Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by (...) those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups. (shrink)

Human clinical research has become a huge economic enterprise (Morin et al. 2002; Noah 2002). Because the human subject at the center can be so easily marginalized, many commentators recommend spec...

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

I argue that, in experiencing a recalcitrant emotion, one does not violate a rational requirement of any sort. Rational requirements, as the expression has come to be used, are requirements of coherence. Accordingly, my argument is that there is nothing incoherent in any way about experiencing a recalcitrant emotion. One becomes incoherent only if one allows the emotion to influence one's reasoning and/or action, in which case one violates the ‘consistency principle’ and/or the ‘enkratic principle’. From the standpoint of rationality, (...) it would even be counterproductive to put subjects under the obligation that their emotional experiences and their evaluative judgements must always fit together. When we nevertheless intuitively sense that the subject is irrational in experiencing a recalcitrant emotion this is in cases in which the emotion challenges the subject's agential identity. However, emotions can, but need not, challenge one's agential identity, and, furthermore, perceptions can do so as well. In any case, challenges of this kind do not involve the violation of a rational requirement. (shrink)

In the present article, we introduce a multi-type display calculus for dynamic epistemic logic, which we refer to as Dynamic Calculus. The display approach is suitable to modularly chart the space of dynamic epistemic logics on weaker-than-classical propositional base. The presence of types endows the language of the Dynamic Calculus with additional expressivity, allows for a smooth proof-theoretic treatment, and paves the way towards a general methodology for the design of proof systems for the generality of dynamic logics, and certainly (...) beyond dynamic epistemic logic. We prove that the Dynamic Calculus adequately captures Baltag–Moss–Solecki's dynamic epistemic logic, and enjoys Belnap-style cut elimination. (shrink)

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

Experiences of contact with nature in school education might be beneficial for promoting ecological lifestyles and the wellbeing of children, families, and teachers. Many theories and empirical evidence on restorative environments, as well as on the foundations of classical pedagogical approaches, recognize the value of the direct experience with natural elements, and the related psychological and educational outcomes. In this work we present two studies focusing on the contact with nature in outdoor education interventions with primary and secondary school students (...) in Italy. A questionnaire measuring connectedness to nature, psycho-physical wellbeing, pro-environmental attitudes, students’ life satisfaction, pro-social behavior, empathy and anxiety was completed before and after the education program by the participants to the intervention group and by students of a control group. The students in the intervention groups participated in environmental education programs consisting in guided activities in contact with the nature during four visits in one of two natural protected areas. The students in the control groups attended the same schools as the intervention group but they were not involved in the environmental education program. The students in both the groups completed the questionnaire in the same weeks of the year. Findings show that taking part to the outdoor education program has positive outcomes on psycho-physical wellbeing, on connectedness to nature and on pro-social behavior of students in the intervention group, compared to the control group. The implications related to the effectiveness of outdoor education interventions and future directions of research and practice in environmental psychology and education are discussed. (shrink)

This book opens up a new route to the study of knowledge dynamics and the sociology of knowledge. The focus is on the role of metaphors as powerful catalysts and the book dissects their role in the construction of theories of knowledge and will therefore be of vital interest to social and cognitive scientists alike.

'A comprehensive and important collection that includes essays by some of the leading figures in the field....Essential reading for anyone interested in risk assessment.' Professor Kristin Shrader-Frechette, University of Notre Dame 'The editors are to be congratulated for bringing together a distinguished international group of theorists to reflect on the issues. This volume will be sure to raise the level of debate while at the same time showing the importance of philosophical reflection in approaches to the problems of the age.' (...) Professor Jonathan Wolff, University College London This volume brings together top authors from the fields of risk, philosophy, social sciences and psychology to address the issue of how we should decide how far technological risks are morally acceptable or not. The underlying principles are examined, along with methodological challenges, public involvement and instruments for democratization. A strong theoretical basis is complemented by a range of case studies from some of the most contentious areas, including medical ethics and GM crops. This book is a vital new resource for researchers, students and anyone concerned that traditional approaches to risk management don't adequately address ethical considerations. (shrink)

