Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired (...) of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. Results The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64–74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. Conclusions An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously. (shrink)

Pretheoretically we hold that we cannot gain justification or knowledge through an epistemically circular reasoning process. Epistemically circular reasoning occurs when a subject forms the belief that p on the basis of an argument A, where at least one of the premises of A already presupposes the truth of p. It has often been argued that process reliabilism does not rule out that this kind of reasoning leads to justification or knowledge. For some philosophers, this is a reason to reject (...) reliabilism. Those who try to defend reliabilism have two basic options: (I) accept that reliabilism does not rule out circular reasoning, but argue that this kind of reasoning is not as epistemically “bad” as it seems, or (II) hold on to the view that circular reasoning is epistemically “bad”, but deny that reliabilism really allows this kind of reasoning. Option (I) has been spelled out in several ways, all of which have found to be problematic. Option (II) has not been discussed very widely. Vogel considers and quickly dismisses it on the basis of three reasons. Weisberg has shown in detail that one of these reasons is unconvincing. In this paper I argue that the other two reasons are unconvincing as well and that therefore option (II) might in fact be a more promising starting point to defend reliabilism than option (I). (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

We provide a retrospective of 25 years of the International Conference on AI and Law, which was first held in 1987. Fifty papers have been selected from the thirteen conferences and each of them is described in a short subsection individually written by one of the 24 authors. These subsections attempt to place the paper discussed in the context of the development of AI and Law, while often offering some personal reactions and reflections. As a whole, the subsections build into (...) a history of the last quarter century of the field, and provide some insights into where it has come from, where it is now, and where it might go. (shrink)

Social anxiety disorders (SAD) are among the most prevalent mental disorders (lifetime prevalence: 7–12%), with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy (ISFT) for SAD, and evaluated its feasibility in a pilot randomized controlled trial (RCT). The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused (...) language, social network diagnostics, and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD (ICD F40.1; Liebowitz Social Anxiety Scale, LSAS-SR > 30): 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy (CBT; age:M = 36 years,SD = 14). Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety (LSAS-SR; ISFT:d = 1.67; CBT:d = 1.04), while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT (d = 0.81). Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory (Structured Clinical Interview, SCID; 78% in ST, 45% in CBT,p = 0.083); this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

"Heideggers Interpretation des Neuplatonismus und damit seine Konstruktion der Seinsgeschichte wurden außer von Stimmen aus der Heidegger-Forschung vor allem von Vertretern der Neuplatonismus-Forschung in Frage gestellt. Die Kritikpunkte lauten zumeist: Heidegger hat den Neuplatonismus zu wenig beachtet (Neuplatonismus-Vergessenheit), ein Vorwurf, der durch die geringe Zahl und die Kürze seiner Äußerungen zum Neuplatonismus begünstigt wurde. Auch könne gerade bei dieser Philosophie von Seinsvergessenheit keine Rede sein. Schlüters Arbeit ist eine ausführliche Auseinandersetzung mit dieser Kritik."--P. [4] of cover.

Objectives To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices. Design Cross-sectional postal survey. Setting Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument. Subjects All 1645 physician members of the German Society for Palliative Medicine. Main outcome measures Types (...) and frequencies of limitation of treatment and possible determinants. Results 901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death. Conclusion The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life. (shrink)

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60-77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric (...) Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients. (shrink)

