BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their (...) validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

BackgroundThe UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer’s disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, (...) which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the ‘spatial intervention study’ of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. MethodsPeople with a suspected or confirmed diagnosis of dementia in Alzheimer’s disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed.DiscussionThe results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice.Trial registration: DRKS00030799. (shrink)

A new, definitive translation of Heidegger's most important work.

First published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.

Examines the theories of Plato, Rousseau, Mary Wollstonecraft, Catherine Beecher, and Charlotte Perkins Gilman concerning the education of women.

Increasingly, companies implement social and environmental standards as instruments towards corporate social responsibility in supply chains. This is based on the assumption that such standards increase legitimacy among stakeholders. Yet, a wide variety of standards with different requirement levels exist and companies might tend to introduce the ones with low exigencies, using them as a legitimacy front. This strategy jeopardizes the reputation of social and environmental standards among stakeholders and their long-term trust in these instruments of CSR, meaning that all (...) expenses for their implementation are of no avail for the companies. Therefore, this paper highlights which criteria are important for the selection, implementation and improvement in order to achieve a company's aim, but also to strengthen the legitimacy of social and environmental standards. This research is based on conceptual thought and some existing empirical research, comparing four different social and environmental standards, revealing weaknesses and strengths. It exposes the basic conditions for the success of such standards among stakeholders and identifies the need for more empirical data. (shrink)

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research (...) involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators. (shrink)

This paper proposes how various disciplinary theories of cognition may be combined into a unifying, sub-symbolic, computational theory of cognition. The following theories are considered for integration: psychological theories, including the theory of event coding, event segmentation theory, the theory of anticipatory behavioral control, and concept development; artificial intelligence and machine learning theories, including reinforcement learning and generative artificial neural networks; and theories from theoretical and computational neuroscience, including predictive coding and free energy-based inference. In the light of such a (...) potential unification, it is discussed how abstract cognitive, conceptualized knowledge and understanding may be learned from actively gathered sensorimotor experiences. The unification rests on the free energy-based inference principle, which essentially implies that the brain builds a predictive, generative model of its environment. Neural activity-oriented inference causes the continuous adaptation of the currently active predictive encodings. Neural structure-oriented inference causes the longer term adaptation of the developing generative model as a whole. Finally, active inference strives for maintaining internal homeostasis, causing goal-directed motor behavior. To learn abstract, hierarchical encodings, however, it is proposed that free energy-based inference needs to be enhanced with structural priors, which bias cognitive development towards the formation of particular, behaviorally suitable encoding structures. As a result, it is hypothesized how abstract concepts can develop from, and thus how they are structured by and grounded in, sensorimotor experiences. Moreover, it is sketched-out how symbol-like thought can be generated by a temporarily active set of predictive encodings, which constitute a distributed neural attractor in the form of an interactive free-energy minimum. The activated, interactive network attractor essentially characterizes the semantics of a concept or a concept composition, such as an actual or imagined situation in our environment. Temporal successions of attractors then encode unfolding semantics, which may be generated by a behavioral or mental interaction with an actual or imagined situation in our environment. Implications, further predictions, possible verification and falsifications, as well as potential enhancements into a fully spelled-out unified theory of cognition are discussed at the end of the paper. (shrink)

Recent research illustrates substantial gaps between entrepreneurial intentions and behavior. This is a challenge for entrepreneurship promotion interventions that have primarily focused on stimulating entrepreneurial intentions. However, extant literature suggests that implementation intentions enhance the likelihood of acting congruently to the behavioral intention. Furthermore, theory also suggests the condition effects of situations and the perceived control over them. We therefore hypothesized that implementation intentions mediate the relationship between entrepreneurial intention and action, while perceived family support moderates the movement from implementation (...) intention to entrepreneurial action. Using two-wave survey data from a sample of students at an African university, we measured two psychological attributes as important precursors of entrepreneurship and entrepreneurial intentions present before undertaking an innovations and entrepreneurship course. Implementation intentions regarding entrepreneurship, entrepreneurial actions, and perceived parental support for entrepreneurial activities were also measured 2 weeks after completion of the course. Our results demonstrate support for the proposed moderated double mediation model in which the effects of the two psychological attributes on entrepreneurial actions are explained via entrepreneurial intentions and implementation intentions. We further find moderation effects of perceived family support indicating that implementation intentions more likely predicted entrepreneurial actions in cases of higher family support. (shrink)