“Acceptable Risk” – On the Rationality of Emotional Evaluations of Risk What is “acceptable risk”? That question is appropriate in a number of different contexts, political, social, ethical, and scienti c. Thus the question might be whether the voting public will support a risky proposal or project, whether people will buy or accept a risky product, whether it is morally permissible to pursue this or that potentially harmful venture, or whether it is wise or prudent to test or try out (...) some possibly dangerous hypothesis or product. But complicating all of these queries, the “sand in the machinery” of rational decision-making, are the emotions. It is often noted that voters are swayed by their passions at least as much as they are convinced by rational arguments. And it is obvious to advertisers and retailers that people are seduced by all sorts of appeals to their vanities, their fears, their extravagant hopes, their insecurities. At least one major thread of ethical discourse, the one following Kant, minimizes the importance of the emotions in favor of an emphatically rational decision-making process, and it is worth mulling over the fact that many of those who do not accept Kant’s ethical views more or less applaud his rejection of the “moral sentiment theory” of the time, promoted by such luminary philosophers as David Hume and Adam Smith. (shrink)

Können unsere Gefühle uns Gründe dafür liefern, etwas für wahr zu halten und zu tun? Verfügen wir über bestimmte Werte und moralische Überzeugungen vielleicht sogar nur kraft unserer Gefühle? Entgegen der philosophischen Tradition, in der die Gefühle überwiegend als irrational und subjektiv abgetan wurden, zielt der vorliegende Sammelband auf den Nachweis, dass die Gefühle einen integralen und unverzichtbaren Bestandteil rationalen Urteilens und Handelns bilden. Neben der Darstellung verschiedener Facetten moderner kognitivistischer Gefühlsphilosophie kommt dabei auch die Psychologie zu Wort.

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)

This study investigates the child‐directed speech (CDS) of four Russian‐, six German, and six English‐speaking mothers to their 2‐year‐old children. Typologically Russian has considerably less restricted word order than either German or English, with German showing more word‐order variants than English. This could lead to the prediction that the lexical restrictiveness previously found in the initial strings of English CDS by Cameron‐Faulkner, Lieven, and Tomasello (2003) would not be found in Russian or German CDS. However, despite differences between the three (...) corpora that clearly derive from typological differences between the languages, the most significant finding of this study is a high degree of lexical restrictiveness at the beginnings of CDS utterances in all three languages. (shrink)

In this article, we explore the role that art can play in ethical reflection on risky and controversial technologies. New technologies often give rise to societal controversies about their potential risks and benefits. Over the last decades, social scientists, psychologists, and philosophers have criticized quantitative approaches to risk on the grounds that they oversimplify its societal and ethical implications. There is broad consensus amongst these scholars that stakeholders and their values and concerns should be included in decision-making about technological risks. (...) It has also been argued that the emotional responses of people can shed important light on the ethical aspects of risk and uncertainty. However, people’s emotions can be narrowly focused and biased. This article therefore assesses the role that technology-inspired artworks can play in overcoming such biases, by challenging our imagination and providing us with different perspectives on possible technological developments and their implications for society. Philosophers have not yet studied such artworks, so this constitutes an entirely new field of research for scholars of risk and moral theory. In particular, we focus on the case of BNCI technologies and related artworks. These technologies and artworks touch on questions of what it means to be human, thereby raising profound ethical and philosophical challenges. We discuss the experiences of artists, scientists, and engineers who are directly involved with BNCI technologies, and who were interviewed during a Hackathon at Amsterdam’s Waag Society in June 2016. Their views are analyzed in light of philosophical and aesthetic theories, which allows us to consider relevant ethical and conceptual issues as well as topics for further investigation. (shrink)

