The ability to learn sequential contingencies of actions for predicting future outcomes is indispensable for flexible behavior in many daily decision-making contexts. It remains open whether such ability may be enhanced by transcranial direct current stimulation. The present study combined tDCS with functional near-infrared spectroscopy to investigate potential tDCS-induced effects on sequential decision-making and the neural mechanisms underlying such modulations. Offline tDCS and sham stimulation were applied over the left and right dorsolateral prefrontal cortex in young male adults in a (...) double-blind between-subject design using a three-state Markov decision task. The results showed an enhanced dlPFC hemodynamic response during the acquisition of sequential state transitions that is consistent with the findings from a previous functional magnetic resonance imaging study; a tDCS-induced increase of the hemodynamic response in the dlPFC, but without accompanying performance-enhancing effects at the behavioral level; and a greater tDCS-induced upregulation of hemodynamic responses in the delayed reward condition that seems to be associated with faster decision speed. Taken together, these findings provide empirical evidence for fNIRS as a suitable method for investigating hemodynamic correlates of sequential decision-making as well as functional brain correlates underlying tDCS-induced modulation. Future research with larger sample sizes for carrying out subgroup analysis is necessary in order to decipher interindividual differences in tDCS-induced effects on sequential decision-making process at the behavioral and brain levels. (shrink)

Climate change and decarbonization raise complex justice questions that researchers and policymakers must address. The distributions of greenhouse gas emissions rights and mitigation efforts have dominated justice discourses within scenario research, an integrative element of the IPCC. However, the space of justice considerations is much larger. At present, there is no consistent approach to comprehensively incorporate and examine justice considerations. Here we propose a conceptual framework grounded in philosophical theory for this purpose. We apply this framework to climate mitigation scenarios (...) literature as proof of concept, enabling a more holistic and multidimensional investigation of justice. We identify areas of future research, including new metrics of service provisioning essential for human well-being. [Can be freely read by clicking the ReadCube link below.]. (shrink)

Background: In modern healthcare, the role of solidarity, altruism and the natural response to moral challenges in life-threatening situations is still rather unexplored. The COVID-19 pandemic provided an opportunity to obtain a deeper understanding of nurses’ willingness to care for patients during crisis. Objective: To elucidate clinical expressions of ontological situational ethics through nurses’ willingness to work during a pandemic. Research design, participants and context: A qualitative study with an interpretive design was applied. Twenty nurses who worked in intensive care (...) unit at two Swedish hospitals during the first, second, and third waves of the COVID-19 pandemic were interviewed. The analysis was interpretative and applied a theoretical ethics perspective. Ethical considerations: The study was approved by the Swedish Ethical Review Authority and informed consent was obtained from all participants. Findings: From a philosophical perspective, the nurses expressed sovereign life expressions of mercy and compassion, which arose spontaneously in response to seeing vulnerable fellow humans. They referenced ‘‘the nurse inside me’’ and their choice of profession as motives to provide care. Ontological situational ethics in culture and norms were noted in the constructs of competence, responsibility, solidarity with colleagues and organization; and interest and learning were driving forces. Ethical demand was evident when nurses expressed ideas of meaningfulness in helping their fellow humans; but themes of ambiguity, exhaustion and unwillingness were also present. Conclusions: The nurses showed a high willingness to care for patients during a crisis. Responding to the ethical demand and to care for vulnerable human beings while risking their own health and lives could be interpreted as an inter-human vocation. These spontaneous altruistic actions saved the lives of many patients during the pandemic and need to be understood and supported. (shrink)

The aim of this study was to investigate the consistency between the self-reports and teacher ratings of students’ emotional and social inclusion at school as well as for their academic self-concept. The German version of the Perceptions of Inclusion Questionnaire (PIQ) was administered to 329 grade 8 students (50.8% female, Mage = 14.5 years, SDage = 0.5 years) and their teachers. First, the three-dimensional structure of both PIQ versions was confirmed by confirmatory item factor analysis. The  and  coefficients (...) demonstrated good reliability for all scales. Second, a correlated trait-correlated method minus one model provided evidence that the method-specificity of teacher ratings was larger than the consistency between the self-reports and teacher ratings. Third, the results of a latent difference model indicated that general method effects can partly be explained by a student’s gender or special educational needs. Finally, the low consistency between self-reports and teacher rating is discussed. (shrink)

This Correspondence argues in response to Coolsaet et al. (2024) that there is an important role to play for stance-independent justice discussions that are not tied to specific social, political or critical perspectives. These can be valuable for climate research audiences, but also as a basis upon which to critically debate and research injustices.