Media increasingly accuse firms of exploiting suppliers, and these allegations often result in lurid headlines that threaten the reputations and therefore business successes of these firms. Neither has the phenomenon of supplier exploitation been investigated from a rigorous, ethical standpoint, nor have answers been provided regarding why some firms pursue exploitative approaches. By systemically contrasting economic liberalism and just prices as two divergent perspectives on supplier exploitation, we introduce a distinction of common business practice and unethical supplier exploitation. Since supplier (...) exploitation is based on power, we elucidate several levels of power as antecedents and investigate the role of ethical climate as a moderator. This study extends Victor and Cullen’s ethical climate matrix according to a supply chain dimension and is summarized in an integrated, conceptual model of five propositions for future theory testing. Results provide a frame of reference for executives and scholars, who can now delineate unethical exploitation and understand important antecedents of the phenomenon better. (shrink)

According to both traditional positivist approaches and also to the sociology of scientific knowledge, social analysts should not themselves become involved in the controversies they are investigating. But the experiences of the authors in studying contemporary scientific controversies—specifically, over the Australian Animal Health Laboratory, fluoridation, and vitamin C and cancer—show that analysts, whatever their intentions, cannot avoid being drawn into the fray. The field of controversy studies needs to address the implications of this process for both theory and practice.

This conceptual article introduces behavioral perspectives into the governance arena and undertakes a psychological assessment of managerial decision making in organizations by elaborating on the treatment of trust and pride in the extant literature. While trust is conceived by governance scholars as a device for monitoring relationships with others, we argue that authentic pride, contrary to hubris, could operate as an attribute of emotional self-regulation allowing corporate leaders to govern the social behavior of their own self. Contrasting the features of (...) trust and authentic pride, we advance several propositions to capture their relevance and simultaneous importance as viable governance mechanisms in light of a manager's level of cognitive moral reasoning. Our study builds a unified theoretical framework of governance which integrates human agency, psychological states, and moral judgment to foster a deeper understanding of complex self-regulatory processes that are activated by decision makers in the execution of their roles. (shrink)

Secondary use of clinical data in research or learning activities (SeConts) has the potential to improve patient care and biomedical knowledge. Given this potential, the ethical question arises whether physicians have a professional duty to support SeConts. To investigate this question, we analyze prominent international declarations on physicians’ professional ethics to determine whether they include duties that can be considered as good reasons for a physicians’ professional duty to support SeConts. Next, we examine these documents to identify professional duties that (...) might conflict with a potential duty of physicians to support SeConts. (shrink)

The paper defends the permissibility of paying inducements to research subjects against objections not covered in an earlier paper in Bioethics. The objections are that inducements would cause inequity, crowd out research, and undesirably commercialize the researcher‐subject relationship. The paper shows how these objections presuppose implausible factual and/or normative claims. The final position reached is a qualified defence of freedom of contract which not only supports the permissibility of inducements but also offers guidance to ethics committees in dealing with practical (...) problems that might arise if inducements are offered. (shrink)

I consider three challenges to the traditional view according to which moral responsibility involves an epistemic condition in addition to a freedom condition. The first challenge holds that if a person performs an action A freely, then she thereby knows that she is doing A. The epistemic condition is thus built into the freedom condition. The second challenge contends that no epistemic condition is required for moral responsibility, since a person may be blameworthy for an action that she did not (...) know was wrong. The third challenge invokes the quality of will view. On this view, a person is blameworthy for a wrong action just in case the action manifests a bad quality of will. The blameworthy person need not satisfy an additional epistemic condition. I will argue that contrary to appearances, none of these challenges succeeds. Hence, moral responsibility does require a non-superfluous epistemic condition. (shrink)

