Although rationing of scarce health-care resources is inevitable in clinical practice, there is still limited and scattered information about how physicians perceive and execute this bedside rationing (BSR) and how it can be performed in an ethically fair way. This review gives a systematic overview on physicians’ perspectives on influences, strategies, and consequences of health-care rationing. Relevant references as identified by systematically screening major electronic databases and manuscript references were synthesized by thematic analysis. Retrieved studies focused on themes that fell (...) under three major headings: (i) conditions and influences of BSR, (ii) strategies of BSR, and (iii) consequences of BSR. The range of themes indicates that physicians’ rationing behavior is highly variable, strongly influenced by context-related factors, and consists mainly of implicit rationing strategies. Torn between patient advocacy and the obligation to contain costs, physicians experience various role conflicts. The development of explicit rationing strategies seems necessary to avoid arbitrary BSR and allow a fair allocation of health-care resources. (shrink)

Background: Publications and discussions of survey research in empirical bioethics have steadily increased over the past two decades. However, findings often differ among studies with similar research questions. As a consequence, ethical reasoning that considers only parts of the existing literature and does not apply systematic reviews tends to be biased. To date, we lack a systematic review (SR) methodology that takes into account the specific conceptual and practical challenges of empirical bioethics. Methods: The steps of systematically reviewing empirical findings (...) in bioethics are presented and critically discussed. In particular, (a) the limitations of traditional SR methodologies in the field of empirical bioethics are critically discussed, and (b) conceptual and practical recommendations for SRs in empirical bioethics that are (c) based on the authors’ review experiences in healthcare ethics are presented. Results: A 7-step approach for SRs of empirical bioethics is proposed: (1) careful definition of review question; (2) selection of relevant databases; (3) application of ancillary search strategies; (4) development of search algorithms; (5) relevance assessment of the retrieved references; (6) quality assessment of included studies; and (7) data analysis and presentation. Conceptual and practical challenges arise because of various peculiarities in reviewing empirical bioethics literature and can lead to biased results if they are not taken into account. Conclusions: If suitably adapted to the peculiarities of the field, SRs of empirical bioethics provide transparent information for ethical reasoning and decision-making that is less biased than single studies. (shrink)

Recent work has demonstrated that the sense of agency is not only determined by efference-copy-based internal predictions and internal comparator mechanisms, but by a large variety of different internal and external cues. The study by Moore and colleagues [Moore, J. W., Wegner, D. M., & Haggard, P. . Modulating the sense of agency with external cues. Conscious and Cognition] aimed to provide further evidence for this view by demonstrating that external agency cues might outweigh or even substitute efferent signals to (...) install a basic registration of self-agency. Although the study contains some critical points that, so we argue, are central to a proper interpretation of the data, it hints at a new perspective on agency: optimal cue integration seems to be the key to a robust sense of agency. We here argue that this framework could allow integrating the findings of Moore and colleagues and other recent agency studies into a comprehensive picture of the sense of agency and its pathological disruptions. (shrink)

There is an increasing amount of empirical work investigating the sense of agency, i.e. the registration that we are the initiators of our own actions. Many studies try to relate the sense of agency to an internal feed-forward mechanism, called the ‘‘comparator model’’. In this paper, we draw a sharp distinction between a non-conceptual level of feeling of agency and a conceptual level of judgement of agency. By analyzing recent empirical studies, we show that the comparator model is not able (...) to explain either. Rather, we argue for a two-step account: a multifactorial weighting process of different agency indicators accounts for the feeling of agency, which is, in a second step, further processed by conceptual modules to form an attribution judgement. This new framework is then applied to disruptions of agency in schizophrenia, for which the comparator model also fails. Two further extensions are discussed: We show that the comparator model can neither be extended to account for the sense of ownership (which also has to be differentiated into a feeling and a judgement of ownership) nor for the sense of agency for thoughts. Our framework, however, is able to provide a unified account for the sense of agency for both actions and thoughts. (shrink)

