In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

Most scholars dealing with neo-Kantianism emphasize the existence of an explicit origin that characterizes neo-Kantianism as a clearly defined ‘movement’ with certain objects. In spite of the fact that differences between various neo-Kantian authors are mentioned in the current discourse (e. g. ‘Südwestdeutsche’ and ‘Marburger Schule’) scholars claim a singular unity of all neo-Kantian debates represented in the problem of ‘Geltung’. This is used to construct a certain relevance of neo-Kantianism in today’s philosophy. My contribution will pursue a historical approach (...) following Klaus Christian Köhnke’s and Ulrich Sieg’s demands. Instead of sketching systematic topics I pay further attention to the context in which an essence of neo-Kantianism was claimed or rejected. In doing so I will examine the discussions on the doctrine of postulates in Kant’s philosophy mainly led by Hans Vaihinger’s ‘Philosophy of As If’ and the impact of Eduard von Hartmann on the genesis of neo-Kantianism. I conclude that the definition of a consistent neo-Kantian ‘movement’ was an effect of rejecting spiritualist interpretations of the doctrine of postulates and in the following a rejection of the whole doctrine as ‘mysticism’ in canonical Kant interpretations. (shrink)

Die Publikation untersucht den Umgang mit der kantischen Postulatenlehre in den Diskussionen um 1900 und ordnet diesen ein in die politischen Debatten der Zeit. Die Arbeit weist in diesem Kontext nach, dass diese bis heute zitierten Deutungen der kantischen Morallehre ein Effekt wirkmächtiger spiritistischer und materialistischer Diskurse sind.

The role of the individual scientist as a socialization agent is increasingly emphasized in science policy. This article analyzes offshore wind scientists’ narratives about science–technology–society relations and their role in them. It particularly focuses on the nuanced and detailed reasons that scientists give for their level of engagement with society. The analysis is based on semistructured individual and focus group interviews with thirty-five scientists. It finds a diversity of narratives related to the questions of whether socialization of technology is needed (...) and which approaches to socialization scientists should pursue. The six narratives identified are upstream engagement, design against resistance, the outreaching scientist, the difficulty of outreach, the outsourcing scientist, and disembedded development of technology. Despite the importance attributed to scientists for the socialization of science and technology, most interviewed scientists did not embrace their role as socialization agent. Based on the scientists’ narratives, this article argues that we should rethink both who should be responsible for socialization and what should be the object of sciences’ engagement with society. (shrink)

Der vorliegende Sammelband soll dazu anregen, sich auf den Spuren der wichtigsten politischen Theoretiker des 19. Jahrhunderts mit den Grundlagen unseres politischen Denkens zu beschäftigen und dabei hinter die Kulissen des aktuellen politischen Geschehens unserer Zeit zu schauen. Denn die politischen Diskussionen der Gegenwart können ohne Kenntnis ihrer Vorgeschichte, ohne Analyse und Rezeption der politischen Theorien der Vergangenheit nicht beurteilt werden. Die Vermittlung dieser Grundlagen ist Aufgabe der politischen Ideengeschichte.

On a remarqué très tôt qu’il existait une parenté quant aux moyens rhétoriques entre la phénoménologie de Husserl et l’Archéologie de Foucault. Si on comprend la rhétorique non pas (comme les premiers dialogues de Platon voulaient le montrer) comme contraire de la philosophie, ni comme son vis-à-vis, mais comme dimension incontournable de l’argumentation philosophique, à travers la mise en place de moyens rhétoriques, performatifs et de mise en scène, alors cette parenté gagne une nouvelle signification. Husserl lui-même utilise le concept (...) d’« archéologie phénoménologique », dans un texte de 1932 (ici présenté, pour la première fois en français) et ce, dans un sens programmatique. À partir de cet arrière-plan, une convergence se dessine entre les tentatives de Husserl et de Foucault, d’une part de comprendre leur propre entreprise comme archéologie et de pourvoir celle-ci du prestige d’une science héroïque et en même temps d’une sobriété toute positiviste ; d’autre part d’éviter l’implication d’une ontologie platonicienne-dualiste de l’apparence et de l’Être, de la surface et de la profondeur à travers des interprétations spécifiques, visant à mettre en place une disposition horizontale des objets. (shrink)

A careful reading of Heloise's letters reveals both her contribution to Abelard's ethical thought and the differences between her ethical concerns and his. In her letters, Heloise focuses on the innate moral qualities of the inner person or animus. Hypocrisy—the misrepresentation of the inner person through false outer appearance, exemplified by the potentially deceitful religious habit or habitus—is a matter of great moral concern to her. When Abelard responds to Heloise's ideas, first in his letters to her and later in (...) his Collationes and Scito te ipsum, he turns the discussion away from her original interests. He transforms her metaphor of the habitus as false appearance into a discussion of another type of habitus, the habitual process of acquiring virtue, and integrates her focus on the animus into his developing ideas about sin as intention. Examining the differences between Heloise's ethical thought and Abelard's allows us to appreciate the distinct contributions of both. (shrink)

The current issue of the presents a discussion of social media's future. and debate the sense and non-sense of network-critique in light of the internet's modified usage and perception, which is commonly labeled Web 2.0. Lovink is critical about the increasing tendency towards monopolization in Web 2.0. Users, he contends, become thrilled by, which are presented to them by big companies. Independent of the question whether the need for practical information and the prevalence of economical interests is understandable or not, (...) Lovink is most of all concerned with artistic alternatives and an activist usage of the nets. According to him, it is time for developers, programmers, freaks and nerds of all nations to become conscious of and active against the dark sides of economical and political control over the internet. Heidenreich, on the other hand, is skeptical. In contrast to the project of network-critique, he pursues a rigorously medial approach, which presents itself as unimpressed by ethical or engaged observations of social media. In his view, the heroization of hackers and nerds is informed by Science Fiction and nostalgia, both of which miss Reality 2.0. Heidenreich asserts that the internet's new generation, which has grown up with the new media, is not particularly interested in network-critique, but uses the given internetservices in various ways. (shrink)

