Der Selbstbestimmungdes Patienten kommt in der modernen Debatte über das Gesundheitswesen eine zentrale Bedeutung zu. Selbstbestimmung ist aber ein voraussetzungsvoller Begriff, der für Patientengruppen wie Demenzbetroffene, deren Entscheidungs- und Einwilligungsfähigkeit nachlässt oder nicht mehr gegeben ist, eine Reihe von Fragen aufwirft. Auf der Grundlage der jeweiligen Symptomentwicklung der Demenzerkrankung und eigener Erfahrungen im Umgang mit Demenzbetroffenen wirdde rEntwicklungdes Willens in den verschiedenen Stadien der Demenz nachgegangen. Dabei wird den Dimensionen der Differenziertheit der Denkinhalte, der Beurteilungsbasis und der Entscheidungskonstanz eine besondere (...) Bedeutung zugemessen und für eine Graduierung der Selbstbestimmungsmöglichkeiten im Umgang mit Demenzbetroffenen plädiert. Wegen der Schwererkennbarkeit der oft verschlüsselten Willensbekundungen Demenzbetroffener wird der Willenswahrnehmung und dem Training der genauen Beobachtung, Einfühlung und Sensibilität im Umgang mit den Betroffenen großes Gewicht beigemessen. Als Ziel wird die jeweils weitestgehende Selbstbestimmung, im Verlaufe der Erkrankung auch Teilselbstbestimmung und schließlich Mitwirkung bei der individuellen Wohlbestimmung im Sinne eines Grundrechtsschutzes vertreten. (shrink)

The concept of community is increasingly the focus of political argument in Britain, the United States and elsewhere around the world. The sense people have of belonging to coummunities provides a powerful motivation which continues to affecct the political and social face of the world. Recently, debate about the relationship between individuals and their communities has become central to the making of both, American and European social policy. In the United Kingdom this is especially apparent in the area of health (...) care, where ideas of community have informed recent legislation concerning community care, community health trusts and the Children Act among others. This volume explores the focus of interest in community and the emerging theoretical oppostion between communitarianism and liberalism, as well as the practical, theoretical and ethical issues relating to community in the health care professions, including a discussion of the health service as Civil Association, an analysis of liberal and communitarian views on the allocaiton of health care resources, an exploration of the use of genetic information and an examination of health care decision making for incapacitated elderly patients. (shrink)

Die Arzneimittelzulassung und der Aufnahmeprozess zur Kostenerstattung sollen die Entwicklung und Vermarktung von pharmazeutischen Innovationen mit Patientennutzen nicht behindern, zugleich aber die Wirtschaftlichkeit der Arzneimittelversorgung für die Kostenträger nicht gefährden. Eine Anpassung der Verfahren an die Merkmale personalisierter Arzneimittel erscheint notwendig. Dabei ist allerdings zu fragen, ob eine ungerechtfertigte Privilegierung erfolgt. In den USA und in der EU werden die jeweiligen Zulassungsverfahren für Arzneimittel und Tests schrittweise angepasst und integriert. Zulassung und Erstattungsentscheidungen sollen koordiniert werden. Eine Privilegierung, wie bei Arzneimitteln (...) für seltene Indikationen (Orphan Drugs), findet jedoch für personalisierte Medizin nicht statt. Es bestehen keine unzumutbaren Hürden für die Hersteller. Zurückhaltung bei der Entwicklung innovativer Produkte wäre deshalb nicht gerechtfertigt. (shrink)

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance.The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research (...) evidence which points towards patients wanting more information and a greater degree of openness.Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. (shrink)

ZusammenfassungDer Selbstbestimmungdes Patienten kommt in der modernen Debatte über das Gesundheitswesen eine zentrale Bedeutung zu. Selbstbestimmung ist aber ein voraussetzungsvoller Begriff, der für Patientengruppen wie Demenzbetroffene, deren Entscheidungs- und Einwilligungsfähigkeit nachlässt oder nicht mehr gegeben ist, eine Reihe von Fragen aufwirft. Auf der Grundlage der jeweiligen Symptomentwicklung der Demenzerkrankung und eigener Erfahrungen im Umgang mit Demenzbetroffenen wirdde rEntwicklungdes Willens in den verschiedenen Stadien der Demenz nachgegangen. Dabei wird den Dimensionen der Differenziertheit der Denkinhalte, der Beurteilungsbasis und der Entscheidungskonstanz eine besondere (...) Bedeutung zugemessen und für eine Graduierung der Selbstbestimmungsmöglichkeiten im Umgang mit Demenzbetroffenen plädiert. Wegen der Schwererkennbarkeit der oft verschlüsselten Willensbekundungen Demenzbetroffener wird der Willenswahrnehmung und dem Training der genauen Beobachtung, Einfühlung und Sensibilität im Umgang mit den Betroffenen großes Gewicht beigemessen. Als Ziel wird die jeweils weitestgehende Selbstbestimmung, im Verlaufe der Erkrankung auch Teilselbstbestimmung und schließlich Mitwirkung bei der individuellen Wohlbestimmung im Sinne eines Grundrechtsschutzes vertreten. (shrink)

This book brings together scholars from a variety of epistemological perspectives to explore the multiple ways in which sexuality does indeed matter in the arena of public education.