The neurocognitive structure of the acting self has recently been widely studied, yet is still perplexing and remains an often confounded issue in cognitive neuroscience, psychopathology and philosophy. We provide a new systematic account of two of its main features, the sense of agency and the sense of ownership, demonstrating that although both features appear as phenomenally uniform, they each in fact are complex crossmodal phenomena of largely heterogeneous functional and representational levels. These levels can be arranged within a gradually (...) evolving, onto- and phylogenetically plausible framework which proceeds from basic non-conceptual sensorimotor processes to more complex conceptual and meta-representational processes of agency and ownership, respectively. In particular, three fundamental levels of agency and ownership processing have to be distinguished: The level of feeling, thinking and social interaction. This naturalistic account will not only allow to “ground the self in action”, but also provide an empirically testable taxonomy for cognitive neuroscience and a new tool for disentangling agency and ownership disturbances in psychopathology. (shrink)

Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention, memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making still remain highly unclear. Here it will be argued that also in the medical domain the use of cognition-enhancing drugs is not intrinsically unethical and that, in fact, physicians should assume an important role in gating (...) their usage. For finding normative orientation, concepts of disease, normality or medicine will not be helpful since—due to their cryptonormative nature—they rather hamper than allow targeted discussion and decision-making. As an alternative, the common and widely accepted bioethical criteria of beneficence, non-maleficence, autonomy and distributive justice allow a clinically applicable, highly differentiated context- and case-sensitive approach. By embedding decision-making in a participative physician–patient relationship extrinsic objections against neurocognitive enhancement (e.g. invalid perceptions about efficacy, benefit or risk; questionable voluntariness; restrained decision-making capacity) can be curtailed. (shrink)

We defend our multifactorial weighting model of the sense of agency and our critique of the comparator model against the critiques that have been brought forward by and . Building on the specification of our model that emerges from this response, we will suggest a distinct mechanism how weighting of different agency factors might work: internal and external agency cues are constantly weighted according to their reliability in a given situation. Thus, the weighting process underlying the sense of agency might (...) follow the principles of optimal cue integration. We review recent empirical evidence for this hypothesis, demonstrating that the multifactorial weighting model is not only testable, but has in fact already received first empirical support. (shrink)

Die Fortschritte in der Psychopharmakologie führen zu einem immer breiteren Angebot an Substanzen zur Verbesserung der Stimmung, des Gedächtnisses oder der exekutiven Funktionen. Dieses Angebot trifft auf die Wünsche und Bedürfnisse vieler Menschen, ihre mentalen Leistungen und Zustände zu verbessern. Wie sollte die Medizin mit diesen Wünschen umgehen? An welchen Kriterien sollte sich insbesondere der ärztliche Entscheidungsprozess orientieren? Im Folgenden soll gezeigt werden, dass sich aus einer „Treatment-enhancement-Unterscheidung“, einem Krankheits- oder Normalitätsbegriff oder einem bestimmten Medizinkonzept keine zielführenden normativen Kriterien für (...) diesen Entscheidungsprozess ableiten lassen. Demgegenüber wird ein Entscheidungsmodell entwickelt, das auf traditionellen Kriterien ärztlichen Handelns beruht: dem Kriterium des Wohlergehens, des Nichtschadens und der Autonomie. Mit diesem Modell soll zugleich ein neues Konzept einer „wunscherfüllenden Medizin“ vorgeschlagen werden: eine subjektive Medizin mit ärztlichem Empfehlungs- und Vetovorbehalt. (shrink)

The nature and function of thoughts have been a central topic of philosophy from its ancient beginnings, yet its critical assessment was put forward in particular by the development of the philosophy of mind in the last decades: thoughts were no longer taken to be the secure basis of which we immediately know the content and its nature , but to be mental entities that require critical investigation concerning the determination of their content and nature. Thoughts are traditionally discussed in (...) connection with reasoning, planning, and justification, but the intrinsic connection between thoughts and rationality was later challenged by psychological conceptions that dismissed rationality as a central notion for a theory of thinking. (shrink)