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew (...) Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

Three‐dimensional structured illumination microscopy (3D‐SIM) has opened up new possibilities to study nuclear architecture at the ultrastructural level down to the ∼100 nm range. We present first results and assess the potential using 3D‐SIM in combination with 3D fluorescence in situ hybridization (3D‐FISH) for the topographical analysis of defined nuclear targets. Our study also deals with the concern that artifacts produced by FISH may counteract the gain in resolution. We address the topography of DAPI‐stained DNA in nuclei before and after (...) 3D‐FISH, nuclear pores and the lamina, chromosome territories, chromatin domains, and individual gene loci. We also look at the replication patterns of chromocenters and the topographical relationship ofXist‐RNA within the inactive X‐territory. These examples demonstrate that an appropriately adapted 3D‐FISH/3D‐SIM approach preserves key characteristics of the nuclear ultrastructure and that the gain in information obtained by 3D‐SIM yields new insights into the functional nuclear organization. (shrink)

Human–robot interactions are often affected by error situations that are caused by either the robot or the human. Therefore, robots would profit from the ability to recognize when error situations occur. We investigated the verbal and non-verbal social signals that humans show when error situations occur in human–robot interaction experiments. For that, we analyzed 201 videos of five human–robot interaction user studies with varying tasks from four independent projects. The analysis shows that there are two types of error situations: social (...) norm violations and technical failures. Social norm violations are situations in which the robot does not adhere to the underlying social script of the interaction. Technical failures are caused by technical shortcomings of the robot. The results of the video analysis show that the study participants use many head movements and very few gestures, but they often smile, when in an error situation with the robot. The results suggest that participants do not see the robot as a social interaction partner with comparable communication skills. Our findings have implications for builders and evaluators of human–robot interaction systems. The builders need to consider including modules for recognition and classification of head movements to the robot input channels. The evaluators need to make sure that the presence of an experimenter does not skew the results of their user studies. (shrink)

Emotions are a core factor of learning. Studies have shown that multiple emotions are co-experienced during learning and have a significant impact on learning outcomes. The present study investigated the importance of multiple, co-occurring emotions during learning about human biology with MetaTutor, a hypermedia-based intelligent tutoring system. Person-centered as well as variable-centered approaches of cluster analyses were used to identify emotion clusters. The person-centered clustering analyses indicated three emotion profiles: a positive, negative and neutral profile. Students with a negative profile (...) learned less than those with other profiles and also reported less usage of emotion regulation strategies. Emotion clusters identified through spectral co-clustering confirmed these results. Throughout the learning activity, emotions built a stable correlational structure of a positive, a negative, a neutral and a boredom emotion cluster. Positive emotion cluster scores before the learning activity and negative emotion cluster scores during the learning activity predicted learning, but not consistently. These results reveal the importance of negative emotions during learning with MetaTutor. Potential moderating factors and implications for the design and development of educational interventions that target emotions and emotion regulation with digital learning environments are discussed. (shrink)

This book presents a study of human intelligence beginning with a semantic theory and leading into a critique of music.

