ZusammenfassungIm Rahmen des Modellvorhabens „Patienten als Partner—Tumorpatienten und ihr Mitwirken bei medizinischen Entscheidungen“ wurden zwischen März 2002 und August 2003 272 palliativ behandelte Tumorpatienten nach ihrer Einstellung zur Patientenverfügung und zur gewünschten Beteiligung an medizinischen Entscheidungen befragt. Von den Befragten kannten 30% Patientenverfügungen nicht, darunter signifikant mehr Befragte mit formal niedrigerem Bildungsabschluss. Es hatten bereits 11% eine Patientenverfügung abgeschlossen, 22% wollten wahrscheinlich eine abschließen, und 30% wollten keine abschließen. Es fand sich ein statistisch signifikanter Zusammenhang zwischen dem Abschluss einer Patientenverfügung (...) und dem Wunsch nach mehr eigener Entscheidungsverantwortung. Die Einstellung zur Patientenverfügung und der Wunsch nach partizipativer Entscheidungsfindung stehen in keinem statistisch signifikanten Zusammenhang. Patienten mit schriftlichen Vorausverfügungen haben einen erhöhten Kommunikations- und Rückkopplungsbedarf, auf den Ärzte sensibel eingehen sollten. Bei der Information über Patientenverfügungen sollten Menschen mit niedrigerem Bildungsstand mehr als bisher berücksichtigt werden. (shrink)

Objectives: To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process.Design: The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process.Participants: 727 doctors in three federal states and 469 judges dealing with guardianship matters all over Germany.Main measurements: Comparisons of means, analyses of (...) variance, pivot tables and factor analyses .Results: Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days.Conclusions: A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue. (shrink)

In the field of socio-legal studies or law and society scholarship, it is rare to find empirically rich and conceptually sophisticated understandings of actual legal practice. This book, in contrast, connects the conceptual and the empirical, the abstract and the concrete, and in doing so shows the law to be an irreducibly social, material and temporal practice. Drawing on cutting-edge work in the social study of knowledge, it grapples with conceptual and methodological questions central to the field: how and where (...) judgment empirically takes place; how and where facts are made; and how researchers might study these local and concrete ways of judging and knowing. Drawing on an ethnographic study of how narratives and documents, particularly case files, operate within legal practices, this book's unique and innovative approach consists of rearticulating the traditional boundaries separating judgment from knowledge, urging us to rethink the way truths are made within law. (shrink)

Cognitive reserve postulates that individual differences in task performance can be attributed to differences in the brain’s ability to recruit additional networks or adopt alternative cognitive strategies. Variables that are descriptive of lifetime experience such as socioeconomic status, educational attainment, and leisure activity are common proxies of CR. CR is mostly studied using neuroimaging techniques such as functional MRI in which case individuals with a higher CR were observed to activate a smaller brain network compared to individuals with a lower (...) CR, when performing a task equally effectively, and electroencephalography where a particular EEG component that reflects the attention and working memory load, has been targeted. Despite the contribution of multiple factors such as age, education, working, leisure, and household activities in CR formation, most neuroimaging studies, and those using EEG in particular, focus on formal education level only. The aim of the current EEG study is to investigate how the P300 component, evoked in response to an oddball paradigm, is associated with other components of CR besides education, such as working and leisure activity in older adults. We have used hereto a recently introduced CR index questionnaire that quantifies both professional and leisure activities in terms of their cognitive demand and number of years practiced, as well as a data-driven approach for EEG analysis. We observed complex relationships between CRIq subcomponents and P300 characteristics. These results are especially important given that, unlike previous studies, our measurements do not require active use of the same executive function and, thus, render our results free of a collinearity bias. (shrink)

