Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

This paper investigates the role of a pre-existing body-model that is an enabling constraint for the incorporation of objects into the body. This body-model is also a basis for the distinction between body extensions (e.g., in the case of tool-use) and incorporation (e.g., in the case of successful prosthesis use). It is argued that, in the case of incorporation, changes in the sense of body-ownership involve a reorganization of the body-model, whereas extension of the body with tools does not involve (...) changes in the sense of body-ownership. (shrink)

Is food’s naturalness conceptually connected to its healthiness? Answering the question requires spelling out the following: (1) What is meant by the healthiness of food? (2) What different conceptual meanings the term natural has in the context of food? (3) Are some of those meanings connected to the healthiness of food? In this paper the healthiness of food is understood narrowly as food’s accordance with nutritional needs of its eater. The connection of healthiness to the following five food-related senses of (...) the term “natural’’ is analyzed: naturalness as nutritive suitability, naturalness as moderate need satisfaction, naturalness as lack of human influence, naturalness as authenticity, and naturalness as familiarity. It is concluded that some very common current uses of the term “natural,” such as naturalness as lack of human influence, are not conceptually connected to the healthiness of food. Nevertheless, the first two senses of naturalness are strongly conceptually connected to healthiness in the food context and the last one may be indirectly related to it. Thus, desire for natural food is not necessarily mistaken and misguided. (shrink)

The purpose of the research is to explicate the Buddhist principles of ethical analysis of premeditated murder as an immoral act. The author solves this problem through the method of case study of exegetical treatises of outstanding Buddhist thinkers Vasubandhu (4th-5th centuries) and Yašomitra (8th century). It is shown that the ethical analysis of premeditated murder is based on a religious anthropological concept (the Buddhist doctrine of human action producing karmic retribution). Sinful intent is interpreted as an immoral mental urge (...) that generated a verbal intention to take the life of a certain person or a certain animal. According to the canonical point of view, there are three mental roots of immoral acts - greed, hatred, ignorance. The ethnical analysis of sinful intent is aimed at determining the connection of intent with any of these three mental phenomena. In accordance with this principle, Buddhist thinkers have identified three types of premeditated murder. All of them produce a “black” (unfavorable) karmic fruit, i.e. an unfortunate form of rebirth, exacerbating physical suffering. Great attention is paid by the author to the problem of the karmic responsibility of individuals ordering murders and the executors of such orders. In the considered sources, the verbal order to kill and its physical execution are interpreted as equally immoral actions that produce collective karmic responsibility. The author of the research examines in detail a special class of premeditated murder, fraught with inevitable infernal retribution. This class includes murders of benefactors (mother, father, arhat) and Buddhist ascetics practicing asceticism. These malicious sins were interpreted as an insurmountable obstacle to achieving a soteriological goal, even in the distant transcendental future. It is shown that Buddhist exegetes have developed principles for diagnosing these sins and characterized the immoral personal characteristics of sinners (disrespect towards parents, Buddhist preachers and religious ascetics, heretical denial of spiritual values, shamelessness, arrogance, ignorant self-will, misanthropy). (shrink)

This article outlines the distinctive contribution of Marxism to science studies. It traces the trajectory of Marxist ideas through the decades from the origins of Marxism to the present conjuncture. It looks at certain key episodes, such as the arrival of a Soviet delegation at the International History of Science Congress in London in 1931, as well as subsequent interactions between Marxists and exponents of other positions at later international congresses. It focuses on the impact of several generations of Marxists (...) who have engaged with science in diverse ways. It examines the influence of Marxism on contemporary trends in science studies. It concludes that Marxism survives in circuitous and complex ways. It argues not only for a positive interpretation of its contribution in the past but for its explanatory and ethical power in the present and future. (shrink)