If few authors have paid much attention to the feminine concerns in new reproductive technologies, actually it is mainly some feminist authors, who, to a great extent, have allowed these concerns to enter into public debate. On the other hand, the preoccupation about women's interests and points of view is a feature in common of all feminist approaches, independently of their other philosophical concepts. Nevertheless, another feature of feminist discourses is their plurality and heterogeneity. So, we have not find back (...) answers to the questions we have analysed in this paper, because there is not only one answer. This is not an inconvenience but an incentive to continue the democratic debate within the framework of plurality and tolerance. We must incorporate to this debate the, often forgotten, women's own interests, and a critical view of the underlying assumptions and biases. These two points of view are common to the majority of feminist approaches, and should be seriously considered as worthy to be incorporated to our discourses when debating the issues linked to the new reproductive technologies. (shrink)

Die Verbindlichkeit von Patientenverfügungen (PV) wird kontrovers diskutiert. Dabei ist nicht bekannt, wie verbindlich PV von denen gewollt sind, die sie verfassen. Mit Hilfe eines anonymen Fragebogens wurden Verfasser von PV in bayerischen Palliativeinrichtungen und Beratungsstellen hierzu befragt. Von den 402 Befragten gaben 69,1% an, dass ihre PV auch für Bevollmächtigte und Betreuer strikt verbindlich sein soll. Demgegenüber räumten 23,9% ihrem Stellvertreter ein, von der PV abzuweichen. Die lebensbedrohlich Erkrankten unter den Befragten legten nicht weniger, sondern signifikant mehr Wert auf (...) hohe Verbindlichkeit. Für den Fall, dass die PV nicht anwendbar sein sollte, wünschen deren Verfasser eine Entscheidung durch ihren Vertreter. Abgelehnt wird die richterliche Entscheidung bei Dissens. (shrink)

The aim of the article is to introduce a new concept of “pain-related bodily doubt,” which complements current concepts currently in use, such as pain-related fear, pain catastrophizing, and pain self-efficacy. This new concept, adapted from recent philosophical work on illness experience, has the potential to positively contribute to pain research and clinical practice by providing a vocabulary for clinicians and patients to discuss implicit or tacit dimensions of pain-related experiences.

Number processing abilities are important for academic and personal development. The course of initial specialization of ventral occipito-temporal cortex sensitivity to visual number processing is crucial for the acquisition of numeric and arithmetic skills. We examined the visual N1, the electrophysiological correlate of vOTC activation across five time points in kindergarten, middle and end of first grade, second grade, and fifth grade. A combination of cross-sectional and longitudinal EEG data of a total of 62 children at varying familial risk for (...) dyslexia were available to form groups of 23, 22, 27, 27, and 42 participants for each of the five time points. The children performed a target detection task which included visual presentation of single digits, false fonts, and letters to derive measures for coarse and fine digit sensitive processing across development. The N1 amplitude analyses indicated coarse and fine sensitivity characterized by a stronger N1 to digits than false fonts across all five time points, and stronger N1 to digits than letters at all but the second time point. In addition, lower arithmetic skills were associated with stronger coarse N1 digit sensitivity over the left hemisphere in second grade, possibly reflecting allocation of more attentional resources or stronger reliance on the verbal system in children with poorer arithmetic skills. To summarize, our results show persistent visual N1 sensitivity to digits that is already present early on in pre-school and remains stable until fifth grade. This pattern of digit sensitivity development clearly differs from the relatively sharp rise and fall of the visual N1 sensitivity to words or letters between kindergarten and middle of elementary school and suggests unique developmental trajectories for visual processing of written characters that are relevant to numeracy and literacy. (shrink)

Providing high-quality education for students with emergent proficiency in the language of instruction (referred to here as multilingual students) presents a challenge to inclusion for educational systems the world over. In Austria, a new German language support model was implemented in the school year 2018/19 which provides language support in separate classrooms up to 20 h a week. Since its implementation, the model has been strongly criticized for excluding multilingual students from the mainstream classroom, which is argued to reinforce the (...) educational disadvantages that they face. The study presented here provides unprecedented qualitative insight into how schooling for students within the so-called German language support classes (GLSC) was organized during the COVID-19 pandemic. It builds on results of a previous large-scale quantitative study (n= 3,400 teachers), which was conducted during the first lockdown (spring 2020) and indicated a high risk of exclusion for marginalized students, especially for multilingual students in GLSC. To gain deeper insights into the situation of these students during school closures, 37 teachers who work in these classes at both primary and lower-secondary schools in Vienna were interviewed, of which 18 interviews were considered for analysis. The interviews focus on the situation during the first and second school closures in the city of Vienna. A thematic analysis of the interview data reveals teachers’ perceptions of aspects which harmed or promoted inclusion for students in GLSC during these periods of school closure. Teachers’ perceptions of the most harming factors for students included strong language barriers between teachers and students, restricted access to technical equipment and supportive learning spaces, and low parental engagement. A development that promoted inclusion of these students was the option to allow them to come to school during the second school closure. Since existing studies on the schooling of students during school closures have hardly addressed the situation of students in GLSC, this study contributes to closing this research gap. (shrink)

