Definition of the problemAdvance directives involve evaluative assumptions about the further course of one’s life that can be more or less appropriate and thus call for ethical reflection. This contribution focuses on the basis and criteria of such assumptions. We argue that considerations regarding the temporal structure of a good life constitute a particularly relevant perspective in this context.ArgumentsEmpirical studies on the individual composition of advance directives point to the important role of personal values and life plans that can change (...) over time. Therefore, we first contextualize advance directives from the perspective of an ethics of the good life and then discuss their implications with regard to different levels of temporality, comprising fundamental parameters of human existence in time, cultural models of the life course, as well as narratives of the individual trajectory of life.ConclusionConceptions of a good life and its temporal structure represent an important perspective for drafting and interpreting advance directives. Their consideration provides a more nuanced understanding of the evaluative implications of advance care planning. This can benefit individual patients, service providers, as well as policy makers. (shrink)

Patientenverfügungen und andere Arten gesundheitlicher Vorausverfügungen wie Advance Care Planning und in gewisser Hinsicht auch Vorsorgevollmachten und Betreuungsverfügungen schließen evaluativ gehaltvolle Annahmen und Werturteile über den weiteren Verlauf des eigenen Lebens ein, die sich als mehr oder weniger angemessen erweisen können und daher einer ethischen Klärung und Reflexion bedürfen. Der Beitrag geht der Frage nach den Grundlagen dieser Annahmen und Urteile nach und argumentiert, dass für ihre Analyse eine strebensethische Perspektive auf Vorstellungen eines guten Lebens in der Zeit besonders geeignet (...) ist. Dazu geben wir zunächst einen kurzen Überblick über die empirische Forschung zu Einflussfaktoren bei der Abfassung gesundheitlicher Vorausverfügungen, insbesondere der Bedeutung von individuellen Wertvorstellungen und Lebensorientierungen. Im nächsten Schritt wenden wir uns vor diesem Hintergrund der Bewertung von Lebensqualität im Lebensverlauf zu. Wie sich dabei zeigt, verweisen die betreffenden Werturteile in mehrfacher Hinsicht auf umfassendere Vorstellungen eines guten Lebens und seines zeitlichen Verlaufs. Daher nehmen wir im Anschluss die Frage des guten Lebens in der Zeit in den Blick und arbeiten typologisierend unterschiedliche Vorstellungen heraus, an denen sich die Implikationen der zeitlichen Erstreckung und Verlaufsstruktur guten Lebens für gesundheitliche Vorausverfügungen deutlich machen lassen. Der Aufsatz formuliert so nicht nur wichtige Perspektiven für eine eingehendere empirische Erforschung evaluativer Aspekte der Abfassung gesundheitlicher Vorausverfügungen. Die Klärung der Bedeutung der Zeitstruktur guten Lebens für solche Verfügungen eröffnet auch einen theoretischen Zugang zu den grundlegenden strebensethischen Fragen, mit denen sich die Betroffenen innerhalb des Rahmens des sollensethisch gut begründeten, gesellschaftlich weithin anerkannten und gesetzlich abgesicherten Rechtes auf ein selbstbestimmtes Sterben konfrontiert sehen. (shrink)

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting (...) Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core. (shrink)

ABSTRACTDepression is associated with increased emotional response to stress. This is especially the case during the developmental period of adolescence. Cognitive reappraisal is an effective emotion regulation strategy that has been shown to reduce the impact of emotional response on psychopathology. However, less is known about whether cognitive reappraisal impacts the relationship between depressive symptoms and emotional responses, and whether its effects are specific to emotional reactivity or emotional recovery. The current study examined whether cognitive reappraisal moderated the relationship between (...) depressive symptoms and trait or state measures of emotional reactivity and recovery. A community sample of 127 adolescents, at an age of risk for depression, completed self-report measures of trait emotional responding and depressive symptoms. In addition, they completed an in vivo social stress task and were assessed on state emotional reactivity and recove... (shrink)

Journal Name: Semiotica Issue: Ahead of print.

Emotive Interjections in British English: A corpus-based study on variation in acquisition, function and usage constitutes the first in-depth corpus-based study on the use of emotive interjections in Present Day British English. In a novel approach, it systematically distinguishes between child and adult speakers, providing new insights into how they use Ow!, Ouch!, Ugh!, Yuck!, Whoops!, Whoopsadaisy! and Wow! in everyday spoken language. It studies in detail their acquisition by children and pinpoints changes and developments in their use throughout early (...) childhood. The study highlights particularities displayed by child and adult speakers in general and identifies crucial differences regarding how adults use emotive interjections depending on whether they are interacting with children or other adults. This book thus offers an exhaustive overview on the functions of emotive interjections based on thorough empirical research and will appeal to linguists concerned with pragmatics, child language acquisition, the expression of emotion and interjections. (shrink)

Journal Name: Semiotica Issue: Ahead of print.

In Fichte’s early views of the basic laws of traditional formal logic, primarily the law of identity, there is a tension that has gone surprisingly unexplored: While Fichte holds the statements of these laws to be self-evidently true and absolutely certain, he nevertheless claims that they remain to be justified by his “Science of Knowledge.” The aim of this article is to make sense of this tension and to explore how it translates into the dialectical structure and methodology of Fichte’s (...) first Jena Wissenschaftslehre. This is done by, first, conjecturing—in a somewhat ahistorical, yet Fichte-based, fashion—a reason for Fichte’s justificatory demand. It is argued that the validity of the law of identity can be questioned because our belief in its absolute generality appears to be self-refuting in that it involves an antinomy akin to Grelling’s semantic antinomy of the heterological. This antinomy, when, secondly, related to Fichte’s purported justification of the law of identity, serves as a key to understanding why there is an antinomic conflict between Fichte’s supreme principle—namely, the self-positing pure I—and its adversary, the not-I, in the first place. Tracing their contradiction back to that semantic antinomy inherent in our formal-logical certainties opens up a new way of seeing Fichte as radicalizing Kant’s critical philosophy, understood as the project of the self-preservation of reason against reason’s own antinomies. (shrink)

In Fichte’s early views of the basic laws of traditional formal logic, primarily the law of identity, there is a tension that has gone surprisingly unexplored: While Fichte holds the statements of these laws to be self-evidently true and absolutely certain, he nevertheless claims that they remain to be justified by his “Science of Knowledge.” The aim of this article is to make sense of this tension and to explore how it translates into the dialectical structure and methodology of Fichte’s (...) first Jena Wissenschaftslehre. This is done by, first, conjecturing—in a somewhat ahistorical, yet Fichte-based, fashion—a reason for Fichte’s justificatory demand. It is argued that the validity of the law of identity can be questioned because our belief in its absolute generality appears to be self-refuting in that it involves an antinomy akin to Grelling’s semantic antinomy of the heterological. This antinomy, when, secondly, related to Fichte’s purported justification of the law of identity, serves as a key to understanding why there is an antinomic conflict between Fichte’s supreme principle—namely, the self-positing pure I—and its adversary, the not-I, in the first place. Tracing their contradiction (whose synthetic resolution is the main goal of Fichte’s Wissenschaftslehre) back to that semantic antinomy inherent in our formal-logical certainties opens up a new way of seeing Fichte as radicalizing Kant’s critical philosophy, understood as the project of the self-preservation of reason against reason’s own antinomies. (shrink)

When immigrant children are separated from their parents, inexorable medical and legal harms result. Family separation violates a fundamental right of parents to participate in medical decisions involving their children. This paper reviews and contributes to evolving analyses of the public health, legal, and ethical consequences of immigration policy.