Background: Dignity is a multidimensional construct that includes perception, knowledge, and emotions related to competence or respect. Attitudes to aging are a comprehensive personal view of the experience of aging over the course of life, which can be influenced by various factors, such as the levels of health and self-sufficiency and social, psychological, or demographic factors. Aim: The purpose of this study was to explore the attitudes to aging of home-dwelling and inpatient older adults, and whether dignity and other selected (...) factors belong among the predictors influencing attitudes to aging in these two different groups of older adults. Research design: Cross-sectional study using a set of questionnaires: Patient Dignity Inventory, Attitudes to Aging Questionnaire, and Barthel Index. Pearson and Spearman correlation analyses and multivariable linear regression were used for statistical processing. Participants and research context: 233 inpatients and 237 home-dwelling older adults participated in the research in two regions of the Czech Republic. Ethical considerations: Institutional Review Board approval was received from the authors’ university. Findings: The inpatients had more negative attitudes to aging (M = 74.9±10.9; P <0.0001). The predictors of their attitudes to aging were gender and dignity. Women ( β = −2.969, P = 0.045) and inpatients with poor dignity ratings ( β = −0.332, P <0.0001) had more negative attitudes to aging. The predictors for home-dwelling older adults were education, living arrangement, and dignity. More negative attitudes to aging were found in older adults with lower levels of education ( β = 2.716, P = 0.007) who lived alone ( β = 2.163, P = 0.046) and rated their dignity as low ( β = −0.325, P <0.0001). Discussion and Conclusions: The results of this study add to the understanding that a sense of dignity is an important predictor of attitudes to aging for both home-dwelling older adults and inpatients. (shrink)

Provability, Computability and Reflection.

Given the relevance and frequent presence in academic research of the notion of “biopolitics” – developed by the philosopher Michel Foucault –, this article seeks to contribute to the understanding of this notion and its conceptual emergence. To this end, the article analyses the four books published by M. Foucault prior to the initial use of the term “biopolitics” in the second half of the 1970s, aiming so to identify within them the presence of constituent elements of the notion. Elements (...) were found in these books that would later form the conceptualization of biopolitics and inform studies on the subject, particularly the problematization of population and biological life. However, this article did not aim to uncover a biopolitical analysis placed before Foucault’s establishment of the notion; rather, it identified clues related to medicine, biology, statistics, and population present in Foucault’s earlier works that can enhance the understanding of the concept of biopolitics and its historicity. (shrink)

Rousseau and Geneva reconstructs the main aspects of Genevan socio-economic, political and religious thought in the first half of the eighteenth century. In this way Dr Rosenblatt effectively contextualizes the development of Rousseau's thought from the First Discourse through to the Social Contract. Over time Rousseau has been adopted as a French thinker, but this adoption obscures his Genevan origin. Dr Rosenblatt points out that he is, in fact, a Genevan thinker and illustrates for the first time that Rousseau's classical (...) republicanism, his version of natural law theory, his civil religion, and his hostility to the arguments of doux commerce theorists are all responses to the political use of such arguments in Geneva. The author also points out that it was this relationship with Geneva that played an integral part in his development into an original political thinker. (shrink)

In this paper, we discuss the following four alternative ways of understanding the outcomes of resurrection biology. Implications of each of the ways are discussed with respect to concepts of species and extinction. Replication: animals created by resurrection biology do not belong to the original species but are copies of it. The view is compatible with finality of extinction as well as with certain biological and ecological species concepts. Re-creation: animals created are members of the original species but, despite their (...) existence, the species remains extinct. The view is incompatible with all species concepts presented. Non-extinction: animals produced belong to the original species which actually never went extinct. The view may be consistent with phenetic and phylogenetic species concepts as well as with finality of extinction. According to literal resurrection, resurrection biology is successful in reversing extinction through the creation of new members of species that once went extinct. This view presupposes non-finality of extinction and it is compatible with phenetic species concepts. It is notable that no species or extinction concept is consistent with all possible views of resurrection biology nor is any view of resurrection biology consistent with all species or extinction concepts. Thus, one’s views regarding species and extinction determine which views one can adopt regarding resurrection biology and vice versa. (shrink)

In most western countries, there is a ‘human organ shortage’ with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors gave their specific consent.Xenotransplantation – defined as the transplantation of animal cells, tissues or organs into human beings – is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this (...) medical procedure. The objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

The primary objective of this study is to revisit Thomas Aquinas’ notion of justice in light of the author’s own considerations regarding false testimony, specifically in its relation to sin. The intention is to emphasize, within the philosopher, theologian, and advisor’s thinking, the non-sacrificial dimension of justice, which aligns with a testimonial view of cultural evolution and, consequently, philosophical and theological thought. These topics will be addressed through an examination of the discussion surrounding antisemitism in S. Thomas Aquinas, a discussion (...) conducted and explored by Hippolyte Gayraud in his book titled L’Antisémitisme de Saint Thomas D’Aquin (The Antisemitism of Saint Thomas Aquinas). (shrink)

Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and constraints. The (...) work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld. Examining lived experience of embodied intentionality, skilled bodily capacities as highlighted in Merleau-Ponty's non-mechanistic physiology opens new therapeutic, coping and caregiving possibilities. Matching temporal rhythms can decrease the stress of being assisted with activities of daily living. For example, caregivers and patients alike can be taught strategies for extending their lived bodily capacities by altering rhythms, by shifting hyperactivity to different parts of the body and other strategies that change the perceptual experience associated with walking in different environment. A medical account of the pathophysiology of PD is nessessary and useful, but not sufficient for designing caregiving in ways that enrich and extend the existential skills of dwelling of persons with PD. The dominance of mechanistic physiology makes caregivers assume that it is the 'real discourse' about the disease, causing researchers and caregivers alike to overlook the equally real lived experience of the patient which requires different descriptive discourses and different sources of understanding. Lack of dialogue between the two discourses is tragic for patients because caregivers need both in order to provide attuned, effective caregiving. (shrink)

Philanthropic giving among leaders is often assumed to be an expression of ethical leadership in both academic and media discourses; however, this assumption can overlook the ways in which philanthropy produces and is underpinned by inequality. In order to extend current understandings of ethical leadership, this study employs a critical discourse analytic approach to examine how the link between philanthropy and ethical forms of leadership is verbally and visually constructed in the media. Based on the analysis, the article demonstrates how (...) the construction of Australian philanthropists as ethical leaders is achieved through their representation via three paradoxical identities: Aristocratic Battlers; Caring Controllers; and Publicity-Shy Celebrities. These discourses are mediated by Australian cultural norms and serve to conceal yet ultimately reinforce social and economic inequality. The article proposes that a critical discursive approach to understanding leadership ethics can help to explore the hidden or adverse effects of ostensibly ethical practices. (shrink)

The aim of the article is to define the tendencies of elaboration of ethical problems in early medieval exegetical texts - treatises of post-canonical Abhidharma. Ethics as a specific philosophical discipline concerning morals was not specifically developed because of cosmological character of Buddhist philosophy. Explication of the ethical discourse presented in treatises of eminent early medieval Indian Buddhist exegetics Vasubandhu, Asaṅga and Yaśomitra showed that specific for ethics questions on the highest good, sense of human life, the nature and sources (...) of morals, freedom of will etc. were solved in post-canonical period. According to the religious doctrine they interpreted the highest good as the benefit of liberation from the fetches of suffering. The Buddha’s moral instructions known as prātimokṣa is aimed at the attainment of the highest good. Therefore the essence of morality has nothing to do with saṃsāra, and human society forming and perishing in cosmic cycles cannot be the source of moral norms. According to historiosophical myth, human beings get the first instructions on righteous behavior in deep antiquity from charismatic Universal ruler coming to the world as the forerunner of the Buddha. He explains ontological contrariness of the good and the evil but is not the Teacher of the truth. Freedom of will cannot manifest itself spontaneously in a human being attached affectively to saṃsāra. Such an individual falsely takes his ignorant self-will for the freedom of will. Hearing the sermons of salvific teaching is the condition for the rising of free will impulse. (shrink)

Individuals’ food choices are intimately connected to their self-images and world views. Some dietary choices adopted by consumers pose restrictions on their use of genetically modified food (GMF). It is quite generally agreed that some kind of labeling is necessary for respecting consumers’ autonomy of choice regarding GMF. In this paper, we ask whether the current practice of mandatory labeling of GMF products in the European Union is a sufficient administrative procedure for respecting consumers’ autonomy. Three issues concerning this question (...) are discussed. First, we argue that labeling needs to be accompanied by relevant and understandable information on genetic modification, genetically modified food, and the European practice of GMF labeling. Second, we claim that this type of informing makes it less likely that consumers start to avoid GMF products just because labels make them suspicious of the products. It is further noted that even though some consumers may react to labels this way, labels do not restrict their autonomy of choice. Third, a need for more precise labels indicating the source of the transferred gene is considered. It is found out that such labels are not morally necessary when also non-GMF products are available and no relevant differences (such as differences in price and healthiness) exist between them and GMF products. However, in some other cases more precise labels may be needed for respecting consumers’ autonomy of choice. (shrink)

