The authors sum up the central issue of ethics in the conduct of controlled clinical trials in these two paradoxes: 'first, it is unethical to use treatment the efficacy of which has not been examined scientifically; second, it is also unethical to examine the efficacy of treatment scientifically.' In this paper they set out to demonstrate how these antithetical statements apply in controlled trials conducted in psychiatric patients. In such trials the problem of obtaining informed consent may be acute, but (...) in these patients giving 'informed' consent might contribute to a further exacerbation of the illness. Nevertheless the problem cannot be evaded, and scientific judgments must be applied to treatment for it to be sound and improved for the further benefit of patients. These problems in the case of psychiatric controlled trials are a part of the methodology, and in Germany a new drug law has been drafted to attempt to clarify the issue. The authors briefly discuss its application, and its consequences if such a law were enacted. British psychiatrists have exactly the same problems to face but so far no attempts have been made to establish a legal framework. (shrink)

Purpose: Commenting on the transcript of a lecture. Findings: The document reconstructs the development of the original 1973 lecture by Heinz von Foerster into his best-known paper, On Constructing a Reality. Many aspects of that paper can be identified as being shaped through interaction with the audience. Implications: The lecture documented here was a forerunner of a central paper in constructivism.

What role does non-genetic inheritance play in evolution? In recent work we have independently and collectively argued that the existence and scope of non-genetic inheritance systems, including epigenetic inheritance, niche construction/ecological inheritance, and cultural inheritance—alongside certain other theory revisions—necessitates an extension to the neo-Darwinian Modern Synthesis (MS) in the form of an Extended Evolutionary Synthesis (EES). However, this argument has been challenged on the grounds that non-genetic inheritance systems are exclusively proximate mechanisms that serve the ultimate function of calibrating organisms (...) to stochastic environments. In this paper we defend our claims, pointing out that critics of the EES (1) conflate non-genetic inheritance with early 20th-century notions of soft inheritance; (2) misunderstand the nature of the EES in relation to the MS; (3) confuse individual phenotypic plasticity with trans-generational non-genetic inheritance; (4) fail to address the extensive theoretical and empirical literature which shows that non-genetic inheritance can generate novel targets for selection, create new genetic equilibria that would not exist in the absence of non-genetic inheritance, and generate phenotypic variation that is independent of genetic variation; (5) artificially limit ultimate explanations for traits to gene-based selection, which is unsatisfactory for phenotypic traits that originate and spread via non-genetic inheritance systems; and (6) fail to provide an explanation for biological organization. We conclude by noting ways in which we feel that an overly gene-centric theory of evolution is hindering progress in biology and other sciences. (shrink)

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas (...) as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment. (shrink)

I am very happy indeed to contribute to this series of lectures, especially because I owe most of my training in philosophy to Elizabeth Anscombe, whose work has given the series its name. I am deeply indebted to the marvellous generosity of her teaching, to the example she set me of an unrelentingly thorough and serious thinker, to the unobtrusive way she introduced me to Wittgenstein's later philosophy. Through Elizabeth Anscombe I also made the acquaintance of my friend Philippa Foot, (...) whose work in moral philosophy has, over decades and more than anyone else's, influenced my own. I hope it will be possible to recognize in what I am going to say here not indeed the excellence but at least traces of the beneficial influence of both these philosophers. (shrink)

In Part I of ‘Causality and Determination” (CD), Anscombe writes that (1) we understand causality through understanding specific causal expressions, (2) efficient causation can be perceived, (3) “causality consists in the derivativeness of an effect from its causes”, and 4) no “analysis in terms of necessity or universality” has a place for this. Theses (1) and (2) represent fundamental and important insights. (3) is unsatisfactory; for, taken in a sense that does not already build on the general notion of causation, (...) deriving from does little to elucidate this notion. CD is however right to urge the need to identify a “core, the common feature, of causality in its various kinds”—a kind of criterion, such as the one suggested by Makin (2000), that takes account of (4) in that it is more substantial than, but does not entail, “necessity or universality”. What CD seems to underestimate is the important role of regularities, possibly neither necessary nor exceptionless, for our understanding of the causal relation. Finally, such understanding also requires us, not only to rely on a common criterion of causation, but also on a subjective component of this idea: the consciousness of our own causal agency. Anscombe’s own investigations into non-observational practical knowledge open the door to the study of this aspect of causality. (shrink)

