of fire in wood and dairy products in milk, and moon/sun in pools of water and space in pots. Having introduced prevalent ideas about the status of the supreme principle vis-à-vis the souls and creation (...) in Śaivism, Sāṅkhya, and Vedānta, and having investigated instances of the first pair of analogies in multiple textual genres in Part I, here I turn to the discussion of the second set of analogies. Having proposed that the first set reflects the influence of pariṇāma-Vedānta on an early strand of the Śaiva textual corpus, I argue that the second set, attested prevalently in relatively late sources, betrays a Śaṅkarian origin, thereby suggesting a vivartavāda-Advaita Vedānta influence on the Śaiva corpus after the 9th or 10th century. (shrink)

Algebraic Art explores the invention of a peculiarly Victorian account of the nature and value of aesthetic form, and it traces that account to a surprising source: mathematics. Drawing on literature, art, and photography, it explores how the Victorian mathematical conception of form still resonates today.

In Hannah Arendt's political theory, thinking does not precede action; instead, thinking follows from action, because thinking is ‘apolitical’. Arendt first determines politics (action) as the opposite of philosophy (thinking) and later explains the primacy of politics: politics, which follows from the reversal of the metaphysical hierarchy, can be reconstructed as anti-metaphysics. However, the method of reversing the metaphysical hierarchy is fraught with difficulties that justify the critique of the primacy of politics as the central condition of a political theory, (...) because the price of the primacy of politics is the loss of the individual’s autonomy. Because one cannot understand Arendt's political theory (in terms of content) without recognising the (systemic) dichotomy between politics and philosophy, this book contains a glossary which explains what meaning the terms listed have in her political theory. (shrink)

Andrea Sangiacomo offers a new understanding of Spinoza's moral philosophy, how his views significantly evolved over time, and how he himself struggled during his career to develop a theory that could speak to human beings as they actually are--imperfect, passionate, and often not very rational.

‘Soul’, ‘self’, ‘substance’ and ‘person’ are just four of the terms often used to refer to the human individual. Cutting across metaphysics, ethics, and religion the nature of personal identity is a fundamental and long-standing puzzle in philosophy. Personal Identity and Applied Ethics introduces and examines different conceptions of the self, our nature, and personal identity and considers the implications of these for applied ethics. A key feature of the book is that it considers a range of different approaches to (...) personal identity; philosophical, religious, and cross-cultural, including perspectives from non-Western traditions. Within this comparative framework, Andrea Sauchelli examines the following topics: -Early views of the soul in Plato, Christianity, and Descartes -The Buddhist ‘no-self’ views and the self as a fiction -Confucian ideas of our nature and the importance of self-cultivation as constitutive of the self -Locke’s theory of personal identity as continuity of consciousness and memory and objections to Locke’s argument by Butler and Reid as well as contemporary critics -The theory of ‘animalism’ and arguments concerning embodied concepts of personal identity -Practical and narrative theories of personal identity and moral agency -Personal identity and issues in applied ethics, including abortion, organ transplantation, and the idea of life after death -Implications of life-extending technologies for personal identity. Throughout the book Sauchelli also considers the views of important recent philosophers of personal identity such as Sydney Shoemaker, Bernard Williams, Derek Parfit, Marya Schechtman, and Christine Korsgaard, placing these in helpful historical context. Chapter summaries, a glossary of key terms, and suggestions for further reading make this a refreshing, approachable introduction to personal identity and applied ethics. It is an ideal text for courses on personal identity that consider both Western and non-Western approaches and that apply theories of personal identity to ethical problems. It will also be of interest to those in related subjects such as religious studies and history of ideas. (shrink)

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The (...) paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere ‘carrier’. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. (shrink)

That the maximization of quality-adjusted life years violates concerns for fairness is well known. One approach to face this issue is to elicit fairness preferences of the public empirically and to incorporate the corresponding equity weights into cost-utility analysis (CUA). It is thereby sought to encounter the objections by means of an axiological modification while leaving the value-maximizing framework of CUA intact. Based on the work of Lübbe (2005, 2009a, 2009b, 2010, forthcoming), this paper questions this strategy and scrutinizes the (...) concomitant assumptions concerning the nature of prioritization decisions. Empirical studies indicate that these premises are in fact unwarranted. People chose a certain resource allocation because they perceive it as a fair way to treat the persons concerned, not because it maximizes something valuable, and it is questionable if prioritization decision can be represented as value-maximizing choices at all. This reflection on the fundamental distinction between deontological and consequentialist reasoning bears general implications for the scope of ‘economic imperialism.’. (shrink)

