This article presents the new German law on advance directives from 1 September 2009. The history of the parliamentary process of this law is described, the present regulations are explained, their relevance for medical practice discussed and shortcomings are identified. Finally, the new law is compared with other regulations in the international context. Previously established legal practice in Germany has now become largely confirmed by the new law: An advanced directive must be respected in any decision concerning medical treatment, regardless (...) of the stage of the illness. It can be informally revoked at any time, even with limited decision-making capacity. Nobody may be obliged to issue a directive in any way. Advance directives do not need notarisation or routine updating after certain time intervals. Provided that the patient, who is no longer mentally competent, has issued a lasting power of attorney, or provided that the patient has been appointed a healthcare proxy by the courts, this authorised surrogate must assert the patient's will. The role of the guardianship court is clarified: it only needs to be involved in cases of disagreement as to the patient's will. The new German law thus combines more legal certainty with a liberal emphasis on patient autonomy and flexible, adaptable regulations. (shrink)

Richard Koch first made his appearance in the 1920s with works published on the foundations of medicine. These publications describe the character of medicine as an action and the status of medicine within the theory of science. One of his conclusions is that medicine is not a science in the original sense of the word, but a practical discipline. It serves a practical purpose: to heal the sick. All medical knowledge is oriented towards this purpose, which also defines the physician’s (...) role. One kind of knowledge is diagnosis, which is strictly understood in relation to therapy, and is at the core of medical thinking. Diagnosis is not the assignment of a term of a species to a patient’s disease: this would not do justice to the individuality of a clinical manifestation and would fail to provide a reason for individual therapy. Nevertheless, the terms assigned to diseases, although fictitious, are not useless, but assist in differentiating various phenomena. These conclusions carry ethical consequences. Because the task of helping the sick constitutes medicine, morals not only set ethical limits: medicine originates in a moral decision. If there are no diseases but only individual sick people, disease can not be defined as an abnormality. The individual benefit to the patient must not necessarily be the complete restoration of health. With its object being incalculable, medicine cannot guarantee its own success. Here the physician has to develop principles that allow for the best possible response to the challenges faced in varying situations of conduct. (shrink)

Richard Koch1 became known in the 1920s with works on basic medical theory. Among these publications, the character of medical action and its status within the theory of science was presented as the most important theme. While science is inherently driven by the pursuit of knowledge for its own sake, medicine pursues the practical purpose of helping the sick. Therefore, medicine must be seen as an active relationship between a helping and a suffering person. While elucidating this relationship, Koch discusses (...) the fundamental elements of medicine found in natural philosophy and the relationship of medicine to its own history. One of his aims is to unite natural history and the history of ideas without reducing intellectual processes to biological ones. Koch considers free will as something intuitively certain. It must serve as an axiom which will capture human as well as non-human reality. Based on the fact that human free will, considered a psychic quality, evolved out of inanimate matter, Koch grants matter (proto-) psychic qualities. They are evoked through specific constellations of matter. – With regard to history, Koch rejects the notion of constant progress. The history of medicine has provided insights that cannot be surpassed but can be obscured. Historical self-contemplation serves as a means for avoiding any deviations which may prevent medicine from fulfiling its ultimate purpose. Koch connects nature and history through the concept of a unity between natural history and the historical development of medicine. Medicine is considered an especially complex development of a purposive reaction to harmful stimuli, a reaction which can already be encountered in unicellular organisms. Without intending to reduce historical and mental processes to biological ones, Koch sets for himself the aim of gathering different phenomena and presenting them in one encapsulating unity. (shrink)

Der Beitrag nähert sich dem Phänomen des Luxus und seiner sehr unterschiedlichen, in Teilen auch unvereinbaren Deutungen. Ziel ist es nicht, eine bestimmte Konzeption als die überlegene oder letztendlich richtige herauszustellen, sondern die Vielfalt der Zugänge aufzufächern. Diese umfassen dezidiert kulturkritische bis kulturpessimistische Deutungen, scharfe Kontrastierungen von Luxus und Askese oder kapitalismuskritische Einsätze. Näher betrachtet werden Peter Sloterdijks historisch-anthropologische Hypothese, der zufolge der auf eine sehr spezifische Weise verstandene Luxus eine zentrale Bedingung für die Menschwerdung des homo sapiens ist; das (...) u.a. von Thorstein Veblen vertretene soziologische Standardmodell, das Luxus funktional als Mittel zum Zweck fasst; Werner Sombarts Versuch, Luxus als Motor der Entwicklung kapitalistischer Gesellschaften zu rekonstruieren; schließlich Lambert Wiesings Phänomenologie des Luxus, die ihrerseits ganz eigene Wege beschreitet. (shrink)