ZusammenfassungIm Rahmen des Modellvorhabens „Patienten als Partner—Tumorpatienten und ihr Mitwirken bei medizinischen Entscheidungen“ wurden zwischen März 2002 und August 2003 272 palliativ behandelte Tumorpatienten nach ihrer Einstellung zur Patientenverfügung und zur gewünschten Beteiligung an medizinischen Entscheidungen befragt. Von den Befragten kannten 30% Patientenverfügungen nicht, darunter signifikant mehr Befragte mit formal niedrigerem Bildungsabschluss. Es hatten bereits 11% eine Patientenverfügung abgeschlossen, 22% wollten wahrscheinlich eine abschließen, und 30% wollten keine abschließen. Es fand sich ein statistisch signifikanter Zusammenhang zwischen dem Abschluss einer Patientenverfügung (...) und dem Wunsch nach mehr eigener Entscheidungsverantwortung. Die Einstellung zur Patientenverfügung und der Wunsch nach partizipativer Entscheidungsfindung stehen in keinem statistisch signifikanten Zusammenhang. Patienten mit schriftlichen Vorausverfügungen haben einen erhöhten Kommunikations- und Rückkopplungsbedarf, auf den Ärzte sensibel eingehen sollten. Bei der Information über Patientenverfügungen sollten Menschen mit niedrigerem Bildungsstand mehr als bisher berücksichtigt werden. (shrink)

Konzeptionen des Neuen und der Erneuerung begleiten die menschlichen Kulturen und Zeiten. Der Beitrag nimmt konkrete Lebens- und Textwelten der biblischen Überlieferung des Judentums und des Christentums in den Blick, wie sie in den Traditionen der Hebräischen Bibel/des Alten Testaments zu finden sind. Zum einen zeigt sich dabei eine pragmatische und auf die Förderung der Lebensverhältnisse von Gemeinschaft und Mensch orientierte Rede vom Neuen. Zum anderen gibt es ein Wissen um Neues und Vollkommenes als Wissen um einen Schöpfer, der Vollkommenes (...) und Schönes schafft (Kohelet) sowie als Gegenbild zu Defizientem und Bösem, mit dem Bildung, Gesellschaft und Religion ringen. (shrink)

Die alttestamentliche Gottesrede kennt in ihren unterschiedlichen Spielarten ein wechselseitiges Verweisverhältnis zwischen Gott und Mensch. Darin begegnet die Perfektion Gottes als Grenzbestimmung und das Imperfekte als Modus der Darstellung Gottes. In der Konsequenz lassen sich weder der Mensch noch Gott in den Vorstellungen des Perfekten oder des Imperfekten allein angemessen erfassen.

Doing research in a globalized context – regardless of the discipline – requires language decisions at different stages of the research process. Many of these language decisions have ethical implications. Existing literature and ethical guidance tend to focus on ethical concerns that arise in communication with participants who use a language different from the main research language. As this article shows, language decisions with potential ethical implications can occur in many additional ways. Two questions guided this work: how do language (...) decisions and research ethics intersect at different stages of the research process, and what potential harm is related to language decisions and how can such concerns be mitigated? Relevant literature – combined with practical research experiences – show that language decisions can potentially result in harm at the conception stage of research projects, when working with participants, during data analysis, interpretation, and dissemination, as well as when managing a research project. Thus, the article highlights that the role of language-related ethical dilemmas is not only organizational (e.g., ensuring participants can understand what the research is about), but also social (e.g., developing trust and relationships in research teams) as well as ideological (e.g., awareness of power structures and diverse worldviews). In order to support researchers in globalized contexts, this article offers a reflective framework that complements regulatory guidance issued by ethical bodies and facilitates a deeper awareness of ethical implications related to language decisions in a multilingual world. (shrink)