Objectives:Social isolation is increasing in aging societies and several studies have shown a relation with worse cognition in old age. However, less is known about the association in the oldest-old (85+); the group that is at highest risk for both social isolation and dementia. Methods:Analyses were based on follow-up 5 to 9 of the longitudinal German study on aging, cognition, and dementia in primary care patients (AgeCoDe) and the study on needs, health service use, costs, and health-related quality of life (...) in a large sample of oldest-old primary care patients (AgeQualiDe), a multi-center population-based prospective cohort study. Measurements included the Lubben Social Network Scale (LSNS-6), with a score below 12 indicating social isolation, as well as the Mini-Mental Status Examination (MMSE) as an indicator of cognitive function. Results:Dementia-free study participants (n = 942) were M = 86.4 (SD = 3.0) years old at observation onset, 68.2% were women. One third (32.3%) of them were socially isolated. Adjusted linear hybrid mixed effects models revealed significantly lower cognitive function in individuals with smaller social networks (β = 0.5, 95% CI = 0.3-0.7, p <.001). Moreover, changes in an individual's social network size were significantly associated with cognitive changes over time (β = 0.2, 95% CI = 0.1-0.4, p =.003), indicating worse cognitive function with shrinking social networks. Conclusion:Social isolation is highly prevalent among oldest-old individuals, being a risk factor for decreases in cognitive function. Consequently, it is important to maintain a socially active lifestyle into very old age. Likewise, this calls for effective ways to prevent social isolation. (shrink)

There are two sides to Adorno’s idea of natural history: showing that what appears to be natural is in fact subject to social change, while exposing social change as recurrence of the ever same. Focusing on the second side, this article explains how such a naturalisation can contribute to social critique. What distinguishes Adorno’s use of biological vocabulary from social Darwinism is the critical intention. Rather than scorning nature, naturalisation starts with the conventional notion of nature in order to unmask (...) it as a projection. ‘Nature’ in this sense is what we refuse to acknowledge about our own history. In so far as it does not establish any ontological claims about nature but aims at social transformation, Adorno’s strategy can be understood as a critical naturalism. In the process of demonstrating how human practices are part of nature, the underlying concept of nature is being transformed. (shrink)

In der Reihe werden herausragende monographische Untersuchungen und Sammelbände zu allen Aspekten der Philosophie Kants veröffentlicht, ebenso zum systematischen Verhältnis seiner Philosophie zu anderen philosophischen Ansätzen in Geschichte und Gegenwart. Veröffentlicht werden Studien, die einen innovativen Charakter haben und ausdrückliche Desiderate der Forschung erfüllen. Die Publikationen repräsentieren den aktuellsten Stand der Forschung.

In the present research, we examine the relation between leader mindfulness and employee performance through the lenses of organizational justice and leader-member relations. We hypothesize that employees of more mindful leaders view their relations as being of higher leader-member exchange quality. We further hypothesize two mediating mechanisms of this relation: increased interpersonal justice and reduced employee stress. In other words, we posit that employees of more mindful leaders feel treated with greater respect and experience less stress. Finally, we predict that (...) LMX quality serves as a mediator linking leader mindfulness to employee performance—defined in terms of both in-role and extra-role performance. Across two field studies of triadic leader-employee-peer data and dyadic leader–employee data, we find support for this sequential mediation model. We discuss implications for theorizing on leadership, organizational justice, business ethics, LMX, and mindfulness, as well as practical implications. (shrink)

Sentences containing predicates of personal taste (for example, ‘tasty’, ‘funny’) and aesthetic predicates (for example, ‘beautiful’) give rise to an acquaintance inference: They convey the information that speakers have first-hand experience with the object of predication, and that they can only be uttered appropriately if that is the case. This is surprisingly hard to explain. I will concentrate on aesthetic predicates, and firstly criticize previous attempts to explain the acquaintance phenomena. Second, I will suggest an explanation that rests on a (...) speech act theoretical version of hybrid expressivism, according to which, in uttering ‘X is beautiful’ speakers perform two illocutionary acts simultaneously: an expressive and an assertive one. I will spell out this suggestion in detail and defend it against objections. Considering puzzles related to the acquaintance inference will lead to a new argument for a promising version of hybrid expressivism in meta-aesthetics. (shrink)

This paper aims to delineate the class of aesthetic judgments linguistically. The main idea is that aesthetic judgments can be specified by a certain set of assertibility conditions, i.e., by norms that govern appropriate speech-acts. This idea is spelled out in detail and defended against various objections. The suggestion leads to an interesting account of aesthetic judgments that is theoretically fruitful: It provides the basis for a non-circular and satisfying characterization of the whole domain of aesthetic research and it marks (...) an important linguistic difference between aesthetic judgments and judgments of personal taste. (shrink)

Name der Zeitschrift: Kant-Studien Jahrgang: 108 Heft: 1 Seiten: 55-88.