Die Philosophie von Hans Jonas hat eine tiefe Wirkung auf ein weites Spektrum von Lesern in Europa, Asien und in Amerika entfaltet. Mit seinem ethischen Entwurf "Das Prinzip Verantwortung" gewann er insbesondere in Deutschland in der ökologischen Bewegung in den 70er Jahren einen enormen Einfluss. Die Autoren dieses von Christian Wiese und Eric Jacobson herausgegebenen Bandes (u.a. Micha Brumlik, Konrad Liessmann, Michael Löwy) versuchen hier eine Neubewertung seines herausragenden Beitrags zum religionsgeschichtlichen und philosophischen Diskurs seiner Zeit. Erstmals liegt hier der (...) Versuch vor, die vier zentralen Elemente des Werkes von Hans Jonas in ihrer Gesamtheit und ihrem inneren Zusammenhang zu beleuchten: deutsch-jüdische Geistesgeschichte des 20. Jahrhunderts, Erforschung der spätantiken Gnosis, Ethik und Philosophie der Verantwortung für die technologische Zivilisation sowie theologische Reflexionen nach dem Zivilisationsbruch von Auschwitz. Die international anerkannten Forscherinnen und Forscher arbeiten die vielfältigen Facetten des Denkens von Hans Jonas heraus. Sein leidenschaftliches Plädoyer für die "Weiterwohnlichkeit der Welt" ist vor diesem Hintergrund von bleibender Aktualität. (shrink)

This article argues that the causal loops that occur in some time-travel scenarios and in certain solutions of the theory of relativity are no more mysterious than the infinitely descending causal chains familiar from Newtonian mechanics.

It is argued by Lie et al in the current issue of the Journal of Medical Ethics that an international consensus opinion has formed on the issue of standards of care in clinical trials undertaken in developing countries. This opinion, so they argue, rejects the Declaration of Helsinki’s traditional view on this matter. They propose furthermore that the Declaration of Helsinki has lost its moral authority in the controversy in research ethics. Although the latter conclusion is supported by this author, (...) it will be demonstrated in this paper that there is not such a thing as an international consensus opinion, and that the authorities used by Lie et al as evidence in support of their claim should not be relied upon as authorities or final arbiters in this debate. Furthermore, it will be shown that arguments advanced substantively to show that lower standards of care are ethically acceptable in the developing world, conflate scientific with economic reasons, and ultimately fail to bolster the case they are designed to support. (shrink)

According to the concept of direct parameter specification, nonconsciously registered information can be processed to the extent that it matches currently active intentions of a person. This prediction was tested and confirmed in the current study. Masked visual information provided by peripheral cues led to reaction time effects only if the information specified one of the required responses . Information delivered by the same masked cues that did not match the intentions was not used. However, the same information influenced RT (...) if it was provided by visible cues . The results suggest that the processing of nonconsciously registered information is flexible because it is susceptible to the changing intentions of a person. Yet, these processes are apparently restricted, as nonconsciously registered information cannot be used as easily for purposes not corresponding to the currently active intentions as better visible information. (shrink)

Based on extensive questionnaire data, this paper focuses on parents’ views about children’s right to decide about participation in research. The data originates from 4000 families participating in a longitudinal prospective screening as 1997. Although current regulations and recommendations underline that children should have influence over their participation, many parents in this study disagree. Most (66%) were positive providing information to the child about relevant aspects of the study. However, responding parents were split about whether or not children should at (...) some point be allowed decisional authority when participating in research: 41.6% of the parents reported being against or unsure. Those who responded positively believed that children should be allowed to decide about blood-sampling procedures (70%), but to a less extent about participation (48.5%), analyses of samples (19.7%) and biological bank storage (15.4%). That as many as possible should remain in the study, and that children do not have the competence to understand the consequences for research was strongly stressed by respondents who do not think children should have a right to decide. When asked what interests they consider most important in paediatric research, child autonomy and decision-making was ranked lowest. We discuss the implications of these findings. (shrink)

