The paper first defines palliative treatment and distinguishes it from symptomatic treatment. Then, the palliative situation is delineated as inseparably linked to the finitude of human life. Given the objectives of palliative treatment — responding to symptoms, damage to the patients' self-image, and the proximity of death — a subjective concept of disease is described, that is regarded as the focus of palliative treatment. The essence of the concept of disease is analysed as the patient's experience with a tendency of (...) reduction of her or his vitality. Palliative medicine is shown not to be symptom-oriented, but disease — directed as other domains of medicine. Implications and practical consequences, especially the status of objective findings, of this concept are discussed and therapeutic opportunities in the palliative situation reconsidered. (shrink)

Background: The experimental method to acquire knowledge about efficacy and efficiency of medical procedures is well established in evidence-based medicine. A method to attain evidence about the significance of diseases and interventions from the patients' perspectives taking into account their right to self-determination about their lives and bodies has however not been sufficiently characterized.Design: Identification of a method to acquire evidence about the clinical significance of disease and therapeutic options from the patients' perspectives.Arguments: Communication between patient and physician is analyzed (...) as the method to attain evidence about what is at stake for individual patients in disease and therapy. It is the method that enables physicians to directly take into account patients' disease experiences and their aims regarding treatments. These patients' perspectives in turn determine the clinical significance of diagnoses and therapeutic options, if patient-autonomy is taken seriously.Conclusions: A full account of evidence-based medicine needs to include experimentation and communication between physician and patient as equally important methods to attain evidence necessary to practice patient-oriented medicine. The communicative method is especially important for primary physicians as they direct patients within the medical system to have their medical problems most effectively and efficiently addressed. (shrink)

The paper attempts to give an account of the fallibility of medical judgments without recourse to the incompleteness of scientific knowledge. It is argued that because of the inexactness of observations and thus the existence of borderline cases any theory applied for explanation and predicition will produce some false results. This state of affairs is independent of the nature of a theory, i.e., it applies both for non-probabilistic and for probabilistic theories. Some epistemological issues and consequences with regard to a (...) better understanding of clinical reasoning are discussed and the view is compared with the theory of medical fallibility of Gorovitz and MacIntyre.1. (shrink)

The paper attempts to give an account of the fallibility of medical judgments without recourse to the incompleteness of scientific knowledge. It is argued that because of the inexactness of observations and thus the existence of borderline cases any theory applied for explanation and predicition will produce some false results. This state of affairs is independent of the nature of a theory, i.e., it applies both for non-probabilistic and for probabilistic theories. Some epistemological issues and consequences with regard to a (...) better understanding of clinical reasoning are discussed and the view is compared with the theory of medical fallibility of Gorovitz and MacIntyre.1. (shrink)

The Historical Dictionary of Philosophy, the _Historisches Wörterbuch der Philosophie,_ is distinguished by its particular presentation of philosophical terms, ideas and concepts. Rather than providing mere defintions or descriptive and analytical explanantions the _HWPh_ strictly applies the critical method of history of concepts developed by the eminent German scholar and philosopher Joachim Ritter. By means of precise and detailed references it documents the origin, first occurrence, the historical evolution and the changes of meaning of each concept, from Ancient Greek (...) to contemporary philosophy. For the reader this presentation is of unique value: it makes traceable the importance of terms and concepts at certain periods or for a particular philosopher, as well as its changes and development of meaning. Voulmes 1–12 of the _HWPh_ comprises more than 17.000 text columns on 3.670 philosophical terms. The dictionary does not include articles on persons. Volume 13 includes, besides of a comprehensive introductory essay, three different indexes: - the Subject Index classifies the articles by disciplinary and systematic categories - the Main Index includes all philosophical keywords with more than 30.000 references to their occurrences in other articles and contexts - the Author Index lists all authors and their contributions The included CD-ROM allows full text research of the _HWPh's_ entire content. (shrink)

It is now—at least loosely—acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study—usually in a binary way—the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our (...) thinking from ‘cause and effect’ to ‘causes and effects’ since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a ‘causes and effects’ frame so we can choose the research methodology that reflects the relationships between variables of interest—one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand ‘causes and effects’. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple ‘causes and effects’ on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how ‘causes and effects’ explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity. (shrink)

This chapter contains sections titled: Introduction What is Chemistry about? Is Chemistry Reducible to Physics? Are There Fundamental Limits to Chemical Knowledge? Is Chemical Research Ethically Neutral? Conclusion References.