Two core motivational systems have been conceptualized as underlying emotion and behavior. The approach system drives the organism toward stimuli or events in the environment, and the avoidance system instead deters the organism away from these stimuli or events. This approach—avoidance dichotomy has been central to theories of emotion. Advances in neuroscience complementing well-designed behavioral experiments have begun to elucidate the neural mechanisms underlying approach—avoidance motivation, suggesting that these two systems exist in parallel and are lateralized in the brain. This (...) review explores the notion of approach—avoidance and the cerebral lateralization of these motivational tendencies. (shrink)

The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly speaking compel (...) people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

The European Commission has recently proposed the introduction of legally binding quotas for women on corporate boards of European companies. This proposal has put the spotlight on the question of whether increasing female representation on the board brings economic benefits to the firm. In order to shed light on the issue, this study investigates the direct and indirect effects of women on the board on firm value. We use a simultaneous equation model to estimate the effects of women on the (...) board on firm value, financial performance, and compliance with ethical and social principles adopted by the firm. We find no evidence that a higher female representation on the board directly affects firm’s value. However, we find indirect effects. Women on the board are positively related with financial performance (measured in terms of return on assets and return on sales) and with ethical and social compliance, which in turn are positively related with firm value. The findings in this study suggest that greater female representation on corporate boards of large European firms can increase firm value indirectly. Further, part of the indirect effect comes from stronger compliance with ethical principles, something that is not captured by accounting-based financial performance. (shrink)

Background A psychosocial problem faced by people with early-stage dementia (PwESD) is the perception of threats to personal dignity. Insights into its dynamics are important for understanding how it changes as dementia advances and to develop suitable interventions. However, longitudinal studies on this change in PwESD are lacking. Aims To determine how perceptions of dignity and selected clinical and social factors change over 1 year in home-dwelling PwESD and the predictors associated with changes in perceptions of dignity over 1 year. (...) Research design and methods A longitudinal study was conducted. The sample included 258 home-dwelling Czech PwESD. Data were collected using the Patient Dignity Inventory (PDI-CZ), Mini-Mental State Examination, Bristol Activities of Daily Living Scale, Geriatric Depression Scale and items related to social involvement. Questionnaires were completed by the PwESD at baseline and after 1 year. Ethical considerations The study was approved by the ethics committee and informed consent was provided by the participants. Results People with Early-Stage Dementia rated the threat to dignity as mild and the ratings did not change significantly after 1 year. Cognitive function, self-sufficiency, vision, and hearing worsened, and more PwESD lived with others rather than with a partner after 1 year. Worsened depression was the only predictor of change in perceived personal dignity after 1 year, both overall and in each of the PDI-CZ domains. Predictors of self-sufficiency and pain affected only some PDI-CZ domains. Conclusions Perceptions of threat to dignity were mild in PwESD after 1 year, although worsened clinical factors represented a potential threat to dignity. Our findings lead us to hypothesise that perceived threats to personal dignity are not directly influenced by health condition, but rather by the social context. (shrink)

La percepción del Otro desde una perspectiva hegemónica es recurrente en las literaturas heterogéneas, entendidas a grandes rasgos como un tipo de literatura fruto del encuentro entre culturas. Mi objetivo es presentar a la poesía negrista como un evidente caso de literatura heterogénea, aunque con una diferencia: en lugar de perpetuar el punto de vista hegemónico, la poesía negrista latinoamericana, en particular la de Nicolás Guillén, logra una visión de los negros desde la búsqueda de una identidad propia. Teniendo como (...) fundamento la dialéctica nietzscheana dionisíaco-apolíneo, sostengo que la literatura heterogénea en general evidencia una insuficiencia del lenguaje -elemento característicamente apolíneo- en su búsqueda de la representación del Otro, mientras que la poesía de Guillén muestra un mayor grado de cercanía con el Otro, a través de la adopción de un elemento distintivamente dionisíaco: la musicalidad. The perception of the Other from a hegemonic perspective is recurrent in heterogeneous literatures, broadly understood as a kind of literature resulted from the encounter between cultures. The aim of this work is to present "negrista" poetry as an evident case of heterogeneous literature, though different in a way: instead of perpetuating the hegemonic point of view, Latinamerican "negrista" poetry, particularly Nicolás Guillén's, achieves a vision of black people in search of their own identity. Based on Nietzschean Apollonian-Dyonisian dialectic, I maintain that heterogeneous literature in general shows an insufficiency of language -typically Apollonian- in its search for the representation of the Other, whereas Guillén's poetry shows a greater degree of closeness to the Other by adopting an element which is distinctively Dyonisian: musicality. (shrink)

