Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

From the early 1790s until after the turn of the century, a very productive but also controversial exchange took place between Reinhold and Fichte. Though many key aspects of post-Kantian philosophy were discussed, the philosophical confrontation between Reinhold and Fichte is most instructive for the understanding of post-Kantian philosophy. The exchange started when Fichte published his verdict on Reinhold's Elementarphilosophie and disapproved of its fundamental principle. In 1794 Fichte challenged Reinhold by presenting his Wissenschaftslehre. Reinhold was not convinced of Fichte's (...) foundation of philosophy at first, but announced that he accepted the Wissenschaftslehre in 1797. While Reinhold and Fichte officially collaborated in the following three years, tensions concerning fundamental questions were still present. When Reinhold adopted Rational Realism, his relation to Fichte deteriorated and the exchange between the two finally ended. The contributions in the present collection focus on the central systematic issues at the different stages of the confrontation between Fichte and Reinhold, thereby illuminating questions that are essential to the understanding of the evolution of post-Kantian German philosophy. (shrink)

There is sufficient evidence to believe that variations in the error-related negativity (ERN) are linked to dispositional characteristics in individuals. However, explanations of individual differences in the amplitude of the ERN cannot be derived from functional theories of the ERN. The ERN has a counterpart that occurs after correct responses (correct-response negativity, CRN). Based on the assumption that ERN and CRN reflect an identical cognitive process, variations in CRN might be associated with dispositional characteristics as well. Higher CRN amplitudes have (...) been found to reflect task engagement. In the present study, a simple-choice-reaction task was used to investigate ERN and CRN amplitudes in relation to their score on a conscientiousness scale. The task consisted of a simple rule that required pressing the left or right key when a circle or square appeared, respectively. During alternative conditions that occur infrequently, participants were instructed to violate or reverse the previously established response rules. Smaller ΔERN amplitudes (manifested in almost equal CRN and ERN amplitudes) and a tendency of better task performance from participants scoring high on the conscientiousness scale might indicate a greater focus on the task and higher motivation of responding correctly. In addition, higher Pc amplitudes directly following the CRN indicated that the response monitoring system of less conscientious participants showed a higher disengagement. The role of individual differences in CRN amplitude should be studied in future experiments on performance monitoring. (shrink)

In the first paragraph of the Grundlage der gesammten Wissenschaftslehre Fichte gives an extended exposition of his first principle. The aim of the article is to show that, first, this exposition is in fact an argument in favour of the first principle of the Wissenschaftslehre, and, second, that it answers the central point of the sceptical criticism put forward by Jacobi, Maimon and Schulze against Kantian philosophy. In order to corroborate these theses, the central point of the sceptical critique has (...) to be identified in a first step. Next, I examine Fichte’s strategy to meet the sceptical challenge. As a result, only a pre-systematic form of argument is adequate for Fichte to establish a principle that is immune to sceptical doubts, and, therefore, is a suitable starting point for a transcendental deduction. Finally, Fichte’s argument against the sceptics can be reconstructed in the following way: He takes up the central point of the sceptical critique and reformulates it as a criterion for a first principle. He then shows that the criterion is fulfilled by the I, if it is conceived in his own way, i.e. as pure activity.Fichte entwickelt im ersten Paragraphen der Grundlage der gesammten Wissenschaftslehre eine ausführliche Exposition seines ersten Grundsatzes. Der Beitrag hat zum Ziel zu zeigen, dass diese Exposition ein Argument für das erste Prinzip der Wissenschaftslehre darstellt und dass es ein Argument gegen den zentralen Punkt der skeptischen Kritik an der Transzendentalphilosophie, wie sie Jacobi, Maimon und Schulze formulierten, ist. Um diese Thesen zu untermauern, wird in einem ersten Schritt der zentrale Punkt der skeptischen Kritik identifiziert. Dem folgt eine Untersuchung der Strategie, mit der Fichte der Kritik begegnet, wobei sich eine vorsystematische Argumentation als geeignet erweist, einen ersten Grundsatz aufzustellen, der gegen die vorgebrachten Zweifel resistent und daher als Basis einer transzendentalen Deduktion tauglich ist. Fichtes Argumentation gegen den Skeptizismus kann dann folgendermaßen rekonstruiert werden: Fichte nimmt den zentralen Punkt der skeptischen Kritik auf und formt ihn in ein Kriterium für ein erstes Prinzip um. Er kann dann zeigen, dass das Ich das Kriterium erfüllt, sofern es als reine Tätigkeit aufgefasst wird. (shrink)