Zusammenfassung Todes- und Suizidwünsche älterer Menschen stellen ein relevantes und moralisch herausforderndes Thema für Pflegefachpersonen dar. Insbesondere im Zusammenhang möglicher Wünsche nach Suizidassistenz wächst das Potenzial moralischer Ungewissheit bis hin zu Moral Distress. Im Setting der ambulanten und stationären Langzeitpflege erweist sich die professionelle Sensibilität und ethische Einordnung gegenüber geäußerten Todes- und Suizidwünschen als besonders bedeutsam, denn sowohl die Suizidraten als auch die Anfragen nach Suizidassistenz sind Studien zufolge bei Menschen über 65 Jahren hoch. Dieser Sachverhalt unterstreicht zugleich die Bedeutsamkeit (...) der jüngst auch durch die Bundesregierung gestärkten Suizidprävention und den Auftrag, ein entsprechendes Gesetz hierfür auf den Weg zu bringen. Die situative Konfrontation der Pflegefachpersonen mit Todes- und Suizidwünschen kann aufgrund der aktuell in der Praxis vorherrschenden rechtlichen Unsicherheiten – so unsere Hypothese – ein ethisches Spannungsfeld zwischen einem vorurteilsfreien, offenen, empathischen und respektvollen Aufgreifen von Todes- und Suizidwünschen einerseits und dem Ziel der Suizidprävention andererseits hervorrufen. Internationale Studien verweisen auf das Potenzial von Moral Distress von Pflegefachpersonen in der Konfrontation mit Todes- und Suizidwünschen. Diese Erkenntnisse und die Bezugnahme auf die aktuellen rechtlichen Unsicherheiten und Rahmenbedingungen im nationalen Kontext untermauern die Bedeutsamkeit der professionsbezogenen Auseinandersetzung mit der Thematik, die Notwendigkeit (zukünftige) Pflegefachpersonen für potenzielle ethische Spannungsfelder zu sensibilisieren und einen kompetenten Umgang mit der einhergehenden moralischen Ungewissheit zu ermöglichen. (shrink)

Definition of the problem Death and suicide wishes of older people represent a relevant and morally challenging issue for nurses. Especially in the context of wishes for assisted suicide, the risk for the development of moral uncertainty or even moral distress grows. As suicide rates and requests for assisted suicide are particularly high among people 65 years of age or older, the topic proves to be particularly relevant to the settings of long-term community and nursing home care. At the same (...) time, this fact underlines the importance of suicide prevention, which has recently been strengthened by the federal government, with the intention of launching a national strategy and a corresponding law. Arguments According to our hypothesis, the situational confrontation of nursing professionals with death and suicide wishes may cause an ethical field of tension between an unprejudiced, open, empathetic and respectful acceptance of death and suicide wishes on the one hand and the goal of suicide prevention on the other. The legal uncertainties in regards to the practice of assisted suicide, which currently prevails in practice, may intensify this risk. International studies point to the potential of moral distress of nurses when confronted with death and suicide wishes. Conclusion These findings and the reference to the current legal uncertainties and framework conditions in the national (German) context underpin the importance of the professional discussion about the topic, the need to sensitise (future) nursing professionals to potential ethical tensions and to enable them to deal with the accompanying moral uncertainty in a professional and competent manner. (shrink)

BackgroundVascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient.MethodsQualitative, semi-structured interviews were conducted with 19 (...) vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.ResultsThe surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course.ConclusionsThis study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care. (shrink)

Hans Blumenbergs Werk ist mit einer Theorie des Mythos, der Metapher und der Epochenumbrüche, technikphilosophischen Reflexionen, literaturtheoretischen Überlegungen und literarischen Glossen ungewöhnlich vielgestaltig. Die Beiträge des Bandes begegnen diesem Umstand, indem sie nicht einzelne Grundgedanken, sondern Vorgehensweisen und Techniken, methodische Ansätze und taktische Blickwendungen fokussieren. Ihr Interesse gilt Blumenbergs Verfahren. Sie betrachten etwa den Metapherngebrauch des Metaphorologen und seine Vorliebe für implikative Zugänge, die unmögliche Abschreitung des Horizonts und die Verabschiedung der Theorie als theoretisches Verfahren. Auf welche Weise nähert sich (...) Blumenberg den Wirklichkeiten, in denen wir leben? Wie wird die Arbeit an der Bedeutsamkeit ins Werk gesetzt? Und welche dieser Verfahren lassen sich heute noch in Anspruch nehmen oder weiterdenken? Mit Beiträgen von Hannes Bajohr, Rüdiger Campe, Johannes Endres, Sebastian Feil, Petra Gehring, Eva Geulen, Anselm Haverkamp, Felix Heidenreich, Katharina Hertfelder, Wolfgang Hottner, Niklaus Largier, Christoph Paret, Birgit Recki und Christine Weder. (shrink)

Heart disease is the leading cause of death amongst adult Americans and has recently become a top killer worldwide. The direct costs of cardiovascular disease are projected to triple in the next 20 years, from $272.5 billion to $818.1 billion (Heidenreich et al. 2011). Although there has been a decreased incidence and prevalence of ischemic heart disease over the past several decades in the United States, heart failure remains a major cause of morbidity and mortality. In the United States, (...) approximately 500,000 to 700,000 new cases are identified each year (Lloyd-Jones et al. 2009). Heart failure is now the number one diagnosis leading to hospitalization. As such, it is an increasingly heavy economic burden on .. (shrink)