Leibniz has long faced a challenge about the coherence of the distinction between necessary and contingent truths in his philosophy. In this paper, I propose and examine a new way to save genuine contingency within a Leibnizian framework. I conclude that it succeeds in formally solving the problem, but at unbearable cost. I present Leibniz’s challenge by considering God’s choice of the best possible world (Sect. 2). God necessarily exists and necessarily chooses to actualise the best possible world. The actual (...) world therefore could not be different, for if it were different it would be a distinct and inferior world and hence would not be created. In Sect. 3 I defend Leibniz from this challenge. I argue that while it is necessary for God to choose to create the best possible world, it is not necessary for any world to be the best possible. This is because the criterion for judging perfection can itself be contingent. Different criteria will judge different worlds as the best. Thus it is necessary for God to create the best, but not necessary which is the best. Distinguishing between possible worlds in Leibniz’s sense and in the modern sense allows a fuller exposition of this position. There are worries that can arise with the claim that the criterion of perfection is contingent. I consider two of the most pressing (Sect. 4). The first argues that the criterion is in God’s understanding and hence is necessary; the second alleges that a contingent criterion of perfection violates Leibniz’s cherished Principle of Sufficient Reason. These worries are well-grounded, and examining them reveals a deep incompatibility between this solution and Leibniz’s metaphysical views. I conclude that there is a real solution available, but that it is unacceptable to Leibniz or a Leibnizian. The search for a genuine solution that is genuinely Leibnizian goes on. (shrink)

Nursing acts occur in thousands of instances daily, being a major component of professional health care delivery in institutions, communities and homes. It follows that the ethical practice of most nurses is put to the test on an everyday rather than an occasional basis. Hence, within nursing practice there must be a rich and deep seam of reflective interpretation and practical wisdom that is 'embedded' within the experiences of every experienced nurse. This article presents discussion on some of the main (...) findings of a recently completed study on nursing ethics in New Zealand. An interpretation of a nurse's story taken from the study is offered and suggestions are made for nursing ethics education. (shrink)

The article explores epistemic and social conditions of the trustworthiness of scientific expertise. I claim that there are three kinds of conditions for the trustworthiness of scientific expertise. The first condition is epistemic and means that scientific knowledge enjoys high credibility. The second condition concerns the significance of scientific knowledge. It means that scientific generalizations are relevant for elucidating the particular cases that constitute the challenges for expert judgment. The third condition concerns the social processes involved in producing science-based recommendations. (...) In this context trust is created by social robustness, expert legitimacy, and social participation. (shrink)

Abstract:This article argues for the compatibility of casuistry and the business case method. It describes the salient features of casuistry and the case method, shows how the two methods are similar yet different, and suggests how elements of casuistry might benefit the use of the case method in management education. Toward these ends, it shows how casuistry and the case method are both inductive and practical methods of reasoning focussed on single settings and real-life situations and how both methods stress (...) that real-life decision making is not the exclusive domain of experts. It also shows how casuistry and the case method are not identical processes but have different purposes and emphasize order and problem-resolution differently. In the end,Casuistry and the Business Case Methodsuggests that, despite their differences, casuistry and the case method might be brought together to benefit business management and the field of business ethics. (shrink)

Prior research has demonstrated a strong relationship between team performance and team members’ team efficacy beliefs and perceptions of social integration. Performing well increases the feelings of collective ability that comprise team efficacy and the feelings of psychological connectedness that make up social integration, while performing poorly erodes them. In this article, we draw from the social cognitive base of ethical leadership theory to argue that ethical leadership moderates the relationship between team performance and team efficacy beliefs, and between team (...) performance and social integration, such that these important team attitudes are buffered against the negative effects of poor performance when leaders act ethically. Alternatively, when leaders act less ethically, team efficacy and social integration break down following poor performance. We test our hypotheses in a field study of U.S. military teams actively engaged in competition. The data support our arguments. We find that ethical leadership weakens the relationships among team performance and team efficacy and social integration, respectively, such that ethical leaders preserve team efficacy and social integration when their teams do not perform well. (shrink)