The name of Thomas Reid rarely appears in discussions of the history of moral thought. This is a pity, since Reid has a lot of interesting ideas that can contribute to the current discussions in meta-ethics. Reid can be understood as an ethical intuitionist. What makes his account especially interesting is the role affective states play in his intuitionist theory. Reid defends a cognitive theory of moral emotions. According to Reid, there are moral feelings that are the result of a (...) moral judgment made by reason. The judgment and the feeling together constitute what Reid calls sentiments. Reid thinks that affective states (feelings and sentiments) play the role of helping reason to guide and control the egoistic feelings and passions. The affective states are particularly important, in Reid's view, because the motivating force of reason is often defeated by the stronger motivating force of the passions. So without affective states, we would often not be able to do what is morally good or right. In this paper, I will argue that the role of the affective states is still too limited in Reid's approach. He takes affective states to have a merely motivational function, namely, to help reason to control the passions and motivate to action where reason is too weak. Reid thinks that in making moral judgments we do not need to have feelings, feelings are at most a result of a judgment. Instead, I will argue that affective states also play an epistemological role. (shrink)

This paper addresses the question of whether the appearance ofthen in a conditional construction has any effect on the meaning of the sentence as a whole. It will be suggested thatthen does make a contribution by way of a particular presupposition associated with it. This also results inthen sometimes conflicting with the intended meaning of the sentence; in such cases its appearance is precluded. Certain aspects of the syntax ofthen will be discussed in parallel.

This paper discusses the issue of legitimacy and, in particular the processes of building, losing, and repairing environmental legitimacy in the context of the Deepwater Horizon case. Following the Deepwater Horizon catastrophe in 2010, BP plc. was accused of having set new records in the degree of divergence between its actual operations and what it had been communicating with regard to corporate responsibility. Its legitimacy crisis is here to be appraised as a case study in the discrepancy between symbolic and (...) substantive strategies in corporate greening and its communication. A narrative analysis of BP’s “beyond petroleum”-rebranding and the “making this right”-campaign issued in response to the Gulf of Mexico disaster discusses their respective implications for corporate change. Further, the question is addressed why BP’s green image endeavors were so widely accepted at first, only to find themselves dismissed as corporate greenwashing now. The study concludes that where a corporation’s “green narrative” consistently evokes established narratives, its legitimacy will be judged against narrative, rather than empirical truth. Thus, the narrative will be more willingly accepted as speaking for the issuing company’s legitimacy, irrespective of whether it reflects substantive greening or not. (shrink)

Unter Body Integrity Identity Disorder (BIID) versteht man das sehr seltene Phänomen, dass jemand die Amputation einer oder mehrerer gesunder Gliedmaßen oder die Beibringung einer Querschnittslähmung verlangt. Manche dieser Menschen verstümmeln sich selbst; andere fordern von Chirurgen eine Amputation oder die Durchtrennung des Rückenmarks. Von Psychologen und Psychiatern gibt es unterschiedliche Erklärungsansätze für dieses Phänomen; bisher ist aber keine erfolgreiche psychotherapeutische oder pharmazeutische Therapie bekannt. Betroffenenvertreter erklären den Amputationswunsch in Analogie zu dem Verlangen von Transsexuellen nach chirurgischer Angleichung an ihr (...) Wunschgeschlecht. Unter Medizinethikern ist die Amputation gesunder Gliedmaßen höchst umstritten; einerseits wird aus dem Autonomie-Prinzip das Recht auf Körpermodifikation abgeleitet, andererseits wird angenommen, dass der Amputationswunsch aus innerem Zwang oder Wahn resultiert. Neurologische Befunde legen nahe, dass BIID wahrscheinlich eine hirnorganisch bedingte Störung des Körperbildes ist, vergleichbar mit bestimmten Schlaganfallfolgen. Wenn BIID eine neuropsychologische Störung ist, zu deren Symptomen fehlende Krankheitseinsicht und eine durch inneren Zwang eingeschränkte Fähigkeit zu vernünftigen Entscheidungen gehören, sind die von BIID-Aktivisten und einigen Medizinethikern geforderten Amputationen kontraindiziert und stellen Körperverletzungen an Menschen mit einer neuropsychologischen Störung dar. Statt des Kurierens an einem Symptom sollte eine kausale Therapie entwickelt werden, mit dem Ziel der Integration des als fremd empfundenen Körperteils in das Körperbild. (shrink)

