Within the ethical debate on Machine Learning-driven decision support systems (ML_CDSS), notions such as “human in the loop” or “meaningful human control” are often cited as being necessary for ethical legitimacy. In addition, ethical principles usually serve as the major point of reference in ethical guidance documents, stating that conflicts between principles need to be weighed and balanced against each other. Starting from a neo-Kantian viewpoint inspired by Onora O'Neill, this article makes a concrete suggestion of how to interpret the (...) role of the “human in the loop” and to overcome the perspective of rivaling ethical principles in the evaluation of AI in health care. We argue that patients should be perceived as “fellow workers” and epistemic partners in the interpretation of ML_CDSS outputs. We further highlight that a meaningful process of integrating (rather than weighing and balancing) ethical principles is most appropriate in the evaluation of medical AI. (shrink)

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)

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)

Platons Uberlegungen zur Okonomie verdienen mehr Aufmerksamkeit. Dies zeigt die systematische Untersuchung seiner zentralen Texte. Sie erhellt die allgemeinen Grundlagen von Platons Okonomie sowie die Ansatze seiner Regulierungsvorschlage und zeigt die Verbindung zu modernen wirtschaftstheoretischen Reflexionen uber den homo oeconomicus und die Bedeutung kultureller Faktoren fur das wirtschaftliche Handeln des Individuums. ".

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 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.

BackgroundHealthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use.MethodsPubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract (...) screened according to defined inclusion and exclusion criteria, resulting in 44 papers whose full texts were analysed using the Kuckartz method of qualitative text analysis.ResultsArtificial Intelligence might increase patient autonomy by improving the accuracy of predictions and allowing patients to receive their preferred treatment. It is thought to increase beneficence by providing reliable information, thereby, supporting surrogate decision-making. Some authors fear that reducing ethical decision-making to statistical correlations may limit autonomy. Others argue that AI may not be able to replicate the process of ethical deliberation because it lacks human characteristics. Concerns have been raised about issues of justice, as AI may replicate existing biases in the decision-making process.ConclusionsThe prospective benefits of using AI in clinical ethical decision-making are manifold, but its development and use should be undertaken carefully to avoid ethical pitfalls. Several issues that are central to the discussion of Clinical Decision Support Systems, such as justice, explicability or human–machine interaction, have been neglected in the debate on AI for clinical ethics so far.Trial registrationThis review is registered at Open Science Framework (https://osf.io/wvcs9). (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)

‘Scientific advice to politics’, the ‘nature of expertise’, and the ‘relation between experts, policy makers, and the public’ are variations of a topic that currently attracts the attention of social scientists, philosophers of science as well as practitioners in the public sphere and the media. This renewed interest in a persistent theme is initiated by the call for a democratization of expertise that has become the order of the day in the legitimation of research funding. The new significance of ‘participation’ (...) and ‘accountability’ has motivated scholars to take a new look at the science – politics interface and to probe questions such as "What is new in the arrangement of scientific expertise and political decision-making?", "How can reliable knowledge be made useful for politics and society at large, and how can epistemically and ethically sound decisions be achieved without losing democratic legitimacy?", "How can the objective of democratization of expertise be achieved without compromising the quality and reliability of knowledge?" Scientific knowledge and the ‘experts’ that represent it no longer command the unquestioned authority and public trust that was once bestowed upon them, and yet, policy makers are more dependent on them than ever before. This collection of essays explores the relations between science and politics with the instruments of the social studies of science, thereby providing new insights into their re-alignment under a new régime of governance. (shrink)

In previous research, cultural proximity has been operationalized by ‘hard facts’ such as geographical distance, the exchange of goods or persons and the similarity of political systems. This article will try to complement current work in the field by suggesting a new operationalization derived from Hofstede's cultural dimensions. A survey was conducted in eight countries with a student sample to find out if international audiences which resemble each other in terms of Hofstede's cultural dimensions have similar attitudes towards U.S. prime-time (...) fictional programming. The results show that Hofstede's four cultural dimensions significantly differentiate between the U.S.A., Asian and European countries in a student population. However, operationalizations based on geographical distance allow a better differentiation between nation-states in terms of how they evaluate U.S. fiction. It will be discussed whether cultural dimensions in general are able to measure cultural proximity. (shrink)