Digitalisierung ist nicht nur ein technisches Geschehen, sondern erfasst als machtvoller kultureller Prozess alle Lebensbereiche. Die Einsicht, dass soziotechnische Vorgänge gestaltbar sind, erlaubt eine grundsätzliche Reflexion über die neuen Handlungsmöglichkeiten und Zumutungen sowohl in individueller wie auch in kollektiver Perspektive. Welche Herausforderungen stellen sich für unsere bewährten Überzeugungen und sozialen Praktiken in den Prozessen von Verantwortung, Verständigung, Vernunft und Macht? Die Beiträger*innen analysieren aktuelle Entwicklungen der Digitalisierung und tragen im Lichte provisorischer Maßstäbe praktischer Vernunft zu einer aufgeklärten öffentlichen Diskussion über (...) (nicht) wünschenswerte technokulturelle Zukünfte bei. (shrink)

The notion of common morality plays a prominent role in some of the most influential theories of biomedical ethics. Here, I focus on Beauchamp and Childress’s models in the fourth and fifth edition of Principles of Biomedical Ethics as well as on a revision that Beauchamp proposed in a recent article. Although there are significant differences in these works that require separate analysis, all include a role for common morality as starting point and normative framework for theory construction in combination (...) with a coherence theory of moral justification. I defend to some extent the existence and empirical significance of common morality, as delineated by Beauchamp and Childress in different versions, but criticize its normative role. It is neither convincing as a moral foundation nor well compatible with a standard coherentist justification. I suggest that the authors should give up the foundational account for a more modest account of common morality as resource of well-established moral insights and experiences, which have proved generally valid but neither sufficient nor infallible. Beauchamp’s latest proposal appears as a step in this direction; indeed, it may be the beginning of the end of his common-morality theory. (shrink)

Social anxiety may disrupt the empathic process, and well-regulated empathy is critical for navigating the social world. Two studies aimed to further understand empathy in the context of social anxiety. Study 1 compared individuals with elevated or normative social anxiety on a measure assessing cognitive and affective empathy for positive and negative emotions conveyed by other people (“targets”), completed under social threat. Relative to individuals with normative social anxiety, individuals with elevated social anxiety had greater cognitive empathy and no differences (...) in affective empathy, regardless of emotion type. As greater cognitive empathy can be maladaptive, Study 2 tested whether this could be down-regulated. Individuals with elevated social anxiety underwent emotional working memory training (eWMT) for negative emotional information, or control training (CT). Effects on an empathy measure completed under social threat were assessed. Cognitive empathy for negative emotions decreased following eWMT but not CT, and this was only evident for those with higher pre-training working memory capacity. Cognitive empathy for positive emotions and affective empathy were not affected. Overall, social anxiety is associated with aberrant elevated cognitive empathy for negative and positive emotions, and the deviation in cognitive empathy for negative emotions can be regulated with eWMT for certain individuals.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618001196235.. (shrink)

Since assisted reproductive technologies (ART) are becoming increasingly important in wildlife conservation breeding programs, we need to discuss their implications to ensure their responsible use regarding the environment, the animals, and the people involved. In this article, we seek to contribute to the ongoing ethical and philosophical debate on ART in conservation by discussing the current attempt to save the northern white rhino (Ceratotherium simum cottoni, NWR) from extinction. Only two female NWRs are known to the world, both unable to (...) carry a pregnancy, and the last chance to avoid sure extinction relies on pushing the boundaries of contemporary science through the use of advanced ART and stem cell-associated techniques. The attempt to save the NWR constitutes a valuable testbed for assessing the use of ART in conservation and an occasion for identifying possible critical issues. It touches upon several ethically relevant points—that we identify and organize in an Ethical Matrix—such as the need to guarantee animal welfare, and it provides the opportunity to discuss some significant questions related to conservation. For instance, how far is it legitimate to go in trying to save a taxon? Is using sophisticated technologies to remedy anthropogenic harm a part of the problem rather than the solution? (shrink)