ABSTRACTEthical scandals involving journalists in English-speaking West African countries have been documented to include conflict of interest, freebies, intellectual theft, deception, carelessness, kowtowing to advertisers and politicians, use of dubious evidence, and outright bias. This study explores how pronounced and clear the rules relating to these breaches are in the codes of these countries and whether the similarities and dissimilarities in wording indicate the influence of individual actors involved in writing them. Relying on thematic and qualitative document analysis methods, the (...) study found that rules in the codes addressing the ethical breaches are pronounced and clear. Although largely similar in content, the codes also feature important differences that are strongly related to the composition of the groups that wrote them. This study discusses why ethical challenges in these countries persist in the midst well-written code of ethics. (shrink)

Die „künstliche Ernährung“ steht in enger Beziehung zu den grundsätzlichen Fragen nach medizinisch sinnvollen und angemessenen Maßnahmen, nach Therapiebegrenzung, Lebensqualität und Sterbehilfe. Im Diskurs müssen die dabei verwendeten Begriffe hinsichtlich der ihnen innewohnenden, oft unbewussten Wertungen zur Diskussion gestellt werden. Einer ethischen Entscheidungsberatung muss eine sorgfältige Abklärung der naturwissenschaftlichen Aspekte, einschließlich einer umfassenden Erhebung der Vorsituation und der gegenwärtigen Befindlichkeit des einzelnen Kranken sowie eine aufrichtige Einschätzung der Zielorientierung vorausgehen. Unter Zugrundelegung der—unter Umständen auch nur ersatzweise wahrgenommenen—Selbstbestimmung des Patienten werden (...) in der ethischen Diskussion mögliche stereotype Vorgehensweisen, latente Entscheidungskonflikte oder eine vermeintliche Vorrangigkeit naturwissenschaftlicher Lösungsansätze zur Sprache kommen. Ziel ist eine gemeinsam erarbeitete individuell angemessene Lösung, die sich—unabhängig vom Ergebnis—heilsam in den Lebenshorizont des Patienten einbetten lässt. (shrink)

The similarity of documents in a large database of published Fractals articles was examined for redundancy. Three different text matching techniques were used on publisheds to identify redundancy candidates, and predictions were verified by reading full text versions of the redundancy candidate articles. A small fraction of the total articles in the database was judged to be redundant. This was viewed as a lower limit, because it excluded cases where the concepts remained the same, but the text was altered substantially.Far (...) more pervasive than redundant publications were publications that did not violate the letter of redundancy but rather violated the spirit of redundancy. There appeared to be widespread publication maximization strategies. Studies that resulted in one comprehensive paper decades ago now result in multiple papers that focus on one major problem, but are differentiated by parameter ranges, or other stratifying variables. This ‘paper inflation’ is due in large part to the increasing use of metrics (publications, patents, citations, etc) to evaluate research performance, and the researchers’ motivation to maximize the metrics. (shrink)

A team of renowned philosophers and a new generation of thinkers come together to offer the first book-length examination of the relationship between philosophical anthropology and animal studies.

Onora O’Neill hat 1984 den Zusammenhang zwischen grundsätzlichen Bedenken gegenüber dem ethischen Autonomiebegriff und der Kritik an der paternalistisch geprägten medizinethischen Praxis hergestellt, nicht die tatsächliche Einwilligung des konkreten Patienten zu berücksichtigen, sondern die angenommene, hypothetische Einwilligung, die ein idealisierter, völlig rationaler Patient geben würde. Im Anschluss an experimentalpsychologische Studien zur subliminalen Wahrnehmung, zu Volition und Handlungskontrolle erfahren kompatibilistische Theorien menschlicher Freiheit innerhalb der theoretischen Philosophie neue Popularität. Eine Handlung ist demnach frei, wenn sie das Resultat bestimmter Fähigkeiten einer Person (...) ist („Kompetenztheorie“). Der Artikel setzt sich mit zwei dieser Theorien, Henrik Walters Konzept „natürlicher Freiheit“ und Michael Pauens „Minimalkonzeption personaler Freiheit“ näher auseinander—und zwar vorderhand im Hinblick auf den Entwurf eines nichtidealisierten ethischen Autonomiekonzeptes. Als solches ist es an der aktualen bzw. faktischen Fähigkeit einer Person ausgerichtet, rekurrierend auf die spezifische Determiniertheit autonomer Entscheidungen und Handlungen sowie auf ein relativiertes Konzept menschlicher Vernunft. (shrink)