International Relations scholars have been reluctant to engage with questions of friendship in the international system. This may be a consequence of the predominance of (neo)realism in IR and its implications – to view the international arena as an anarchic, self‐help system, where states are trapped in the security dilemma. However, over the last six decades, some regions have overcome the security dilemma and states have constructed peaceful relationships based on mutual trust and confidence, resembling friendship at the interstate level. (...) Building upon securitization theory, this essay distinguishes between different perceptions that states may have of their own security, and links them with different types of regional peace. It proposes a two‐phase process whereby relationships may move from negative to positive peace, suggesting different mechanisms for each phase. It illustrates this model by examining the Argentine–Brazilian détente of the late 1970s and the determination to build a zone of positive peace in Latin America’s Southern Cone. (shrink)

Until is a notoriously difficult temporal operator as it is both existential and universal at the same time: A∪B holds at the current time instant w iff either B holds at w or there exists a time instant w' in the future at which B holds and such that A holds in all the time instants between the current one and ẃ. This “ambivalent” nature poses a significant challenge when attempting to give deduction rules for until. In this paper, in (...) contrast, we make explicit this duality of until by introducing a new temporal operator ∇ that allows us to formalize the “history” of until, i.e., the “internal” universal quantification over the time instants between the current one and ẃ. This approach provides the basis for formalizing deduction systems for temporal logics endowed with the until operator. For concreteness, we give here a labeled natural deduction system N(LTL∇) for a linear-time logic LTL∇ endowed with the new history operator. We show that LTL∇ is equivalent to the linear temporal logic LTL with until, which follows by formalizing back and forth translations between the two logics. We also define an indirect translation from LTL∇ into LTL via temporal logics with past operators; such a result provides an upper bound to the problem of satisfiability for LTL∇ formulas. (shrink)

According to the Institute of Medicine, chronic pain affects at least 116 million adults in the United States, which is more than the total affected by heart disease, cancer, and diabetes combined. Pain costs the nation up to $635 billion each year in medical treatment and lost productivity. It has been conceptualized as a public health problem due to its prevalence, seriousness, disparities, vulnerable populations, the utility of population health strategies, and the importance of prevention at both the population and (...) individual levels. For many patients, treatment of pain is inadequate due to uncertain diagnoses, societal stigma, the lack of effective treatments, and inadequate patient and clinician knowledge about the best ways to manage pain. This article explores the inadequate treatment of pain in the U.S. and the subsequent rise of prescription painkiller abuse, misuse, and overdoses. This is followed by a review of the actions taken by states to regulate the prescribing of controlled substances. (shrink)

In a recent paper, Cassinadri raised substantial criticism about the possibility of using moral reasons to endorse the hypothesis of extended cognition over its most popular alternative, the embedded view. In particular, Cassinadri criticized 4 of the arguments we formulated to defend EXT and argued that our claim that EXT might be preferable to EMB does not stand close scrutiny. In this short reply, we point out—contra Cassinadri—why we still believe that there are moral reasons to prefer EXT over EMB, (...) hence why we think that the former is more inclusive and more progressive than the latter. (shrink)

It is commonly assumed that the scientific study of emotions should focus on discrete categories such as fear, anger, sadness, joy, disgust, shame, guilt, and so on. This view has recently been questioned by the emergence of the “core affect movement,” according to which discrete emotions are not natural kinds. Affective science, it is argued, should focus on core affect, a blend of hedonic and arousal values. Here, I argue that the empirical evidence does not support the thesis that core (...) affect is a more “natural” category than discrete emotions. I conclude by recommending a splitting strategy in our search for natural affective kinds. †To contact the author, please write to: Andrea Scarantino, Department of Philosophy and Neuroscience Institute, Georgia State University, P.O. Box 4089, Atlanta, GA 30302‐4089; email: [email protected]. (shrink)

Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the organizational context (...) in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of “alibi ethics”. CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs. (shrink)