The study “Psychoanalysis—its image and its public” intimates that common sense is increasingly informed by science. But common sense asserts its autonomy and, in turn, may affect the trajectory of science. This is a process that leads to many differentiations—in common sense, in scientific innovation and in political and regulatory structures. Bauer and Gaskell's toblerone model of triangles of mediation provided a distillation of their reading of “La Psychanalyse.” Here it was argued that representations are multi-modal phenomena necessitating the use (...) of multiple methodologies .In this paper we briefly summarise these arguments and elaborate ways in which social representation theory can be considered a progressive research programme. “Progressive” because as the theory has developed it has extended the range and depth of its conceptual basis; it provides a new synthesis for the social scientific understanding of the phenomena of common sense and of representation; it acts as an antidote to the reductionism of public opinion and, finally, it is a stimulus to depart from disciplinary silos. However, there remain unresolved issues: how to segment the relevant social milieus and how to close the feedback loop from common sense to science? (shrink)

This philosophical-political profile offers the first of its kind intellectual reconstruction of HabermasOs defining existential and historical situations, his generational profile and interventions, his impact on as well as the discontents that his life work generates in others. In this work the reader is taken on a journey with Habermas through the 20th-century intellectual and political history from the defeat of Nazism, to the Cold War restoration of the 1950s, the student movement of the 1960s, the historical revisions of the (...) 1970s and 1980s, the hope of the post-Wall era after 1989, all the way to the controversies surrounding the allied wars of intervention against Iraq and Serbia in the 1990s. (shrink)

Rhonheimer applies moral theology to practical questions, such as, what does it mean to violate the natural law, or to be “unnatural”?

The recent success of the Mars 2020 project and the high quality images relayed back to Earth have provided further impetus and expectations for human missions to Mars. To support space agency and private enterprise plans to establish a sustainable colony on Mars in the 2030s, synthetic biology may play a vital role to enable astronaut self-sufficiency. In this review, we describe some aspects of where synthetic biology may inform and guide in situ resource utilisation strategies. We address the nature (...) of Martian regolith and describe methods by which it may be rendered fit for purpose to support growth and yield of bioengineered crops. Lastly, we illustrate some examples of innate human adaptation which may confer characteristics desirable in the selection of colonists and with a future looking lens, offer potential targets for human enhancement. (shrink)

Daniel Taylor and Dawn Goodwin present a case study of the Morecambe Bay Inquiry (MBI), which examined the high rate of maternal and neonatal deaths over a period of 9 years (2004–2013), within the small maternity unit of Furness General Hospital (FGH), one of the three hospitals comprising Morecambe Bay Hospitals Trust.1 They examine this through a conceptual lens, and provide a solution involving changes in medical education. This commentary explores both these elements. First, they use the lens of ‘Normalisation (...) of Deviance’ (NoD) to explain organisational failure. However, other available lenses such as ‘Sociology of Disasters’, ‘Organisational Silence’ and ‘Comfort-seeking Behaviour’ may point to different problems and solutions. More justification for their choice of the lens of NoD would have been useful. Similarly, more justification for their focus on a cluster of five ‘serious untoward incidents’ (SUIs) occurring in 2008 would also have been useful. They suggest that before 2008, the perinatal mortality rate was low, patient satisfaction was high and recent level 2 accreditation of maternity services by the Clinical Negligence Scheme for Trusts all suggested standards of care within the obstetric department were adequate. This stream of positive signals is likely to have contributed towards a genuine belief of safe operation within the maternity unit by staff and board members. However, as they acknowledge, the first problem can be seen in 2004. According to the MBI,2 there were SUIs in the years before and after 2008, but this …. (shrink)