Do the virtues, as is often said, conflict with each other? The history of philosophy knows various attempts to conceive of them so as to exclude such conflict. Nicolai Hartmann ("Ethik", 1925) is the most prominent representative "and" critic of this tradition in our century. Each Aristotelian "mean", for him, represents a "synthesis" of "conflicting values"; but only the "one and only virtue" synthesizing "all" values would exclude all tragic conflict. In contrast, the Aristotelian and medieval conception of "connexio virtutum" (...) by "prudence" allows the virtues to "limit each other" and thus be "compatible" without merging into one super-virtue. (shrink)

Mit diesem Buch geht die analytische Handlungstheorie neue Wege. Statt den von Davidson vorgezeichneten Mustern zu folgen, knüpft der Autor an die aristotelische Unterscheidung von poiesis und praxis an, um die komplexen teleologischen Strukturen menschlichen Handelns zu untersuchen. Als überraschend ergiebiger Leitfaden erweist sich dabei der Begriff der Erziehung. Eine Fülle detaillierter Analysen zeitigt nicht nur anthropologisch und moralphilosophisch bedeutsame Resultate, sondern auch zeitkritische Folgerungen. 'Wie im Bereich der Erziehung, so gewöhnen wir uns auch sonst daran, die Wirklichkeit unseres Handelns (...) mit Kategorien des Hervorbringens zu überziehen und auch da nach Produkten zu suchen, wo es eigentlich um die Qualität des Lebens geht. Angesichts solcher Verirrungen fundamentale Strukturen und Ansprüche praktischer Vernunft erneut zu bedenken, ist heute vielleicht die vornehmste Aufgabe der Handlungsphilosophie.'. (shrink)

The volume brings together a collection of original papers on some of the main tenets of Joseph Raz's legal and political philosophy: Legal positivism and the nature of law, practical reason, authority, the value of equality, incommensurability, harm, group rights, and multiculturalism.

Background: Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). Methods: An anonymous questionnaire was sent to the 411 (...) DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of “intolerable suffering” in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. Results: The response rate was 61% (n=251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. Conclusions: In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents’ negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests for EUT by terminally ill patients. (shrink)

Context: Many recent research areas such as human cognition and quantum physics call the observer-independence of traditional science into question. Also, there is a growing need for self-reflexivity in science, i.e., a science that reflects on its own outcomes and products. Problem: We introduce the concept of second-order science that is based on the operation of re-entry. Our goal is to provide an overview of this largely unexplored science domain and of potential approaches in second-order fields. Method: We provide the (...) necessary conceptual groundwork for explorations in second-order science, in which we discuss the differences between first- and second-order science and where we present a roadmap for second-order science. The article operates mainly with conceptual differentiations such as the separation between three seemingly identical concepts such as Science II, Science 2.0 and second-order science. Results: Compared with first-order science, the potential of second-order science lies in 1. higher levels of novelty and innovations, 2. higher levels of robustness and 3. wider integration as well as higher generality. As first-order science advances, second-order science, with re-entry as its basic operation, provides three vital functions for first-order science, namely a rich source of novelty and innovation, the necessary quality control and greater integration and generality. Implications: Second-order science should be viewed as a major expansion of traditional scientific fields and as a scientific breakthrough towards a new wave of innovative research. Constructivist content: Second-order science has strong ties with radical constructivism, which can be qualified as the most important root/origin of second-order science. Moreover, it will be argued that a new form of cybernetics is needed to cope with the new problems and challenges of second-order science. (shrink)