Specification is an integral part of Tom L Beauchamp and James F Childress' principlist approach to biomedical ethics. At the same time, the authors give much space conceding to critics that the method has significant limits. Although their pointing to limitations is not unreasonable as such, the emphasis Beauchamp and Childress put on them does not serve countering the critics' view that specification is insufficient for its intended purpose in applied ethics. This paper defends specification against Carson Strong's critique, showing (...) that his casuistic approach shares strong structural and functional similarities with specification. It concludes with the more general point that specification or some closely related method for determining morally relevant facts of concrete cases and issues is indispensable for any account of applied ethics. Beauchamp and Childress should endorse and defend specification more vigorously than they appear to do. (shrink)

This article examines transnational patterns and compares national specificities of new right reading practices and literary politics in Germany and the United States. It focuses on questions of canonization, politicization, and self-victimization and studies the performance of reading as ›metapolitical‹ cultural technique in online book clubs on both sides of the Atlantic.

Critical reasoning (CR) when confronted with contradictory information from multiple sources is a crucial ability in a knowledge-based society and digital world. Using information without critically reflecting on the content and its quality may lead to the acceptance of information based on unwarranted claims. Previous personal beliefs are assumed to play a decisive role when it comes to critically differentiating between assertions and claims and warranted knowledge and facts. The role of generic epistemic beliefs on critical stance and attitude in (...) reflectively dealing with information is well researched. Relatively few studies have been conducted on the influence of domain-specific beliefs, i.e. beliefs in relation to specific content encountered in a piece of information or task, on the reasoning process, and on how these beliefs may affect the information-processing and decision-making processes. This study focuses on students’ task- and topic-related beliefs that may influence their reasoning when dealing with multiple and partly contradictory sources of information. To validly assess CR among university students, we used a newly developed computer-based performance assessment in which the students were confronted with an authentic task which contains theoretically defined psychological stimuli for measuring CR. To investigate the particular role of task- and topic-related beliefs on CR, a purposeful sample of 30 university students took part in a performance assessment and then were interviewed immediately afterwards. In the semi-structured cognitive interviews, the participants’ task-related beliefs were assessed. Based on qualitative analyses of the interview transcripts, three distinct profiles of decision-making among students have been identified. More specifically, the different types of students’ beliefs and attitudes derived from the cognitive interview data suggest their influence on information processing, reasoning approaches and decision-making. The results indicated that the students’ beliefs had an influence on their selection, critical evaluation and use of information as well as on their reasoning processes and final decisions. (shrink)

We are in a time of rapid change on multiple levels. Change can be seen as positive by one group and negative by another. As a result, different perspectives on any given change can draw completely different conclusions. In these proceedings we want to address different approaches to change from all kinds of perspectives within the realm of citizen science and participatory research. We discuss both active, transformative change, and the observation of change monitored by citizen science in all kinds (...) of disciplines. We highlight the potential of citizen science to be a change maker in research and society, and as a tool to manage the change happening around us. The proceedings "Change - The transformative power of citizen science" showcase a selection of topics that have been presented and discussed at the ECSA/ACSC 2024 double conference in Vienna and highlight the transformative power, citizen science can have. (shrink)

Sounding Fragilities enacts a polyphony of writing on contemporary composition, music and performing arts in relation to music theatre. Co-edited by a theatre and performance scholar and by a composer and artistic researcher, this anthology considers its field of investigation through the lens of positionalities. Irene Lehmann and Pia Palme invite readers into intimate encounters with an artist's practice, feminist and queer perspectives, and personal explorations into aspects of musicology, theatre studies, technology and ecology. By presenting female* composers who write (...) with/through/about their own practice, Sounding Fragilities is a remarkable contribution to an interdisciplinary debate around the agency of artistic research. With this synthesis, the editors evaluate how moving beyond the binary of art and science reveals the rich yet fragile territories of artistic knowledge-production and literacy in music theatre. Sounding Fragilities: An Anthology brings together essays, discussions and interventions on contemporary music, dance and music theatre to offer a polyphony of new approaches to listening, watching, composing and performing. Artistic and academic researchers present reflections and insights into the fragilities of artistic materials, collaborations and the communities that build around live performances. Challenging the idea of isolated composers, choreographers, audience members and academic researchers, they stress instead the interconnectedness of these positions as indispensable elements of thriving performance and research. This feature of all live performance is envisaged by several of the book's contributors as linked to political, democratic thought and ecological or feminist thinking. (shrink)