Consequentialist positions in philosophy spell out normative notions by recourse to final aims. Hedonistic versions of ETHICAL consequentialism spell out what is MORALLY right/justified via recourse to the aim of increasing pleasure and decreasing pain. Veritistic versions of EPISTEMIC consequentialism spell out what is EPISTEMICALLY right/justified via recourse to the aim of increasing the number of true beliefs and decreasing the number of false ones. Even though these theories are in many respects structurally analogous, there are also interesting disanalogies. For (...) example, popular versions of epistemic consequentialism implicitly endorse the truth-indication principle (which claims that a belief is epistemically justified only if there are factors indicating that the belief itself is true), whereas popular versions of ethical consequentialism do not subscribe to an analogous pleasure-indicating principle (which claims that an act is morally justified only if there are factors indicating that performing the act itself is pleasurable). In a first step I will argue that this difference rests on the fact that plausible versions of epistemic consequentialism have to meet certain constraints, which versions of ethical consequentialism do not have to satisfy. As these constraints can be easily met by incorporating the truth-indication principle, epistemic consequentialists tend to subscribe to it. In a second step I will investigate whether the identified constraints can also be met independent from the truth-indication principle. Are there plausible versions of veritistic epistemic consequentialism that reject the principle, thereby allowing that some beliefs can be epistemically justified even though no factors speak in favor of their truth? Building on ideas put forward by Ludwig Wittgenstein, Crispin Wright, and others, I will answer this question affirmatively. (shrink)

Mazzino Montinari nannte Die Geburt der Tragödie "Nietzsches schwierigstes Werk". Es greift auf antike Traditionen zurück und orientiert sich weltanschaulich an Schopenhauer und Wagner, dessen,Musikdrama' Nietzsche als "Wiedergeburt der Tragödie"darstellt. Bei Nietzsche selbst und in der Kulturkritik wirkte vor allem das Konzept des Dionysischen nach. Gegen die Décadence gerichtet, wurde es zum Ideogramm eines rauschhaften Lebenskults.

With this special issue, we would like to promote research on changes in the funding of the sciences, social sciences, and humanities. Since funding secures the livelihood of researchers and the means to do research, it is an indispensable condition for almost all research; as funding arrangements are undergoing dramatic changes, we think it timely to renew the science studies community’s efforts to understand the funding of research. Changes in the governance of science have garnered considerable attention from science studies (...) and higher education research; however, the impact of these changes on the conduct and content of research has not received sufficient attention, and theoretical insights into the connections between funding practices and research practices are few and far between. The aim of this special issue is to contribute to our theoretical understanding of the changing nature of research funding and its impact on the production of scientific knowledge. More specifically, we are interested in the interplay between funding and research practices: What is the impact of institutionalised funding arrangements on the production of scientific knowledge? (shrink)

According to a widespread view, Kant's claim that moral wrongness has its ground in a contradiction underlying every immoral action is a “bluff” rooted in “dogmatic moralism”. Ever since Benjamin Constant's exchange with Kant, counterexamples have played a crucial role in showing why Kant's “universalization procedure” fails to determine the moral validity of our judgments. Despite recent attempts to bring Kant's ethics closer to Aristotle's, these counterexamples have prevailed. Most recently, Jesse Prinz has launched another attack along the same lines. (...) Prinz insists that Kant's universalization procedure fundamentally begs the question and fails to generate plausible results. Even authors who are very sympathetic to Kant, such as Allen Wood, have tried to downplay universalization, focusing instead on other formulations of the categorical imperative. In this paper, I respond directly to four of the most prominent counterexamples. In each case, I aim to show how we can uphold Kant's fundamental claim that the universal law formulation of the categorical imperative articulates the form of our particular moral judgments. (shrink)

