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)

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)

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)

In this article, the authors examine the circumstances under which scholars can become effective figures of identification in medicine, after whom prizes or institutions are named – and under which circumstances scholars cannot or can no longer fulfill such a role. Trends and changes in professional cultural memory are examined, illustrated by the biographies and receptions of the human geneticist Hans Nachtsheim, the circulatory researcher Rudolf Thauer, the urologist Dora Teleky as well as the dentists Karl Häupl and Elsbeth von (...) Schnizer. This study shows that the evaluation criteria themselves are historically changeable and that gender is an important influencing factor. While formal criteria (e. g., membership in parties and organizations) have traditionally been important evaluation criteria, the authors advocate that actions in research and clinical practice be given even greater attention in the future. (shrink)

Remind little ones that God will always be there to love, support, and comfort them--no matter the situation--with this uplifting, reassuring board book. This powerful little book is filled to the brim with hope and comfort. Simple, child-friendly verse outlines relatable moments of crisis, uncertainty, and fear common to a child's life, and asks who helps us in each of those scenarios. "God, that's who" is the reliable answer, forming a pattern kids will quickly pick up on. Each answer reinforces (...) the book's deeply comforting message: God is always there for us. He loves us, He knows us, and He cares about our needs. As they listen to the book and look at the reassuring illustrations, little ones will learn that they can lean on God when they are upset or frightened, or anytime at all. (shrink)

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)

Since the 1980s scholars have been increasingly confronted with expectations to orient themselves toward societal and economic priorities. This normative demand for societal responsiveness is inscribed in discourses aimed at increasing the usefulness, competitiveness, and control of academia. New performance criteria, funding conditions, and organizational forms are central drivers of this debate – thereby, they change the conditions in which scholars conduct research and advance their careers. However, little is known so far about the impact these institutional changes have on (...) the habitus of academics. This article analyzes how stable and consistent habitus formations among academics turn out to be in the course of institutional changes. We compare the habitus formations of two generations of German scholars before and after institutional changes gained pace in Germany. Three distinct habitus formations can be identified, which we refer to as “self-fulfilling,” “self-surpassing,” and “self-asserting.” These habitus formations hold across the two generations, but the lines between them become blurry in the new generation. (shrink)

Cet article discute, à travers le parcours critique d’un récent ouvrage d’Anselm Jappe, la thèse d’une illimitation « narcissique » constitutive de la forme subjective propre aux rapports de production capitalistes contemporains. Montrant que cette perspective est fondée sur une conception monolithique et unilatérale de l’histoire du capital et de ses sujets, ainsi que sur une réduction illégitime de toute forme d’in????inité au « mauvais in????ini » de l’illimitation, nous soutenons la nécessité de penser un infini positif irréductible tant à (...) l’illimitation abstraite de la valorisation qu’aux dispositifs capitalistes qui limitent les puissances d’autodétermination et d’autoactivation des individus.This article critically discusses the thesis, recently developed by Anselm Jappe, of a “narcissistic” illimitation constitutive of the subjective form typical of contemporary capitalist relations of production. By showing that this perspective is grounded on a monolithic and one-sided conception of the history of capital and its subjects, as well as on an illegitimate reduction of every form of infinity to the “bad infinity” of illimitation, we defend the necessity to conceive a positive form of infinity, irreducible to both the abstract illimitation of valorization and the capitalist apparatuses that limit the individual power of self-determination and self-activity. (shrink)

In this paper we elaborate Lacan's theory on courtly love to establish a link between literature, psychoanalytic practice and psychoanalytic theory. Lacan himself had already established the link between courtly love and psychoanalytic practice as a way of working through the mourning for the structural lack in the Symbolic order. As such, both can be seen as an anticipation of anticipation: not the object itself is anticipated, but rather the anticipation of this object. Through the use of Stiegler's reinterpretation of (...) the concept of the pharmakon we understand psychoanalytic theory and literature in general as attempts to work through this mourning by creating an anamnesis, a “long circuit” of knowledge in which the creators are implied with their own subjectivity. An analysis of Graham Swift's novel Ever After and of Italo Calvino's novel If on a winter's night a traveler demonstrate how this principle applies to the processes of writing and reading. (shrink)

In his recent political writings, Habermas has opposed his cosmopolitan project to that of the Bushite neoconservatives. However, this article argues that in some respects Habermas's works come closer to the neoconservative agenda than he realizes and that this poses a potential danger of its being appropriated by precisely the camp he opposes. These problems particularly come to the fore in his analysis of Islamic fundamentalism, democracy and the Middle East, but also in his recommendations concerning UN-based internationalism and his (...) appeals to Woodrow Wilson. By tracking these problematic areas in Habermas's work, this article argues that Habermas needs to engage in a more carefully articulated, concrete and empirical analysis if he is to avoid these problems. (shrink)

This paper makes the point that Kierkegaard’s ideas concerning individuality cannot be understood clearly without placing them in the context of what I am calling ontological isolation. This means the radical deprivation by selfhood of every aspect of reality, to the point where not even the possibility or illusion of reality is available to the self. In this context the self is required to become itself, forming itself in and out of its own absolute nothingness, ontological destitution, or wrongness. With (...) this form of isolation as our investigative key, we unlock what Kierkegaard means by his command to become a self, where becoming itself, in absence of prior possibility, constitutes the reality of self, and why Kierkegaard places crucial emphasis, contrary to the tradition, on the priority of negativity. By having the self originate itself in “absolute difficulty,” or that wherein the act itself, or pure doing without result, is primary, Kierkegaard now replaces metaphysics with ethics in order of priority, and places the self inseparably in a world that responds directly to that act. I show here a parallel between Kierkegaard’s approach to ethical action with that of artistic creation of a kind of world, the work of art. In doing so I reveal the inadequacy of interpretations that would impose traditional forms of isolation, social and cosmic, on Kierkegaard, as some of his critics do, or that would place Kierkegaard’s ethics within traditional developmental models, as many of his sympathizers do. (shrink)