The so‐called “empirical turn” in bioethics gave rise to extensive theoretical and methodological debates and has significantly shaped the research landscape from two decades ago until the present day. Attentive observers of the evolution of the bioethical research field now notice a new trend towards the inclusion of data science methods for the treatment of ethical research questions. This new research domain of “digital bioethics” encompasses both studies replacing (or complementing) socio‐empirical research on bioethical topics (“empirical digital bioethics”) and argumentative (...) approaches towards normative questions in the healthcare domain (“argumentative digital bioethics”). This article draws on insights taken from the debate on the “empirical turn” for sounding out perspectives for the newly developing field of “digital bioethics.” We particularly discuss the disciplinary boundaries, chances and challenges, and potentially undesirable developments of the research field. The article closes with concrete suggestions on which debates need to be initiated and which measures need to be taken so that the path forward of “digital bioethics” will be a scientific success. (shrink)

L’historienne, l’une des fondatrices de la revue d’histoire des femmes Memoria, a publié des essais sur la Révolution française, l’histoire sociale de l’État pontifical et l’histoire du travail. Sa dernière recherche nous conduit à nouveau dans l’Etat pontifical pour observer une institution qui va jouer un grand rôle dans le destin de centaines de femmes, les « Conservatoires de la vertu », nés au XVIe siècle pour accueillir les petites filles orphelines ou abandonnées afin de protéger leur...

Wenn es um „den Kapitalismus“ geht, regieren schnell die Gefühle. Die Philosophen Sabine Döring und Lars Neth appellieren an die Vernunft. -/- Interview: Wolf Lotter.

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)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

'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)

BackgroundThe methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts.DiscussionA considered reference to normative research questions can be expected from good quality empirical research in medical ethics. (...) However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics.SummaryHigh quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. (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)

Wie arbeitet Aristoteles als wissenschaftlicher Autor? Wie nutzt er das Schreiben für seine Argumentation und ihre Darstellung? Dieser Frage geht die vorliegende Monografie für die Schrift De generatione animalium systematisch nach. In ihr entwickelt Aristoteles eine komplexe Theorie, mit der er Fortpflanzungs- und Vererbungsphänomene in der gesamten Tierwelt einschließlich des Menschen erklären möchte. Aristoteles‘ Argumentation ist dicht und wechselt zwischen Beweisführung, Diskursivität und Darstellung. Eine im Rahmen einer Makroplanung insgesamt prozessuale Vorgehensweise schließt die rhetorische Gestaltung einzelner Passagen nicht aus. Insgesamt (...) kann gezeigt werden, wie Aristoteles das Schreiben nutzt, um auf innovative Weise die eigene Theorie zu entwickeln (‚epistemisches Schreiben‘) und gleichzeitig den Weg seiner Forschung zu vermitteln. Mit der detaillierten Analyse der Bücher I-IV, der systematischen Auswertung der Ergebnisse und einem Katalog signifikanter Formulierungen bietet das Buch einen Ausgangspunkt und ein Instrumentarium für die weitere detaillierte Erforschung Aristotelischer Schriften und gleichzeitig einen Beitrag zur Geschichte der Wissenschaftsliteratur. (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 past, Schiller has often been underestimated as a philosopher in his own right. Fortunately, this has been changing, beginning with the bicentennial commemoration of his death in 2005, which has since then produced a fair number of volumes, mostly in French, German, Italian, and Spanish. Unfortunately, Frederick Beiser's 2005 Schiller the Philosopher: A Re-Examination, one of the still rare book-length treatments by a single author, has failed to lead to a similar "new wave" in the English-speaking world. Thus, (...) it is heartening to have here a volume of essays focusing on his philosophical writings and bringing together titans of the fields of philosophical Schiller-studies, German early romantic... (shrink)

Previous correlational studies have shown that both psychological detachment from work and positively thinking about work during non-work time are associated with favorable affective states. In our research we integrate these contradictory findings and add more rigor to detachment research by using an experimental design. In two experimental studies conducted in the laboratory, we manipulated two different kinds of detachment from work (thinking about a hobby; explicit detachment instruction) and three different kinds of thinking about work (thinking negatively, thinking positively, (...) thinking in an unspecific way) by short written instructions. Results show that both detachment strategies lead to a reduction in negative affect (in both studies) and to an increase in positive affect (in one study). The effect of detachment was particularly strong when it was contrasted with thinking negatively about work and when end-of-workday negative affect was high. In some of the comparisons, the affective benefits of positively thinking about work were stronger than those of psychological detachment from work. Taken together, our studies demonstrate that detachment from work as well as positive thinking improves subsequent affect, highlighting the causality underlying the association between psychological detachment from work – as a core recovery experience – and subsequent affective states. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)