Anthony Brueckner argues for a strong connection between the closure and the underdetermination argument for scepticism. Moreover, he claims that both arguments rest on infallibilism: In order to motivate the premises of the arguments, the sceptic has to refer to an infallibility principle. If this were true, fallibilists would be right in not taking the problems posed by these sceptical arguments seriously. As many epistemologists are sympathetic to fallibilism, this would be a very interesting result. However, in this paper I (...) will argue that Brueckner’s claims are wrong: The closure and the underdetermination argument are not as closely related as he assumes and neither rests on infallibilism. Thus even a fallibilist should take these arguments to raise serious problems that must be dealt with somehow. (shrink)

Is art epistemically valuable? Catherine Z. Elgin answers this question in the affirmative. She argues for the epistemic value of art on the basis of her innovative epistemological theory, in which the focus is shifted from knowledge and truth to a non-factive account of understanding. After an exposition and critique of her view, as she develops it in her most recent book “True Enough” (MIT-Press, 2017), I will build on some of her ideas in order to strengthen her account.

In Chapter 12 of the General Theory, on “The State of Long-Term Expectation,” Keynes writes: “It would be foolish, in forming our expectations, to attach great weight to matters which are very uncertain”. In a footnote to this sentence, Keynes points out that by “very uncertain” he does not mean the same as “very improbable” and refers to the chapter on “The Weight of Arguments” in his earlier Treatise on Probability. The purpose of this article, in the first place, is (...) to provide an account of, and to sort out the relations between, Keynes's views on probability, uncertainty, and the weight of arguments. (shrink)

Aesthetic statements of the form ‘X is beautiful’ are evaluative; they indicate the speaker’s positive affective attitude regarding X. Why is this so? Is the evaluative content part of the truth conditions, or is it a pragmatic phenomenon (i.e. presupposition, implicature)? First, I argue that semantic approaches as well as these pragmatic ones cannot satisfactorily explain the evaluativity of aesthetic statements. Second, I offer a positive proposal based on a speech-act theoretical version of hybrid expressivism, which states that, with the (...) literal utterance of ‘X is beautiful’, we perform two illocutionary acts simultaneously, an assertive and an expressive one. I will specify this theory in detail and argue that it can satisfactorily account for the evaluative content of aesthetic statements. I will also discuss the advantages of the theory over other variants of expressivism in meta-aesthetics. (shrink)

This essay presents a phenomenological analysis of the functioning of symbols as elements of the life-world with the purpose of demonstrating the interrelationship of individual and society. On the basis of Alfred Schutz''s theory of the life-world, signs and symbols are viewed as mechanisms by means of which the individual can overcome the transcendences posed by time, space, the world of the Other, and multiple realities which confront him or her. Accordingly, the individual''s life-world divides itself into the dimensions of (...) time, space, the social world and various reality spheres which form the boundaries or transcendences that the I has to understand and integrate. Signs and symbols are described as appresentational modes which stand for experiences originating in the different spheres of the life-world within the world of everyday life, within which they can be communicated, thereby establishing intersubjectivity. Schutz''s theory of the symbol explains how social entities – such as nations, states or religious groups – are symbolically integrated to become components of the individual''s life-world. The following paper reconstructs Schutz''s concept of the symbol as a crucial component of his theory of the life-world, which is seen as an outstanding phenomenological contribution to the theory of the sign and the symbol in general. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and other (...) sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

This paper argues that there is a problem for the justificatory significance of perceptions that has been overlooked thus far. Assuming that perceptual experiences are propositional attitudes and that only propositional attitudes which assertively represent the world can function as justifiers, the problem consists in specifying what it means for a propositional attitude to assertively represent the world without losing the justificatory significance of perceptions—a challenge that is harder to meet than might first be thought. That there is such a (...) problem can be seen by reconsidering and modifying a well-known argument to the conclusion that beliefs cannot be justified by perceptions but only by other beliefs. Nevertheless, the aim of the paper is not to conclude that perceptions are actually incapable of justifying our beliefs but rather to highlight an overlooked problem that needs to be solved in order to properly understand the justificatory relationship between perceptions and beliefs. (shrink)

