Psychiatrie und Psychotherapie sind Bereiche medizinischer Praxis, die in besonderer Weise ethische Fragen aufwerfen. Die Beiträge des Bandes hierzu werden durch zwei übersetzte Beiträge des polnischen Psychiaters Antoni Kępiński (1918-1972) erweitert. Diese eröffnen neue Perspektiven in der Diskussion um ethische Fragen in der Psychiatrie.

AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

This article discusses the role of moment-to-moment affect dynamics in mental disorder and aims to integrate recent literature on this topic in the context of complex dynamical system theory. First, we will review the relevance of temporal and contextual aspects of affect dynamics in relation to psychopathology. Related to this, we will discuss recent insights resulting from a network view on affect dynamics in psychopathology. Next, we explore how we can reconcile literature findings from a perspective of complex dynamical system (...) theory. Finally, future directions with regard to personalized assessment of risk and diagnostic use are discussed. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

Today's modern car is an assemblage of mechanical and digital components, of metal panels that comprise its structure and silicon chips that run its functions. Communication and information studies scholars have interrogated the problematic aspects of the programs that run those functions, revealing serious issues surrounding privacy and security, worker surveillance, and racial, gendered, and class-based bias. This article contributes to that work by taking a step back and asking about the issues inherent not in the software running on these (...) chips, but on the microchips themselves. Using the lens of “chipification”—the process by which a device is rendered capable of reading and processing data through the embedding of microchips—this article explores how the integration of microchips also involves processes that are often borne from, replicate, or create troubling power dynamics of their own. It takes light-duty passenger vehicles as a case study into how chipification is radically reshaping such processes as resource allocation, labor flows, and cultural practices around car manufacture, use, repair, and modification. By naming the process of chipification, this article allows researchers to identify and analyze the ways that integrating data processing capabilities into everyday devices is not a frictionless practice, but rather one that implicates a variety of power dynamics within these massive industries. (shrink)

In the past decades, an enormous amount of precious information has been collected about molecular and genetic characteristics of cancer. This knowledge is mainly based on a reductionistic approach, meanwhile cancer is widely recognized to be a ‘system biology disease’. The behavior of complex physiological processes cannot be understood simply by knowing how the parts work in isolation. There is not solely a matter how to integrate all available knowledge in such a way that we can still deal with complexity, (...) but we must be aware that a deeply transformation of the currently accepted oncologic paradigm is urgently needed. We have to think in terms of biological networks: understanding of complex functions may in fact be impossible without taking into consideration influences outside of the genome. Systems Biology involves connecting experimental unsupervised multivariate data to mathematical and computational approach than can simulate biologic systems for hypothesis testing or that can account for what it is not known from high-throughput data sets. Metabolomics could establish the requested link between genotype and phenotype, providing informations that ensure an integrated understanding of pathogenic mechanisms and metabolic phenotypes and provide a screening tool for new targeted drug. (shrink)

Ghazālī’s The Incoherence of the Philosophers is an unusual philosophical work for a number of reasons, not the least of which is the author’s explicit disavowalof any of the conclusions contained within it. The present essay examines some of the hermeneutical challenges that face readers of the work and offers anexegetical account of the much-neglected Third Discussion, which examines a key point of Neoplatonic metaphysics. The paper argues that Ghazālī’s maintaining of the incompatibility of metaphysical creationism and Neoplatonic emanationism should (...) not be viewed as simply a rhetorical or dialectical argument, but rather is best understood, to use Ghazālī’s words, as a philosophical “proof.” Essential to this proof in the solution to the argument of the Third Discussion is an implicit theory of metaphorical predication that can be pieced together from several of Ghazālī’s remarks as well as a reductio ad absurdum argument about the very possibility of ethical discourse. (shrink)

This article explores yet another paradox – aside from the privacy paradox – related to the datafication of media: citizens trust least the media they use most It investigates the role that daily life plays in shaping the trust that citizens place in datafied media. The study reveals five sets of heuristics guiding the trust assessments of citizens: characteristics of media organisations, old media standards, context of use and purpose, experiences of datafication and understandings of datafication. The article discusses the (...) use of these heuristics and the value that everyday life holds in assessing trust in datafied media. It concludes that, guided by a partial ‘structure of perception’ and enticed into trusting datafied media in the context of their daily lives, citizens may be highly concerned by the datafication of media but use them nevertheless. (shrink)

MR. R. G. M. Nisbet has made the attractive suggestion that the Vinnius to whom Horace addressed his thirteenth epistle was the Vinnius Valens mentioned by the elder Pliny as a centurion of immense strength who had served in the praetorian guard of Augustus. To the points which he has made in support of this identification may be added the appropriateness, if Horace's Vinnius was a soldier, of the words victor propositi and the fact that Horace's comparison between Vinnius and (...) a pack-animal gains in point if Vinnius was famous for feats of strength involving wagons and beasts of burden. (shrink)

Critical educational research offers the researcher a position and an ethos of comfort. Even the declared recognition of the relativity of principles, norms or criteria so characteristic of much critical research does not prevent it from looking immediately for a way out of this uncomfortable situation i.e. to keep to the idea that comfort is needed and desirable. However, we suggest that this uncomfortable condition is constitutive for critical educational research and may be even for education as such. Therefore the (...) article can be considered as a genealogical analysis of this comfortable critical research, in which we show how the birth of the milieu of the modern school goes together with the instauration of two forms of a comfortable research ‘ethos’: a research ethos rooted in a pastoral milieu and a research ethos rooted in a bureaucratic milieu. In the last section of the article we indicate that another ‘experimental’ ethos of research is possible, including the acceptance of discomfort. This is the ethos of a critical researcher as an inhabitant of a coming research community and as being exposed to the present. (shrink)

The paper consists of a reflexive exercise in which Herbert Simon 's views concerning science are applied to his own research. It argues that what connected his ventures into so many different disciplinary domains was a search for complex, hierarchical systems. In the process, the paper establishes a close connection between Simon 's insights and his focus on simulation. Instead of simulating Simon on a computer, though, it simulates Simon on paper. This exercise is then contrasted with Simon 's own (...) attempts to simulate science. This comparison leads to a reflexive evaluation of Simon 's simulations. (shrink)

Gay marriages (as such) are not as yet allowed anywhere but the demand for them is increasing. Most countries take a liberal attitude towards marriage: few obstacles are put in its way. But objections to gay marriages continue to be raised. These objections are refuted and the case for gay marriage is assessed through the prism of various forms of liberalism. The normative argument for allowing gay marriage is shown to be both strong and consistent with many of the values (...) upheld by the opponents of such unions. (shrink)