Since industrial trade fair Hannover Messe 2011, the term “Industrie 4.0” has ignited a vision of a new Industrial Revolution and has been inspiring a lively, ongoing debate among the German public about the future of work, and hence society, ever since. The discourse around this vision of the future eventually spread to other countries, with public awareness reaching a temporary peak in 2016 when the World Economic Forum’s meeting in Davos was held with the motto “Mastering the Fourth Industrial (...) Revolution.” How is it possible for a vision originally established by three German engineers to unfold and bear fruit at a global level in such a short period of time? This article begins with a summary of the key ideas that are discussed under the label Industrie 4.0. The main purpose, based on an in-depth discourse analysis, is to debunk the myth about the origin of this powerful vision and to trace the narrative back to the global economic crisis in 2009 and thus to the real actors, central discourse patterns, and hidden intentions of this vision of a new Industrial Revolution. In conclusion, the discourse analysis reveals that this is not a case of visioneering but one of a future told, tamed, and traded. (shrink)

Almost all contemporary philosophers on the subject agree that emotions play an indispensable role in the justification (as opposed to the mere causation) of other mental states and actions. However, how this role is to be understood is still an open question. At the core of the debate is the phenomenon of conflict without contradiction: why is it that an emotion need not be revised in the light of better judgment and knowledge? Conflict without contradiction has been explained either by (...) difference in content between emotion and judgment, or by a difference in the respective attitude towards content. I argue that conflict without contradiction is due to both differences, where difference in content is prior to difference in attitude. (shrink)

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs (...) a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.Sabine MNeuroScienceAndNorms: Ethical and Legal Aspects of Norms in Neuroimaging at Bonn University Hospital, Germany. Her main research interests are in neuroethics. She is coauthor of three German books about neuroethics and bioethics.Henrik Walter, M.D., Ph.D., is Full Professor of Medical Psychology at the University of Bonn, Germany, and vice-director of the Department of Psychiatry and Psychotherapy at the University Clinic of Bonn. He is author of Neurophilosophy of Free Will and editor of the book From Neuroethics to Neurolaw?. His research fields are biological psychiatry, cognitive neuroscience, neuroimaging, neurophilosophy, and neuroethics. (shrink)

We critically analyze the rationale of arguments from finetuning and naturalness in particle physics and cosmology, notably the small values of the mass of the Higgs-boson and the cosmological constant. We identify several new reasons why these arguments are not scientifically relevant. Besides laying out why the necessity to define a probability distribution renders arguments from naturalness internally contradictory, it is also explained why it is conceptually questionable to single out assumptions about dimensionless parameters from among a host of other (...) assumptions. Some other numerological coincidences and their problems are also discussed. (shrink)

Not all countries do their fair share in the effort of preventing dangerous climate change. This presents those who are willing to do their part with the question whether they should 'take up the slack' and try to compensate for the non-compliers' failure to reduce emissions. There is a pro tanto reason for doing so given the human rights violations associated with dangerous climate change. The article focuses on fending off two objections against a duty to take up the slack: (...) that it is unfair and ineffective. We grant that it is unfair if some have to step in for others but argue that this does not amount to a decisive objection under conditions of partial compliance. With regard to the charge of emission reductions being ineffective, we argue that the empirical case for this claim is missing and that even if it were not, there still remains the option of taking up the slack in other forms. (shrink)