David Estlund holds that ultimate normative principles are insensitive to bad facts. This is a deliberately twisted appropriation of Jerry Cohen’s famous dictum that ultimate normative principles are fact-insensitive. In this paper, I will show why Estlund’s twist misses the point of Cohen’s argument. The fact-insensitivity claim is not a requirement to eliminate all facts from our normative theories because facts necessarily make these theories concessive. Instead, it may help us to locate the true origin of these concessions. In normative (...) theorizing, we have not explained why a fact supports a principle if we fail to articulate the higher-order principle in light of which that fact is normatively significant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"But I Don’t Feel It":Values and Emotions in the Assessment of Competence in Patients With Anorexia NervosaJochen Vollmann (bio)Keywordscompetence assessment, mental capacity, informed consent, psychiatry, anorexia nervosaThe respect of the self-determination of patients obliges physicians to obtain the patient's consent before providing medical treatment. One important condition for a valid informed consent is the patient's competence to make autonomous health care decisions. Therefore, a proper assessment of competence to (...) make health care decisions is crucial particularly in patients with mental disorders (Vollmann 2000; Helmchen and Vollmann 2001). In recent years, several empirical studies on the assessment of competence in patients suffering from different mental disorders have been performed using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; Grisso and Appelbaum1998). This assessment tool is based on legal standards of competence such as understanding, reasoning, appreciation, and expressing a choice. Since its first publication, the MacCAT-T has been widely accepted as a "gold standard" of competence assessment in the psychiatric literature. In recent years the MacCAT-T has been applied to patients suffering from depression, schizophrenia, dementia, angina pectoris, and normal controls (for overview, see Welie [2001] and Bauer and Vollmann [2002]).Tan and her colleagues (2006) use the MacCAT-T the first time to assess competence to make treatment decisions in patients with anorexia nervosa. Coming from clinical practice, the authors have noticed that the MacCAT-T might not work in this group of patients. Therefore, they use semi-structured interviews in addition to the MacCAT-T to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. They use grounded theory techniques for a qualitative analysis of the data as well as five brief, self-administered questionnaires to ascertain levels of psychopathology.The results of the study show that anorexia nervosa can have complex and variable effects on concentration, beliefs, and thought processing without affecting the ability to perform well on the MacCAT-T. At the same time, participants also report a change in their value system as well as in their personal identity. The authors argue that the results of their studies suggest that the competence to refuse treatment might be compromised in [End Page 289] people with anorexia nervosa in ways that are not captured by the MacCAT-T. This is an interesting finding in patients with anorexia nervosa, because in all other studies with patients suffering from mental disorders such as dementia, depression, and schizophrenia, the MacCAT-T identified more patients as limited in their competence to make health care decisions in comparison with other methods of competence assessment such as clinical judgment (Vollmann et al. 2003). The authors argue on the basis on their qualitative, semistructured interviews that anorexia nervosa–specific difficulties with a thought process and the change of values are missed by the MacCAT-T.Furthermore, Tan and her associated could not find a relationship between the participants' scores on the psychopathological scales, the MacCAT-T scores, and their difficulties expressed during the qualitative interviews, although the small size of the study precludes statistical analysis. In an earlier study, clinical dementia scales but not neuropsychological testing correlated with formal (MacCAT-T) and clinical assessment of competence. Therefore, psychopathological factors might play a different role in different subgroups of patients suffering from different mental problems. However, the idea of an objective neuropsychological model of competence assessment, again, finds no support in the presented empirical data.The qualitative data from patients with anorexia nervosa underline the problem of the cognitive bias of the MacCAT-T assessment and the illusion of value-free categories. It has been argued that the cognitive focus for the MacCAT-T is in itself a normative convention and that the MacCAT-T is missing the complexity of the process to make health care decisions in real life. Therefore, values and emotions should be considered in addition to cognitive functions in assessing competence to make health care decisions (Breden and Vollmann 2004; see also "Mental capacity" 2004). Although many authors agree that the cognitive approach of capacity assessment is important but not sufficient for the assessment of competence to make health care decisions, it remains an... (shrink)