The capability of logical systems to express their own satisfaction relation is a key issue in mathematical logic. Our notion of self definability is based on encodings of pairs of the type (structure, formula) into single structures wherein the two components can be clearly distinguished. Hence, the ambiguity between structures and formulas, forming the basis for many classical results, is avoided. We restrict ourselves to countable, regular, logics over finite vocabularies. Our main theorem states that self definability, in this framework, (...) is equivalent to the existence of complete problems under quantifier free reductions. Whereas this holds true for arbitrary structures, we focus on examples from Finite Model Theory. Here, the theorem sheds a new light on nesting hierarchies for certain generalized quantifiers. They can be interpreted as failure of self definability in the according extensions of first order logic. As a further application we study the possibility of the existence of recursive logics for PTIME. We restate a result of Dawar concluding from recursive logics to complete problems. We show that for the model checking Turing machines associated with a recursive logic, it makes no difference whether or not they may use built in clocks. (shrink)

Concluding the deduction of imagination in § 4 of the Grundlage der gesammten Wissenschaftslehre, Fichte remarks that one lesson of the Wissenschaftslehre is that all reality is a product of imagination. One of the greatest thinkers of the age, Fichte writes, is teaching the same, but calls it a deception of imagination. Fichte’s remark is aimed at Salomon Maimon, and it shows that his deduction shouldn’t be read only as part of the systematic development of the theoretical Wissenschaftslehre, but should (...) also be considered as an argument against a specific kind of scepticism. In order to examine this overlooked anti-sceptical aim in the first Wissenschaftslehre, an overview of the deduction of § 4 with a focus on the systematic role of imagination will first be given. Second, Maimon’s sceptical argument against transcendental philosophy will be explained. In the centre again will stand Maimon’s Humean concept of imagination. Finally, it will be shown in which sense Fichte’s deduction of imagination has to be taken in order to be an adequate response to Maimonian scepticism.An die Deduktion der Einbildungskraft in § 4 der Grundlage der gesammten Wissenschaftslehre schließt Fichte die Bemerkung an, es werde hier gelehrt, dass alle Realität durch die Einbildungskraft hervorgebracht wird. Einer der größten Denker des Zeitalters – gemeint ist Salomon Maimon – lehre das Gleiche, nur nenne er es eine Täuschung durch die Einbildungskraft. Diese Bemerkung lässt erkennen, dass die Deduktion der Einbildungskraft nicht nur im Dienst der Entwicklung des theoretischen Teils der Wissenschaftslehre steht, sondern dass sie auch im Sinne eines antiskeptischen Arguments verstanden werden muss. Um diesen Aspekt von Fichtes Konzeption der Einbildungskraft genauer zu beleuchten, wird erstens die Deduktion in § 4 mit Blick auf die systematische Rolle der Einbildungskraft dargestellt. Zweitens wird Maimons skeptisches Argument gegen die Transzendentalphilosophie präzisiert, auf das sich Fichte mit seiner Äußerung bezieht, wobei Maimons sich an Hume orientierendes Verständnis der Einbildungskraft im Zentrum steht. Zuletzt wird geprüft, in welchem Sinn Fichtes Deduktion der Einbildungskraft als Antwort auf Maimons Skeptizismus verstanden werden muss. (shrink)

In 1791 Karl Leonhard Reinhold expressed full agreement with Kant’s verdict that appeal to common understanding is not acceptable in philosophy. Only three years later Reinhold presented a philosophical methodology in which common understanding was explicitly assigned an essential function. In my contribution, I shall first reconstruct Reinhold’s account of the relation between common understanding and philosophising reason (Section 2). According to this account, common understanding is supposed to provide a multitude of empirical facts of consciousness. Philosophising reason takes these (...) facts as the starting point of philosophical analysis and establishes their a priori, transcendental grounds. Common understanding and philosophising reason thus fulfil complementary roles: philosophy analyses, explains, and justifies the basic beliefs of common understanding; philosophical claims are, in turn, substantiated through their reference to the facts provided by common understanding. I shall also show that the account of the relation between common understanding and philosophising reason enables Reinhold to deal with some objections against his philosophical system. The appeal to common understanding thus serves the purpose of corroborating the structure and the contents of the Elementarphilosophie. In Section 3, I shall suggest that Reinhold’s introduction of common understanding was not influenced by common-sense philosophy but rather by the Wolffian conception of the relation between common cognition and philosophical cognition. Reinhold accepted the general outline of Wolff’s rationalist conception but adopted it to the framework of critical philosophy. In my concluding remarks (Section 4) I shall briefly indicate that the main characteristics of the account of the relation between common understanding and philosophical reason withstood Reinhold’s later changes of philosophical systems. (shrink)