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

National governments have failed spectacularly to mitigate anthropogenic climate change and a sustainable approach to mitigation remains out of sight. This circumstance alone demonstrates t...

The Historical Dictionary of Philosophy, the Historisches Wörterbuch der Philosophie (HWPh), is distinguished by its particular presentation of philosophical terms, ideas and concepts. Rather than providing mere defintions or descriptive and analytical explanantions the HWPh strictly applies the critical method of history of concepts developed by the eminent German scholar and philosopher Joachim Ritter. By means of precise and detailed references it documents the origin, first occurrence, the historical evolution and the changes of meaning of each concept, from Ancient (...) Greek to contemporary philosophy. For the reader this presentation is of unique value: it makes traceable the importance of terms and concepts at certain periods or for a particular philosopher, as well as its changes and development of meaning. Voulmes 1–12 of the HWPh comprises more than 17.000 text columns on 3.670 philosophical terms. The dictionary does not include articles on persons. Volume 13 includes, besides of a comprehensive introductory essay, three different indexes: - the Subject Index classifies the articles by disciplinary and systematic categories - the Main Index includes all philosophical keywords with more than 30.000 references to their occurrences in other articles and contexts - the Author Index lists all authors and their contributions The included CD-ROM allows full text research of the HWPh's entire content. (shrink)

In dieser Aufsatzsammlung wird Johann Georg Hamanns Grundthese von Gott als Schriftsteller interpretiert und in weitest reichende literarische Zusammenhange gestellt. Der Zusammenhang von Reden, Horen und Sehen wird theologisch und eschatologisch untersucht. Hamanns Gedanken zum Abendmahl und Sacrament der Sprache werden mit der Rolle des Essens und Trinkens in Beziehung gebracht. Die Narziss-Episode der Metamorphosen des Ovid deutete der Schriftsteller christologisch und als Kenner des Hebraerbriefs verfasste er eine kritische Rezension des Kommentars von J. D. Michaelis (Gottingen). Der Autor arbeitet (...) die Bedeutung Hamanns als der massgebliche theologische Sprachdenker nach Luther heraus, dessen Worttheologie u. a. Kierkegaard gepragt hat. (shrink)

Algorithmic predictions are promising for insurance companies to develop personalized risk models for determining premiums. In this context, issues of fairness, discrimination, and social injustice might arise: Algorithms for estimating the risk based on personal data may be biased towards specific social groups, leading to systematic disadvantages for those groups. Personalized premiums may thus lead to discrimination and social injustice. It is well known from many application fields that such biases occur frequently and naturally when prediction models are applied to (...) people unless special efforts are made to avoid them. Insurance is no exception. In this paper, we provide a thorough analysis of algorithmic fairness in the case of insurance premiums. We ask what “fairness” might mean in this context and how the fairness of a premium system can be measured. For this, we apply the established fairness frameworks of the fair machine learning literature to the case of insurance premiums and show which of the existing fairness criteria can be applied to assess the fairness of insurance premiums. We argue that two of the often-discussed group fairness criteria, independence (also called statistical parity or demographic parity) and separation (also known as equalized odds), are not normatively appropriate for insurance premiums. Instead, we propose the sufficiency criterion (also known as well-calibration) as a morally defensible alternative that allows us to test for systematic biases in premiums towards certain groups based on the risk they bring to the pool. In addition, we clarify the connection between group fairness and different degrees of personalization. Our findings enable insurers to assess the fairness properties of their risk models, helping them avoid reputation damage resulting from potentially unfair and discriminatory premium systems. (shrink)