The present study examined what participants perceive of their hand movements when using a tool. In the experiments different gains for either the x-axis or the y-axis perturbed the relation between hand movements on a digitizer tablet and cursor movements on a display. As a consequence of the perturbation participants drew circles on the display while their covered hand movements followed either vertical or horizontal ellipses on the digitizer tablet. When asked to evaluate their hand movements, participants were extremely uncertain (...) about their trajectories. By varying the amount of visual feedback, findings indicated that the low awareness of one’s own movements originated mainly from an insufficient quality of the humans’ tactile and proprioceptive system or from an insufficient spatial reconstruction of this information in memory. (shrink)

Are our actions morally good because we approve of them or are they good independently of our approval? Are we projecting moral values onto the world or do we detect values that are already there? For many these questions don’t state a real alternative but a secular variant of the Euthyphro dilemma: If our actions are good because we approve of them moral goodness appears to be arbitrary. If they are good independently of our approval, it is unclear how we (...) come to know their moral quality and how moral knowledge can be motivating. None of these options seems attractive; the source of moral goodness unclear. Despite the growing literature on Kant’s moral epistemology and moral epistemology the question remains open what Kant’s answer to this apparent dilemma is. The Kantian view I attempt to lay out in this paper is supposed to dissolve the secular version of the Euthyphro dilemma. In responding to this dilemma we need to get clear about the source or the origin of our moral knowledge: Voluntary approval or mind-independent moral facts? Projectivism or detectivism? Construction or given? I believe that all these ways of articulating the problem turn out, on closer inspection, to be false alternatives. (shrink)

Forschungs- und Therapieansätze einer „personalisierten Medizin“ erhalten gegenwärtig große Aufmerksamkeit und Förderung in Forschung, Wirtschaft und Politik und erwecken große Hoffnungen. Auf der Grundlage molekulargenetischer Biomarker soll ein zielgerichtetes, stratifiziertes Vorgehen im Bereich der Prävention, Diagnostik und Therapie erreicht werden. Häufig wird der Begriff „personalisierte Medizin“ als Synonym für medizinischen Fortschritt überhaupt benutzt und eine persönlichere, bessere und kostengünstigere Medizin versprochen. 1) Fortschritte in der genetischen Forschung können nicht mit besseren medizinischen Behandlungsmöglichkeiten für eine Vielzahl von Patienten gleichgesetzt werden. In (...) Wirklichkeit beschränken sich die aktuellen Fortschritte einer an genetischen Biomarkern ausgerichteten Diagnostik und Therapie auf Untergruppen von Patienten. Die Mehrheit der Kranken hat bisher keinen Vorteil. 2) Der Begriff „personalisierte Medizin“ ist unangemessen und irreführend. Vielmehr handelt es sich um eine auf genetischen Biomarkern basierte stratifizierende Medizin und nicht um eine patienten- oder personenzentrierte Medizin. 3) Die sog. „personalisierte Medizin“ ist ein stark forschungs- und industriegetriebener Bereich der Medizin. Globale Stakeholder bestimmen die Entwicklung, unabhängig finanzierte Forschung gibt es kaum. Daher besteht die Gefahr, dass wissenschaftlicher Erkenntnisgewinn durch wirtschaftliche Einzelinteressen behindert wird. Empirische Erfahrungen, z. B. der Preisentwicklung neuer Krebsmedikamente, zeigen, dass das Versprechen der Kostenersparnis jeder Evidenz entbehrt. 4) Die hohen Investitionen in die „personalisierte Medizin“ werfen wichtige ethische Fragen nach Opportunitätskosten und Prioritätensetzungen im öffentlichen Gesundheitswesen auf. Derzeit profitieren wenige Patientengruppen von den hohen Forschungs- und Behandlungskosten der „personalisierten Medizin.“ Gleichzeitig bleiben Forschung und Versorgung in anderen wichtigen medizinischen Bereichen unterfinanziert. Eine öffentliche Debatte über die Prioritäten in medizinischer Forschung und Versorgung sowie darüber, wie diese in demokratischen Gesellschaften und in öffentlichen Gesundheitssystemen umgesetzt werden können, ist erforderlich. Eine an genetischen Biomarkern ausgerichtete sog. „personalisierte Medizin“ führt nicht zu einer persönlicheren Behandlung des einzelnen Patienten und ist von einer personen- oder patientenzentrierten Medizin zu unterscheiden. Von den bisherigen Therapiefortschritten profitieren Untergruppen von Patienten, z. B. in der Onkologie. Für die Mehrheit der Patienten konnten keine Verbesserungen erzielt werden. Für eine Kostenersparnis im Gesundheitswesen fehlt jegliche empirische Evidenz, vielmehr muss nach bisherigen Erfahrungen mit Kostensteigerungen gerechnet werden. (shrink)