ZusammenfassungAngesichts begrenzter anderweitiger Behandlungsmöglichkeiten wird der Gabe von Antidementiva in der gegenwärtigen medizinischen Demenz-Behandlung eine besondere Bedeutung zugeordnet. Eine evidenzbasierte ethische Analyse unter den Kriterien des Wohlergehens, des Nicht-Schadens, der Autonomie und der Gerechtigkeit zeigt jedoch, dass die Bedeutung von Antidementiva oftmals überschätzt wird und die Erwartungen zu hoch sind: Die Wirksamkeit von Antidementiva ist rein symptomatisch, sie fällt bei einer großen Anzahl an Patienten nur gering aus und bleibt für manche Patienten ohne Nutzen. Zudem sind Antidementiva mit Schadensrisiken behaftet (...) und verbrauchen finanzielle Ressourcen, deren Verteilung auf verschiedenen Ebenen zur Diskussion steht. Angesichts dieser Schwierigkeiten tritt eine bislang nur unzureichend beantwortete Grundfrage des Umgangs mit Demenz-Patienten in den Vordergrund: An welchen Zielen soll sich die Behandlung orientieren? Der folgende Artikel analysiert diese Frage vor dem Hintergrund der Grundstrukturen der derzeitigen Demenz-Behandlung und fordert hier zu einem grundlegenden Umdenken auf. (shrink)

Angesichts begrenzter anderweitiger Behandlungsmöglichkeiten wird der Gabe von Antidementiva in der gegenwärtigen medizinischen Demenz-Behandlung eine besondere Bedeutung zugeordnet. Eine evidenzbasierte ethische Analyse unter den Kriterien des Wohlergehens, des Nicht-Schadens, der Autonomie und der Gerechtigkeit zeigt jedoch, dass die Bedeutung von Antidementiva oftmals überschätzt wird und die Erwartungen zu hoch sind: Die Wirksamkeit von Antidementiva ist rein symptomatisch, sie fällt bei einer großen Anzahl an Patienten nur gering aus und bleibt für manche Patienten ohne Nutzen. Zudem sind Antidementiva mit Schadensrisiken behaftet (...) und verbrauchen finanzielle Ressourcen, deren Verteilung auf verschiedenen Ebenen zur Diskussion steht. Angesichts dieser Schwierigkeiten tritt eine bislang nur unzureichend beantwortete Grundfrage des Umgangs mit Demenz-Patienten in den Vordergrund: An welchen Zielen soll sich die Behandlung orientieren? Der folgende Artikel analysiert diese Frage vor dem Hintergrund der Grundstrukturen der derzeitigen Demenz-Behandlung und fordert hier zu einem grundlegenden Umdenken auf. (shrink)

Die Fortschritte in der Psychopharmakologie führen zu einem immer breiteren Angebot an Substanzen zur Verbesserung der Stimmung, des Gedächtnisses oder der exekutiven Funktionen. Dieses Angebot trifft auf die Wünsche und Bedürfnisse vieler Menschen, ihre mentalen Leistungen und Zustände zu verbessern. Wie sollte die Medizin mit diesen Wünschen umgehen? An welchen Kriterien sollte sich insbesondere der ärztliche Entscheidungsprozess orientieren? Im Folgenden soll gezeigt werden, dass sich aus einer „Treatment-enhancement-Unterscheidung“, einem Krankheits- oder Normalitätsbegriff oder einem bestimmten Medizinkonzept keine zielführenden normativen Kriterien für (...) diesen Entscheidungsprozess ableiten lassen. Demgegenüber wird ein Entscheidungsmodell entwickelt, das auf traditionellen Kriterien ärztlichen Handelns beruht: dem Kriterium des Wohlergehens, des Nichtschadens und der Autonomie. Mit diesem Modell soll zugleich ein neues Konzept einer „wunscherfüllenden Medizin“ vorgeschlagen werden: eine subjektive Medizin mit ärztlichem Empfehlungs- und Vetovorbehalt. (shrink)

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

ZusammenfassungAngesichts begrenzter anderweitiger Behandlungsmöglichkeiten wird der Gabe von Antidementiva in der gegenwärtigen medizinischen Demenz-Behandlung eine besondere Bedeutung zugeordnet. Eine evidenzbasierte ethische Analyse unter den Kriterien des Wohlergehens, des Nicht-Schadens, der Autonomie und der Gerechtigkeit zeigt jedoch, dass die Bedeutung von Antidementiva oftmals überschätzt wird und die Erwartungen zu hoch sind: Die Wirksamkeit von Antidementiva ist rein symptomatisch, sie fällt bei einer großen Anzahl an Patienten nur gering aus und bleibt für manche Patienten ohne Nutzen. Zudem sind Antidementiva mit Schadensrisiken behaftet (...) und verbrauchen finanzielle Ressourcen, deren Verteilung auf verschiedenen Ebenen zur Diskussion steht. Angesichts dieser Schwierigkeiten tritt eine bislang nur unzureichend beantwortete Grundfrage des Umgangs mit Demenz-Patienten in den Vordergrund: An welchen Zielen soll sich die Behandlung orientieren? Der folgende Artikel analysiert diese Frage vor dem Hintergrund der Grundstrukturen der derzeitigen Demenz-Behandlung und fordert hier zu einem grundlegenden Umdenken auf. (shrink)