Due to increasing consumer skepticism towards promotional messages, companies are looking for new ways to communicate with their target audiences in a less obtrusive way than traditional advertising. Sponsored content disseminated on the online portals of newspapers (i. e., online advertorials) is regarded as a promising way to promote products and brands. Regulations require communicators to inform consumers about the commercial nature of this ‘masked’ persuasion attempt by including an explicit sponsorship disclosure (i. e., a ‘Sponsored’ label). This study demonstrates (...) that such an explicit advertising cue may not be enough to alert recipients. Furthermore, this study investigates the effects of promotional messages by means of a 2 (no disclosure vs. disclosure) x 2 (no forewarning vs. forewarning) experiment. Results show that both (i) foregoing instructions aimed at activating consumers’ persuasion knowledge (i. e., an additional forewarning message) and (ii) recipients’ prior media literacy can foster the effect of sponsorship disclosures in triggering situational distrust towards brand-related content, and in turn, increasing consumers’ reactance. (shrink)

La notion de temps occupe une place determinante dans l'oeuvre de Lucrece, alors que cet aspect a ete jusqu'alors peu explore. L'ambition de cet ouvrage est de demontrer que le temps unifie dans une vision complexe et ambivalente la physique, l'histoire, la morale et la poetique lucretiennes. Le present livre est fonde sur une etude de la fonction du temps au sein de ces differents domaines et montre comment la duree infinie qui caracterise les mouvements atomiques chez Epicure se traduit (...) pour son disciple latin par la permanence et l'invariance. Cette synthese d'ordre philosophique est soutenue par le genie poetique de Lucrece, qui parvient a reveler l'equilibre eternel, dissimule derriere le regne apparent du hasard et du desordre. L'auteur invite ainsi le lecteur de Lucrece a un parcours a la fois philosophique et poetique a travers le De rerum natura afin de decouvrir le lieu d'ou l'on contemple la permanence immobile du mouvement et l'eternite du temps. L'image de l'eclair immobile dans la plaine s'offre des lors comme un symbole fulgurant de la conception lucretienne du temps, qui concilie mouvement et repos dans la poesie. Sabine Luciani, nee en 1967, est maitre de conferences en langue et litterature latines a l'universite Paul Valery - Montpellier III. Elle est specialiste de philosophie epicurienne, a publie plusieurs articles concernant Lucrece et, plus generalement, l'influence de la philosophie hellenistique sur l'oeuvre des poetes latins. Elle poursuit actuellement des recherches sur les sources de Lucrece. (shrink)

Evidence-based medicine and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors’ freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians’ discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for (...) individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term “professionalism”. It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between professional autonomy and clinical practice guidelines, individualised care and standardisation, and esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa. (shrink)

ZusammenfassungIn der Neonatologie—wie auch in anderen Bereichen der Intensivmedizin—müssen Ärzte und Pflegende häufig die ethisch schwierige Entscheidung treffen, ob die Therapie eines schwer kranken Patienten intensiviert oder eingeschränkt werden soll. In der Literatur existieren verschiedene Instrumente zur Entscheidungsfindung, die, angewandt im Rahmen ethischer Konsile, die Nachvollziehbarkeit einer ausgesprochenen Empfehlung gewährleisten sollen. Zwei dieser verfügbaren Modelle („Schema zur ethischen Urteilsbildung nach dem Muster der aristotelischen Ethik“, Honnefelder 1994 und die „Nimwegener Methode für ethische Fallbesprechung“, Gordijn 1998) wurden anhand klinischer Fälle auf (...) ihre Anwendbarkeit in der Neonatologie hin untersucht. Unsere Studie zeigt, dass die Verwendung eines Entscheidungshilfeinstruments zwar grundsätzlich sinnvoll ist, deckt aber gleichzeitig den Konkretisierungsbedarf der oben genannten Modelle beim Einsatz in der Neonatologie auf. Der daraufhin entwickelte „Kölner Arbeitsbogen zur ethischen Entscheidungsfindung in der Neonatologie“ stellt ein auf die speziellen Bedürfnisse der Neonatologie ausgerichtetes Schema dar und könnte damit eine Lücke für den rasant expandierenden Bereich der Früh- und Neugeborenenmedizin schließen. (shrink)