Consequentialist positions in philosophy spell out normative notions by recourse to final aims. Hedonistic versions of ETHICAL consequentialism spell out what is MORALLY right/justified via recourse to the aim of increasing pleasure and decreasing pain. Veritistic versions of EPISTEMIC consequentialism spell out what is EPISTEMICALLY right/justified via recourse to the aim of increasing the number of true beliefs and decreasing the number of false ones. Even though these theories are in many respects structurally analogous, there are also interesting disanalogies. For (...) example, popular versions of epistemic consequentialism implicitly endorse the truth-indication principle (which claims that a belief is epistemically justified only if there are factors indicating that the belief itself is true), whereas popular versions of ethical consequentialism do not subscribe to an analogous pleasure-indicating principle (which claims that an act is morally justified only if there are factors indicating that performing the act itself is pleasurable). In a first step I will argue that this difference rests on the fact that plausible versions of epistemic consequentialism have to meet certain constraints, which versions of ethical consequentialism do not have to satisfy. As these constraints can be easily met by incorporating the truth-indication principle, epistemic consequentialists tend to subscribe to it. In a second step I will investigate whether the identified constraints can also be met independent from the truth-indication principle. Are there plausible versions of veritistic epistemic consequentialism that reject the principle, thereby allowing that some beliefs can be epistemically justified even though no factors speak in favor of their truth? Building on ideas put forward by Ludwig Wittgenstein, Crispin Wright, and others, I will answer this question affirmatively. (shrink)

Ramsey's critique of Keynes's ‘logical’ approach to probability is widely regarded as decisive, and his own ‘subjective’ approach and SEU framework are now familiar tools in economics. This paper challenges the standard view of Ramsey's critique and assesses the SEU model from a Keynesian viewpoint on probability. It consists of a summary of the two theories and an evaluation of Ramsey's criticisms and alternative. The two main conclusions are that although Keynes yields to Ramsey on the question of the existence (...) of logical probability relations, the formal structure of his theory is compatible with non-objectivist interpretations of probability; and that Ramsey makes far heavier demands on the capacities of the ‘rational agent’ than does Keynes. (shrink)

Comics are complex multimodal documents that make for intriguing materials to analyze with computer vision and computational linguistics. This review summarizes the growing developments in computational modeling which have been progressing to analyze visual narratives across their various substructures.

Although the computational properties of the Region Connection Calculus RCC-8 are well studied, reasoning with RCC-8 entails several representational problems. This includes the problem of representing arbitrary spatial regions in a computational framework, leading to the problem of generating a realization of a consistent set of RCC-8 constraints. A further problem is that RCC-8 performs reasoning about topological space, which does not have a particular dimension. Most applications of spatial reasoning, however, deal with two- or three-dimensional space. Therefore, a consistent (...) set of RCC-8 constraints might not be realizable within the desired dimension. In this paper we address these problems and develop a canonical model of RCC-8 which allows a simple representation of regions with respect to a set of RCC-8 constraints, and, further, enables us to generate realizations in any dimension d = 1. For three-and higher-dimensional space this can also be done for internally connected regions. (shrink)