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

A long-standing theme in discussion of perception and thought has been that our primary cognitive contact with individual objects and events in the world derives from our perceptual contact with them. When I look at a duck in front of me, I am not merely presented with the fact that there is at least one duck in the area, rather I seem to be presented withthisthing (as one might put it from my perspective) in front of me, which looks to (...) me to be a duck. Furthermore, such a perception would seem to put me in a position not merely to make the existential judgment that there is some duck or other present, but rather to make a singular, demonstrative judgment, that that is a duck. My grounds for an existential judgment in this case derives from my apprehension of the demonstrative thought and not vice versa. (shrink)

This book defends antitheodicism, arguing that theodicies, seeking to excuse God for evil and suffering in the world, fail to ethically acknowledge the victims of suffering. The authors argue for this view using literary and philosophical resources, commencing with Immanuel Kant's 1791 "Theodicy Essay" and its reading of the Book of Job. Three important twentieth century antitheodicist positions are explored, including "Jewish" post-Holocaust ethical antitheodicism, Wittgensteinian antitheodicism exemplified by D.Z. Phillips and pragmatist antitheodicism defended by William James. The authors argue (...) that these approaches to evil and suffering are fundamentally Kantian. Literary works such as Franz Kafka'sThe Trial, Samuel Beckett's Waiting for Godot, and George Orwell's Nineteen Eighty-Four, are examined in order to crucially advance the philosophical case for antitheodicism. (shrink)

In his last book, David Armstrong sets out his metaphysical system in a set of concise and lively chapters each dealing with one aspect of the world. He begins with the assumption that all that exists is the physical world of space-time. On this foundation he constructs a coherent metaphysical scheme that gives plausible answers to many of the great problems of metaphysics. He gives accounts of properties, relations, and particulars; laws of nature; modality; abstract objects such as numbers; and (...) time and mind. (shrink)

Is consciousness a purely physical phenomenon? Most contemporary philosophers and theorists hold that it is, and take this to be supported by modern science. But a significant minority endorse non-physicalist theories such as dualism, idealism and panpsychism, among other reasons because it may seem impossible to fully explain consciousness, or capture what it's like to be in conscious states (such as seeing red, or being in pain), in physical terms. This Element will introduce the main non-physicalist theories of consciousness and (...) explain the most important arguments for them, and consider how they each respond to the scientific and other arguments in support of physicalism. This title is also available as Open Access on Cambridge Core. (shrink)

The phenomenal powers view claims that phenomenal properties metaphysically necessitate their effects in virtue of how they feel, and thereby constitute non-Humean causal powers. For example, pain necessitates that subjects who experience it try to avoid it in virtue of feeling bad. I argue for this view based on the inconceivability of certain phenomenal properties necessitating different effects than their actual ones, their ability to predict their effects without induction, and their ability to explain their effects without appeal to laws (...) or regularities. I also offer a harmony argument according to which the view offers the best explanation for otherwise seemingly fortunate psychophysical regularities. I then outline the view’s main implications for the metaphysics of causation and philosophy of mind. (shrink)

The ideal introduction for students of semantics, Lexical Meaning fills the gap left by more general semantics textbooks, providing the teacher and the student with insights into word meaning beyond the traditional overviews of lexical relations. The book explores the relationship between word meanings and syntax and semantics more generally. It provides a balanced overview of the main theoretical approaches, along with a lucid explanation of their relative strengths and weaknesses. After covering the main topics in lexical meaning, such as (...) polysemy and sense relations, the textbook surveys the types of meanings represented by different word classes. It explains abstract concepts in clear language, using a wide range of examples, and includes linguistic puzzles in each chapter to encourage the student to practise using the concepts. 'Adopt-a-Word' exercises give students the chance to research a particular word, building a portfolio of specialist work on a single word. (shrink)

In this book Daniel Wegner offers a novel understanding of the relation of consciousness, the will, and our intentional and voluntary actions. Wegner claims that our experience and common sense view according to which we can influence our behavior roughly the way we experience that we do it is an illusion.

