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prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all.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)

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)

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. ".

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)

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)

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)

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)

Im Mittelpunkt des Buchs steht die Frage, wie heute menschliches Leben im Medium des Unternehmens als geschöpfliches Leben erscheinen kann. Hierfür dienen neben biblischen Zeugnissen, Texten Martin Luthers und Arthur Richs sowie kirchlichen Schriften auch die ökonomischen Ethik-Theorien von Karl Homann, Peter Ulrich und Josef Wieland als Bezugspunkte. Außerdem werden exemplarisch die unternehmensethischen Profile dreier Firmen betrachtet. Die daraus gewonnenen Impulse für eine explorative Ethik geschöpflichen Lebens sind letztlich immer in der Unternehmenspraxis zu erproben, müssen sie sich doch im Unternehmensalltag (...) als tragfähig erweisen. (shrink)

Kritische Theorie und Kritik der Philosophie -- Die Idee der Freiheit in der bürgerlichen Gesellschaft -- Die Dialektik der Freiheit und die Kritik des Kapitals.

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)

‘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)

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...

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)

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)

'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)

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity (...) have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.We recommend a pragmatic approach: empirical research on personality changes arising from brain disorders or interventions, comprehensive information about risks of personality changes, and advance directives, particularly Ulysses contracts. (shrink)

A contrarian scientist wrestles with the big questions that modern physics raises, and what physics says about the human condition Not only can we not currently explain the origin of the universe, it is questionable we will ever be able to explain it. The notion that there are universes within particles, or that particles are conscious, is ascientific, as is the hypothesis that our universe is a computer simulation. On the other hand, the idea that the universe itself is conscious (...) is difficult to rule out entirely. According to Sabine Hossenfelder, it is not a coincidence that quantum entanglement and vacuum energy have become the go-to explanations of alternative healers, or that people believe their deceased grandmother is still alive because of quantum mechanics. Science and religion have the same roots, and they still tackle some of the same questions: Where do we come from? Where do we go to? How much can we know? The area of science that is closest to answering these questions is physics. Over the last century, physicists have learned a lot about which spiritual ideas are still compatible with the laws of nature. Not always, though, have they stayed on the scientific side of the debate. In this lively, thought-provoking book, Hossenfelder takes on the biggest questions in physics: Does the past still exist? Do particles think? Was the universe made for us? Has physics ruled out free will? Will we ever have a theory of everything? She lays out how far physicists are on the way to answering these questions, where the current limits are, and what questions might well remain unanswerable forever. Her book offers a no-nonsense yet entertaining take on some of the toughest riddles in existence, and will give the reader a solid grasp on what we know-and what we don't know. (shrink)

This essay provides a systematic as well as chronological account of Schiller's concepts of freedom and autonomy. Its main thesis is that the duality of Schiller's moral/aesthetic ideal in the Letters on the Aesthetic Education of Man - of beauty and the sublime, of play and the moral law - is a result of his use of conflicting concepts of autonomy. While it is widely accepted that Schiller took over Kant's concept of autonomy, I argue that he simultaneously employed another (...) concept of autonomy, that of the contemporary philosopher Karl Leonhard Reinhold, whose criticism of Kant's concept of free will and alternative formulation of the concept of a neutral will influenced Schiller. (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)

In many educational systems, ethnic minority students score lower in their academic achievement, and consequently, teachers develop low expectations regarding this student group. Relatedly, teachers’ implicit attitudes, explicit expectations, and causal attributions also differ between ethnic minority and ethnic majority students—all in a disadvantageous way for ethnic minority students. However, what is not known so far, is how attitudes and causal attributions contribute together to teachers’ judgments. In the current study, we explored how implicit attitudes and causal attributions contribute to (...) preservice teachers’ judgments of the low educational success of an ethnic minority student. Results showed that both implicit attitudes and causal attributions predicted language proficiency and intelligence judgments. Negative implicit attitudes, assessed with the IRAP, and internal stable causal attributions led to lower judgments of language proficiency, whereas lower judgments of intelligence were predicted by positive implicit attitudes and higher judgments of intelligence by external stable attributions. Substantial differences in the prediction of judgments could be found between the IRAP and BIAT as measures of implicit attitudes. (shrink)

Référence de la pensée critique contemporaine et de la lutte contre les discriminations sexuelles et « culturelles », Judith Butler passe pour une grande philosophe. En prise sur notre actualité, ce livre, dont le titre fait allusion à l'autorité usurpée des Jésuites moqués par Pascal dans Les Provinciales, questionne cette évidence, par une critique sévère et argumentée de la « pensée Butler ».

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)

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)