ObjectiveTo determine the impact of the affiliate stigma on mental well-being of relatives caring for a person with dementia.DesignThe study was conducted in a cross sectional design.SettingThe study was conducted in a public setting, addressing relatives caring for a person with dementia.ParticipantsParticipants were relatives of patients with a formal diagnosis of dementia. Relatives were defined as caring or living closely to a patient. Participants were recruited with the help of care and welfare organizations.Outcome MeasuresThe main outcome measure was the impact (...) of the affiliate stigma on mental well-being of caring relatives.Results228 participants fully completed the survey. Women, relatives with a higher education and partners experienced more impact of the affiliate stigma on mental well-being than man, relatives with a lower education and relatives with another relationship to the person with dementia. The duration of dementia and the age of the caregiver had a clear significant effect on affiliate stigma.ConclusionThis study revealed that caregiver related features are predicting the presence of an affiliate stigma. Interventions to prevent or reduce the impact of this stigma might focus on these groups. Education about dementia and the impact on patients, relatives and the broader social context might alter the affiliate stigma surrounding dementia. (shrink)

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). (...) The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms. (shrink)

Due to the rapid changes in the medical world and the aging population, the need for advanced care planning grows. Despite efforts to make this topic discussed, only a minority of patients discusses the advance directive with their general practitioner. This study aimed to map thresholds: What barriers are identified by GPs and patients in preparing and discussing an advance directive? A cross section survey in patients and GP’s was performed. Citizens were recruited by multimedia and by street interviews. GP’s (...) were recruited by mailing. Most of the 502 citizens already heard of an advance directive but only 17 had declared one while 21 never want one. Eighty percent wants to take the initiative themselves but half of the participants wants the GP to be actively involved. Thirty percent finds the document too difficult to understand. The need to draw an advance directive grew with increasing age. Of the 117 GP’s involved, 65% drafted five or less advance directives the past year. A lack of time, experience and a poor access to the correct administrative requirements were only a few of the barriers. Preparing and drafting an advance directive is a time-consuming and difficult procedure. Patients and GP’s have the right to be informed and instructed on how to prepare an advance directive. (shrink)

The empirical-transcendental debate in philosophy of technology, as debates go, took a turn toward the counterposing of the two perspectives, ‘empirical’-pragmatic-pragmatist versus ‘transcendental’-critical. Postphenomenology aligns itself with the former standpoint, and it is in this spirit that commentators have criticized it for its too-instrumentalist stance and lack of overarching, i.e., transcendental orientation. But the positions may have become too starkly delineated in order for the debate to reach any breakthrough: a seemingly unbridgeable gap yawns between the stances of ‘technology with (...) a small “t”’ and ‘Technology with a capital “T.”' Is there any way to reorient the debate? In this paper I propose to do so by considering whether there would be some way of arriving from one end of the spectrum to the other—crossing the gap. Exploring the purported wasteland in between “technology” and “Technology” by way of object-oriented ontology (OOO)—Harman, Morton—we can find it actually filled with countless gaps, adhering to every thing. Following the radical insights of OOO, we’d have to attest to a ‘thing-transcendentality.’ The ‘gap,’ then, that seemed so threatening and all-encompassing, becomes smeared out, levelled down to a multiplicity of perspectives. And this casts the debate, with its purported strict tension between ‘empirical’ and ‘transcendental’ positions, in fresh terms, opening up new ways for studying how the two interrelate. (shrink)

We discuss games of both perfect and imperfect information at two levels of structural detail: players’ local actions, and their global powers for determining outcomes of the game. We propose matching logical languages for both. In particular, at the ‘action level’, imperfect information games naturally model a combined ‘dynamic-epistemic language’ – and we find correspondences between special axioms and particular modes of playing games with their information dynamics. At the ‘outcome level’, we present suitable notions of game equivalence, plus some (...) simple representation results. (shrink)

Logic is not just about single-agent notions like reasoning, or zero-agent notions like truth, but also about communication between two or more people. What we tell and ask each other can be just as 'logical' as what we infer in Olympic solitude. We show how such interactive phenomena can be studied systematically by merging epistemic and dynamic logic.