Soziale Faktoren haben einen starken Einfluss auf die Gesundheit und Lebenserwartung. Auch in Wohlfahrtsstaaten bestehen signifikante gesundheitliche Ungleichheiten zwischen besser und schlechter gestellten Bevölkerungsgruppen. Sie werden zunehmend als ein Problem der sozialen Gerechtigkeit wahrgenommen. Public Health dient dem Abbau gesundheitlicher Ungleichheiten und somit der Förderung der sozialen Gerechtigkeit. Obwohl Public Health-Maßnahmen effizienter zur Förderung und Angleichung der Bevölkerungsgesundheit beitragen können als viele medizinische Versorgungen, erhalten sie einen geringeren gesundheitspolitischen Stellenwert. Diese Prioritätensetzung zu Gunsten der Medizin kann als irrational kritisiert werden. (...) Allerdings ist zu beachten, dass die medizinische Versorgung eine hohe symbolische Bedeutung für die Fürsorge und soziale Anerkennung hat, die bei Public Health nicht in gleichem Maße gegeben ist. Gesundheitliche Ungleichheiten sind nicht per se sozial ungerecht, sondern dann, wenn sie auf einer ungerechten Verteilung sozialer Gesundheitsfaktoren beruhen. Diese Faktoren wie z. B. Einkommen und Bildung haben auch unabhängig von ihren gesundheitlichen Auswirkungen eine Bedeutung für die soziale Gerechtigkeit. Daher kann die Gesundheitsgerechtigkeit nicht isoliert, sondern nur im Kontext einer umfassenden Theorie der sozialen Gerechtigkeit bestimmt werden. (shrink)

Evaluating the impact of clinical ethics support services remains a challenging task. 1 Against this background, we applaud the authors for developing a theoretical framework that aims to explain how repeated moral case deliberations may promote ‘practical wisdom’ in healthcare professionals and improve the quality of care in health facilities. 2 In our view, it is of particular value to draw attention to the learning processes that may be induced by ethics support services. Understanding such learning processes on the individual (...) and organisational level is a prerequisite for longitudinal research designs that may be suitable to study the impact of specific ethics support services on criteria deemed relevant in patient care. 3 In our comment, we would like to focus on one aspect, which we deem necessary to be able to explain the possible impact of ethics support on the quality of healthcare. This is the... (shrink)

ABSTRACT: A comprehensive introduction to ancient (western) logic from earliest times to the 6th century CE, with an emphasis on topics which may be of interest to contemporary logicians. Content: 1. Pre-Aristotelian Logic 1.1 Syntax and Semantics 1.2 Argument Patterns and Valid Inference 2. Aristotle 2.1 Dialectics 2.2 Sub-sentential Classifications 2.3 Syntax and Semantics of Sentences 2.4 Non-modal Syllogistic 2.5 Modal Logic 3. The early Peripatetics: Theophrastus and Eudemus 3.1 Improvements and Modifications of Aristotle's Logic 3.2 Prosleptic Syllogisms 3.3 Forerunners (...) of Modus Ponens and Modus Tollens 3.4 Wholly Hypothetical Syllogisms 4. Diodorus Cronus and Philo the Logician 5. The Stoics 5.1 Logical Achievements Besides Propositional Logic 5.2 Syntax and Semantics of Complex Propositions 5.3 Arguments 5.4 Stoic Syllogistic 5.5 Logical Paradoxes 6. Epicurus and the Epicureans 7. Later Antiquity. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for (...) this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making. (shrink)