Ding und Begriff stellen den Kern von Peter F. Strawsons Philosophie dar: Worauf beziehen wir uns in unserem alltaglichen Denken und Sprechen und unter welchen Bedingungen konnen wir uns darauf beziehen? Mit dieser Frage, wie wir die Welt begrifflich erfassen, sind eine Reihe von Problemstellungen metaphysisch-ontologischer, epistemologischer, logischer und sprachphilosophischer Natur verbunden. An sie knupfen die hier versammelten Beitrage an. Die systematische Auseinandersetzung mit Strawsons Themen zeigt einige Schwachen seiner Positionen auf, weist aber auch Wege zu moglichen Losungen und bettet (...) Strawsons Philosophieren dadurch in aktuelle Debatten ein.". (shrink)

Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person’s health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001–2004), 350 reports on (...) health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient’s death wish and the intention to solicit assisted suicide. Physicians’ attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient’s request by highlighting a history of suffering as well as reporting understanding and agreement with the patient’s wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient’s death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue. (shrink)

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to (...) patients and their families. Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees. (shrink)

The term fuzzy logic is used in this paper to describe an imprecise logical system, FL, in which the truth-values are fuzzy subsets of the unit interval with linguistic labels such as true, false, not true, very true, quite true, not very true and not very false, etc. The truth-value set, , of FL is assumed to be generated by a context-free grammar, with a semantic rule providing a means of computing the meaning of each linguistic truth-value in as a (...) fuzzy subset of [0, 1].Since is not closed under the operations of negation, conjunction, disjunction and implication, the result of an operation on truth-values in requires, in general, a linguistic approximation by a truth-value in . As a consequence, the truth tables and the rules of inference in fuzzy logic are (i) inexact and (ii) dependent on the meaning associated with the primary truth-value true as well as the modifiers very, quite, more or less, etc. (shrink)

I explore some of the ways that assumptions about the nature of substance shape metaphysical debates about the structure of Reality. Assumptions about the priority of substance play a role in an argument for monism, are embedded in certain pluralist metaphysical treatments of laws of nature, and are central to discussions of substantivalism and relationalism. I will then argue that we should reject such assumptions and collapse the categorical distinction between substance and property.

The best-interests standard is a widely used ethical, legal, and social basis for policy and decision-making involving children and other incompetent persons. It is under attack, however, as self-defeating, individualistic, unknowable, vague, dangerous, and open to abuse. The author defends this standard by identifying its employment, first, as a threshold for intervention and judgment (as in child abuse and neglect rulings), second, as an ideal to establish policies or prima facie duties, and, third, as a standard of reasonableness. Criticisms of (...) the best-interests standard are reconsidered after clarifying these different meanings. (shrink)

Several types of inferences are employed in the diagnosis and prognosis of patients with brain injuries and disorders of consciousness. These inferences introduce unavoidable uncertainty, and can be evaluated in light of inductive risk: the epistemic and nonepistemic risks of being wrong. This article considers several ethically significant inductive risks generated by and interacting with inferences about patients with disorders of consciousness, and argues for prescriptive measures to manage and mitigate inductive risk in the context of disorders of consciousness.

Suppose that the ultimate point of ethics is to make the world a better place. If it is, we must face the question: better in what respect? If the good is prior to the right — that is, if the rationale for all requirements of the right is that they serve to further the good in one way or another — then what is this good? Is there a single fundamental value capable of underlying and unifying all of our moral (...) categories? If so, how might it defeat the claims of rival candidates for this role? If not, is there instead a plurality of basic goods, each irreducible to any of the others? In that case, how do they fit together into a unified picture of the moral life? These are the questions I wish to address, in a necessarily limited way. To many the questions will seem hopelessly old-fashioned or misguided. Some deontologists will wish to reverse my ordering of the good and the right, holding that the right constrains acceptable conceptions of the good. For many contractarians, neither the good nor the right will seem normatively basic, since both are to be derived from a prior conception of rationality. Finally, some theorists will reject the classification of moral theories in terms of their basic normative categories, arguing that the whole foundationalist enterprise in ethics should be abandoned. In the face of these challenges to the priority of the good, and in light of the many current varieties of moral skepticism and relativism, I cannot provide a very convincing justification for raising the questions I intend to discuss. (shrink)

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. -/- This book examines the entanglement of epistemic and ethical (...) uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents. (shrink)

Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic (...) concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered “content neutral” not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and “operationalize” the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore. (shrink)

Progress in automatic control, particularly in optimizing and self‐adaptive controls, is used to establish models in order to connect three horizons: knowledge, human activities and automatic controls. The guiding operation in all these horizons is recognished as the evolution. In the horizon of automatic controls, the evolutions can be said closed, since they are completely defined. In the horizon of human activities, they can be said open, because their over all direction depends both on the constituents and on the partial (...) accomplishment. In the horizon of the acquisition of the knowledge, there appear to be both evolutions in closed and open form; the problem is therefore to know whether these evolutions are teleological or homeostatic. There does not seem to be a ready answer; it could however probably be accelerated by better knowing the concept of matching the analogy. (shrink)