This paper offers a critique of the Bayesian interpretation of quantum mechanics with particular focus on a paper by Caves, Fuchs, and Schack containing a critique of the “objective preparations view” or OPV. It also aims to carry the discussion beyond the hardened positions of Bayesians and proponents of the OPV. Several claims made by Caves et al. are rebutted, including the claim that different pure states may legitimately be assigned to the same system at the same time, and the (...) claim that the quantum nature of a preparation device cannot legitimately be ignored. Both Bayesians and proponents of the OPV regard the time dependence of a quantum state as the continuous dependence on time of an evolving state of some kind. This leads to a false dilemma: quantum states are either objective states of nature or subjective states of belief. In reality they are neither. The present paper views the aforesaid dependence as a dependence on the time of the measurement to whose possible outcomes the quantum state serves to assign probabilities. This makes it possible to recognize the full implications of the only testable feature of the theory, viz., the probabilities it assigns to measurement outcomes. Most important among these are the objective fuzziness of all relative positions and momenta and the consequent incomplete spatiotemporal differentiation of the physical world. The latter makes it possible to draw a clear distinction between the macroscopic and the microscopic. This in turn makes it possible to understand the special status of measurements in all standard formulations of the theory. Whereas Bayesians have written contemptuously about the “folly” of conjoining “objective” to “probability,” there are various reasons why quantum-mechanical probabilities can be considered objective, not least the fact that they are needed to quantify an objective fuzziness. But this cannot be appreciated without giving thought to the makeup of the world, which Bayesians refuse to do. Doing this on the basis of how quantum mechanics assigns probabilities, one finds that what constitutes the macroworld is a single Ultimate Reality, about which we know nothing, except that it manifests the macroworld or manifests itself as the macroworld. The so-called microworld is neither a world nor a part of any world but instead is instrumental in the manifestation of the macroworld. Quantum mechanics affords us a glimpse “behind” the manifested world, at stages in the process of manifestation, but it does not allow us to describe what lies “behind” the manifested world except in terms of the finished product—the manifested world, for without the manifested world there is nothing in whose terms we could describe its manifestation. (shrink)

Historical development of Muslim leaders organization in Burma.

Based on extensive clinical questionnaire data, this paper explores the relation between research subjects’ self-assessed understanding and actual knowledge of a large-scale predictive screening study, and its implications for the proper handling of information and consent routines in longitudinal studies. The intitial data show that low self-assessed understanding among participants was correlated with limited knowledge, concern over participation and collected samples, less satisfaction with information, and feeling passive or negative towards the study. Among those reporting high understanding, a non-negligible number (...) displayed a lack of knowledge regarding central aspects of the study. Regarding high assessed understanding, the multivariate analysis identified the main predictor variables to be knowledge, having a positive attitude towards participation and the study itself, being satisfied with information, having a stable psychosocial background and feeling calm regarding the handling of samples. These findings indicate that to evaluate participants' understanding through self-assessment may not be reliable method. Self-assessed understanding may rather be a good indicator of general attitudes than a tool for analysing content. The data also show that actual understanding varies considerably among participants, suggesting that more effort needs to be put into adjusting the information to the needs of different subgroups. It is argued that when doing this, researchers in longitudinal studies must be careful not to exhaust participants with excessive information that they do not want and that may cause them to drop out. The ethical relevance of obtaining repeated consents in longitudinal research is discussed. (shrink)

Tom 1. Lekt︠s︡ii. Vospominanii︠a︡ -- t. 2. Filosofskai︠a︡ ontologii︠a︡ -- t. 3. Filosofskai︠a︡ ontologii︠a︡ segodni︠a︡; Nauchnye statʹi.

Lambert Wiesing's The Philosophy of Perception challenges current theories of perception. Instead of attempting to understand how a subject perceives the world, Wiesing starts by taking perception to be real. He then asks what this reality means for a subject. In his original approach, the question of how human perception is possible is displaced by questions about what perception obliges us to be and do. He argues that perception requires us to be embodied, to be visible, and to (...) continually participate in the public and physical world we perceive. Only in looking at images, he proposes, can we achieve something like a break in participation, a temporary respite from this, one of perception's relentless demands. Wiesing's methods chart a markedly new path in contemporary perception theory. In addition to identifying common ground among diverse philosophical positions, he identifies how his own, phenomenological approach differs from those of many other philosophers, past and present. As part of the argument, he provides a succinct but comprehensive survey of the philosophy of images His original critical exposition presents scholars of phenomenology, perception and aesthetics with a new, important understanding of the old phenomenon, the human being in the world. (shrink)