This book presents a collection of essays on institutional theory written by the German sociologist and Weber-expert M. Rainer Lepsius. Based on Weber's work, the author develops concepts of institutional theory, which he subsequently applies to topics such as National Socialism, democratization processes, German unification, and the institutionalization of the European Union. By showing how charismatic leadership can under certain circumstances threaten democratic structures and curtail individual freedoms, and by analyzing the structural and cultural conditions under which people develop trust (...) in political and social structures and ultimately come to support and comply with them, the author provides a sound analytical understanding of the development of democratic institutions and a democratic political culture. This collection of essays was edited, translated and commented on by Claus Wendt. (shrink)

The Ismaili Imam and Imamat -- Ethical foundations -- Tradition and modernity -- The ethos of modernism -- Pluralism and cosmopolitan ethics -- Cohesion within the Umma -- Islam and the West -- Cultivating and enabling environment -- Living the ethics of Islam -- Global convergence.

The socialist construction in Vietnam, aspect of human role.

This book integrates pragmatism and transcendental philosophy in examining the most serious problem defining the human condition, death and mortality. Its analysis of human limits and finitude is intended to be relevant to the concerns of philosophers specializing in, for example, transcendental philosophy, philosophical anthropology, pragmatism, Wittgenstein, and the philosophy of religion. Mortality is studied as providing a necessary framework within which questions concerning the meaningfulness or meaninglessness of human life become possible.

A selection of important writings which together suggest that legal philosophy is the nerve of legal reasoning.

For over two centuries, Western scholars have discussed African philosophy and culture, often in disparaging, condescending terms, and always from an alien European perspective. Many Africans now share this perspective, having been trained in the western, empirical tradition. Makinde argues that, particularly in view of the costs and failings of western style culture, Africans must now mold their own modern culture by blending useful western practices with valuable indigenous African elements. Specifically, Makinde demonstrates the potential for the development of African (...) philosophy and even African traditional medicine. Following the lead of a number of countries with government policies of incorporating indigenous medicine with orthodox Western medicine, Makinde argues that traditional African practices should be taken seriously, both medically and scientifically. Further, he charges African scholars with the responsibility of investigating these and other elements of traditional African culture in order to dispel their mystery and secrecy through modern research and useful publications. (shrink)

The emerging field of cognition and culture has had some success in explaining the spread of counterintuitive religious concepts around the world. However, researchers have been reluctant to extend its findings to explain the widespread occurrence of culturally counterintuitive ideas in general. This article develops a broader notion of social counterintuitiveness to include ideas that violate shared expectations of a group of people and argues that the notion of social counterintuitiveness is more crucial to explaining cultural success of surprising ideas (...) than the traditional notion of individual counterintuitiveness. Building on the context-based account of individual counterintuitiveness, the article also outlines how the once unorthodox cultural ideas become conventionalized over time only to be swept under the next wave of cultural innovation. By helping us peel away the layers of tradition that weave together the multilayered tapestry of culture, this account can be useful for understanding the development of cultural scaffolding that is needed to support the spread of maximally counterintuitive concepts such as widespread religious concepts of God and ghosts. (shrink)

Giordano Bruno (1548-1600), who died at the stake, is one of the best-known symbols of anti-establishment thought. The theme of this volume, which is offered as a collection of essays to honor the distinguished Bruno scholar Hilary Gatti, reflects her constant concern for the principles of cultural freedom and independent thinking. Several essays deal with Bruno himself, including an analysis of the Eroici furori, a study of his reception in relation to the group known as the Novatores, and discussions of (...) several important aspects of his stay in England. The authors and texts discussed here are linked by a relentless interest in the question of authority and originality, and they range from literary figures such as Alberti (1404-72), Vasari (1511-74) and the proponents of quantitative verse in sixteenth-century England to controversial philosophers who, like Bruno, were condemned by the Church, such as Tommaso Campanella (1568-1639) and Giulio Cesare Vanini (1585-1619). Taken together, these chapters show how much that was new and revolutionary in early modern culture came from its confrontation with the past. Martin McLaughlin is Agnelli-Serena Professor of Italian at Oxford. Elisabetta Tarantino is a Teaching Fellow in the Department of Italian at the University of Warwick. (shrink)