Transpersonal Psychology concerns the study of those states and processes in which people experience a deeper sense of who they are, or a greater sense of connectedness with others, with nature, or the spiritual dimension. Pioneered by respected researchers such as Jung, Maslow and Tart, it has nonetheless struggled to find recognition among mainstream scientists. Now that is starting to change. Dr. Michael Daniels teaches the subject as part of a broadly-based psychology curriculum, and this book brings together the (...) fruits of his studies over recent years. It will be of special value to students, and its accessible style will appeal also to all who are interested in the spiritual dimension of human experience. The book includes a detailed 38-page glossary of terms and detailed indexes. (shrink)

Nicholas Rescher claims that rational decision theory “may leave us in the lurch”, because there are two apparently acceptable ways of applying “the standard machinery of expected-value analysis” to his Dr. Psycho paradox which recommend contradictory actions. He detects a similar contradiction in Newcomb’s problem. We consider his claims from the point of view of both Bayesian decision theory and causal decision theory. In Dr. Psycho and in Newcomb’s Problem, Rescher has used premisses about probabilities which he assumes to be (...) independent. From the former point of view, we show that the probability premisses are not independent but inconsistent, and their inconsistency is provable within probability theory alone. From the latter point of view, we show that their consistency can be saved, but then the contradictory recommendations evaporate. Consequently, whether one subscribes to evidential or causal decision theory, rational decision theory is not in any way vitiated by Rescher’s arguments. (shrink)

The Circumcision Controversy in Classical Reform in Historical Context Judith Bleich Toward the close of the nineteenth century, a gathering of rabbinic ...

Medicine at the Crossroads is a collection of essays based a column originally published in the Waco-Tribune Herald by renowned cardiologist Dr. Michael Attas of Baylor University. It touches on three perspectives - the physician, the patient, and the healthcare system - and addresses some of the most pressing questions in medicine today.

Introduction to Leviathan.--The moral life in the writings of Thomas Hobbes.--Dr. Leo Strauss on Hobbes.--Leviathan: a myth.

The cardinal role that notions of respect and self-respect play in Rawls’s A Theory of Justice has already been abundantly examined in the literature. However, it has hardly been noticed that these notions are also central for Michael Walzer’s Spheres of Justice. Respect and self-respect are not only central topics of his chapter on “recognition”, but constitute a central aim of his whole theory of justice. This paper substantiates this thesis and elucidates Walzer’s criticism of Rawls’s that we need (...) to distinguish between “self-respect” and “self-esteem”. (shrink)

Join Dr. Esposito, the principal of a school with a reputation for eating administrators alive, on her journey to becoming a great educational leader and influencer. Dr. Esposito uses foundational leadership books to create a leadership philosophy centered around servant leadership to students while creating 360-degree leaders within the school.

The research for this article has been largely done during a stay at the Institute for Advanced Study in Princeton as a visiting fellow in 1970–1980, and an earlier version of it was presented at the Social Science Seminar in the Institute. I am very grateful to the staff of the Institute for their invitation and warm hospitality. I also wish to thank the librarians of the following libraries for their very kind and efficient assistance: The New York Academy of (...) Medicine Library, The College of Physicians of Philadelphia Library, The Bodleian Library and Christ Church Library, Oxford. Finally, thanks are due to Dr. A. Marc Smith, Dr. G. Stroumsa and Ms. Eva Shorr for their help on some textual problems. (shrink)

After the opening address by Dr. J. W. Cook, chairman of the meeting, who welcomed the participants and outlined the programme of speakers, Professor Michael Polanyi of Manchester University, chairman of the Committee on Science and Freedom, spoke on the background and activities of the Committee and showed how the apartheid issue fitted into the series of 'campaigns' which the Committee has fought on behalf of academic freedom.

Essay by Dr. Michael L. Riordan, the founder of Gilead Sciences, on the comparative utility of a medical versus legal education as preparation for public office.

If a man born blind were to gain his sight in later life would he be able to identify the objects he saw around him? Would he recognise a cube and a globe on the basis of his earlier tactile experiences alone? This was William Molyneux's famous question to John Locke and it was much discussed by English and French empiricists in the eighteenth century as part of the controversy over innatism and abstract ideas. Dr Morgan examines the whole history (...) of this debate: Locke's own (negative) answer to the question, the contributions of Berkeley, Condillac, Diderot and Voltaire and the factual accounts of early cataract operations and modern laboratory studies. He shows how this debate is involved in the development and eventual separation of philosophy and experimental psychology after the eighteenth century and considers why the original question is effectively still unanswered. This is one problem-area with its intricate cluster of connected conceptual and technical difficulties which suggests the need for some reunion or at least collaboration between the two subjects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)