Cimpian et al. observed that we accept generic statements of the form ‘Gs are f’ on relatively weak evidence, but that if we are unfamiliar with group G and we learn a generic statement about it, we still treat it inferentially in a much stronger way: all Gs are f. This paper makes use of notions like ‘representativeness’, ‘contingency’ and ‘relative difference’ from psychology to provide a uniform semantics of generics that explains why people accept generics based on weak evidence. (...) The spirit of the approach has much in common with Leslie’s cognition-based ideas about generics, but the semantics will be grounded on a strengthening of Cohen’s relative readings of generic sentences. In contrast to Leslie and Cohen, we propose a uniform semantic analysis of generics. The basic intuition is that a generic of the form ‘Gs are f’ is true because f is typical for G, which means that f is valuably associated with G. We will make use of Kahneman and Tversky’s Heuristics and Biases approach, according to which people tend to confuse questions about probability with questions about representativeness, to explain pragmatically why people treat many generic statements inferentially in a much stronger way. (shrink)

Keuze van artikelen uit het werk van de Vlaamse filosoof over wetenschap, milieu, en medische en biologische ethiek.

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

This book discusses the relationship between the philosophy of science and philosophy of engineering, and demonstrates how philosophers of engineering design as well as design researchers can benefit from the conceptual toolkit that the philosophy of science has to offer. In this regard, it employs conceptual tools from the philosophical literature on scientific explanation to address key issues in engineering design and philosophy of engineering design. Specifically, the book focuses on assessing the explanatory value of function ascriptions used in engineering (...) design and philosophy of technical functions; on elaborating the structure of explanation in engineering design; on assessing the role and value of design representations in engineering design and philosophy thereof; and on elaborating means for the testing of design methods. Presenting a novel and effective approach to tackling key issues in the field, philosophers of engineering and design alike will greatly benefit from this book. (shrink)

Emotions have traditionally been viewed as intrapersonal phenomena. Over the past decades, theory and research have shifted toward a more social perspective that emphasizes the role of emotional ex...

Liang Shuming’s 梁漱溟 China: the Country of Reason is a little-known, posthumously published manuscript composed between 1967 and 1970 during the Cultural Revolution. It offers a unique perspective on Liang’s philosophical attempt to reconcile the Communist revolutionary legacy with the Confucian tradition that he continued to uphold in mainland China after the founding of the People’s Republic. By presenting and analyzing the main themes and concepts of this book, I try to cast some light on Liang’s idiosyncratic repurposing of historical (...) materialist concepts in reinterpreting what he takes to be “early enlightenment” accomplished through the Confucian celebration of “reason” and its “replacement of religion by morality.” In doing so, I explore the complex relations between revolutionary, religious, and ethnic identity in his late philosophy. (shrink)

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In European science and technology policy, various styles have been developed and institutionalised to govern the ethical challenges of science and technology innovations. In this paper, we give an account of the most dominant styles of the past 30 years, particularly in Europe, seeking to show their specific merits and problems. We focus on three styles of governance: a technocratic style, an applied ethics style, and a public participation style. We discuss their merits and deficits, and use this analysis to (...) assess the potential of the recently established governance approach of ‘Responsible Research and Innovation’ (RRI). Based on this analysis, we reflect on the current shaping of RRI in terms of ‘doing governance’. (shrink)

In this paper several arguments are discussed and evaluated concerning the possibility of discrete space and time.

Predictive processing is an increasingly popular approach to cognition, perception and action. It says that the brain is essentially a hierarchical prediction machine. It is typically construed in a representationalist and inferentialist fashion so that the brain makes contentful inferences on the basis of representational models. In this paper, I argue that the predictive processing framework is inconsistent with this epistemic position. In particular, I argue that the combination of hierarchical modeling, contentful inferentialism and representationalism entail an internal inconsistency. Specifically, (...) for a particular set of states, there will be both a representation requirement and not. Yet a system cannot both be required to represent a certain set of states and not be required to represent those states. Due to this contradiction, I propose to reject the standard view. I suggest that predictive processing is best interpreted in terms of reliable covariation instead, entailing an instrumentalist approach to the statistical machinery. (shrink)