Purpose The purpose of this paper is to report on empirical work conducted to open up algorithmic interpretability and transparency. In recent years, significant concerns have arisen regarding the increasing pervasiveness of algorithms and the impact of automated decision-making in our lives. Particularly problematic is the lack of transparency surrounding the development of these algorithmic systems and their use. It is often suggested that to make algorithms more fair, they should be made more transparent, but exactly how this can be (...) achieved remains unclear. Design/methodology/approach An empirical study was conducted to begin unpacking issues around algorithmic interpretability and transparency. The study involved discussion-based experiments centred around a limited resource allocation scenario which required participants to select their most and least preferred algorithms in a particular context. In addition to collecting quantitative data about preferences, qualitative data captured participants’ expressed reasoning behind their selections. Findings Even when provided with the same information about the scenario, participants made different algorithm preference selections and rationalised their selections differently. The study results revealed diversity in participant responses but consistency in the emphasis they placed on normative concerns and the importance of context when accounting for their selections. The issues raised by participants as important to their selections resonate closely with values that have come to the fore in current debates over algorithm prevalence. Originality/value This work developed a novel empirical approach that demonstrates the value in pursuing algorithmic interpretability and transparency while also highlighting the complexities surrounding their accomplishment. (shrink)

This article explores anti-racist education in business schools amidst the backlash against critical race theory in an anti-Black world. I conduct an autoethnography of my experiences as a woman of colour and management educator who has attempted to bring critical discussions of race and racism into my classrooms. The article examines the barriers to anti-racist teaching in business schools and shows how they interweave individual/interpersonal, institutional, and ideological domains of power. Through my stories, I offer an account of the ways (...) anti-racist education may be limited when it relies on the efforts of individual academics and reveal the tolls that anti-racist education can take on the educator, especially when they are navigating wider systems that are hostile to racial justice. By interrogating the challenges of anti-racist education, I also reflect on the practices and conditions that make meaningful anti-racist education possible. (shrink)

In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors give their specific consent. Xenotransplantation--defined as the transplantation of animal cells, tissues or organs into human beings--is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The (...) objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

The primary aim of research is to explore the complex relationships in the digital era between technology, culture, aesthetics, and values. This investigation digs deeply into the underlying philosophical underpinnings of our digital environment, going beyond superficial interpretations. The research negotiates the tricky territory where technology and culture collide by drawing on concepts from philosophy, sociology, and cultural studies. For measuring, the research study, used E-Views software and generated results, including descriptive statistics, unit root test analysis, co-integration analysis, and histogram (...) analysis. The investigation starts with investigate at digital aesthetics and how it might influence how people see beauty and usefulness in the digital sphere. Digital aesthetics are demonstrated to encapsulate cultural narratives and societal ideals through everything from immersive experiences to minimalist interfaces. The main emerging theme is ethical considerations, which invites critical thought on algorithmic prejudice, privacy, and spying. The research pushes readers to think about the moral ramifications of technical decisions by challenging the ideals ingrained in technological systems. The research goes beyond personal ethics to include more general cultural norms and societal values issues. It has been demonstrated that digital technologies alter societal conceptions of identity, community, and human flourishing, forcing society to reconsider the future it hopes to build. Overall, research found that technology philosophy provides a framework for moral analysis and cultural criticism, enabling people and society to wisely and preemptively negotiate the challenges of the digital era. Through the adoption of a technological philosophy rooted in critical analysis and cultural sensitivity, readers are encouraged to envisage and work towards a digital future that is more equitable, kind, and loving. (shrink)

Decision-making capacity (DMC) is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs (...) from existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

ver since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, (...) a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria. (shrink)