Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt to address the dynamics (...) of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family’s wishes and may withhold the ‹naked truth’ about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists. (shrink)
This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded . Their answers demonstrate that in (...) their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive. (shrink)
Das deutsche Gesundheitswesen steht durch die schnell steigende Anzahl an CO- VID-19-Erkrankten vor erheblichen Herausforderungen. In dieser Krisensituation sind alle Beteiligten mit ethischen Fragen konfrontiert, beispielsweise nach gerech- ten Verteilungskriterien bei begrenzten Ressourcen und dem gesundheitlichen Schutz des Personals angesichts einer bisher nicht therapierbaren Erkrankung. Daher werden schon jetzt klinische und ambulante Ethikberatungsangebote verstärkt mit Anfragen nach Unterstützung konfrontiert. Wie können Ethikberater*innen Entscheidungen in der Krankenversorgung im Rahmen der COVID-19-Pandemie unterstützen? Welche Grenzen von Ethikberatung sind zu beachten? Bislang liegen hierzu (...) noch wenige praktische Erfahrungen vor. Angesichts der dynamischen Entwicklung erscheint es der Akademie für Ethik in der Medizin (AEM) wichtig, einen Diskurs über die angemessene Rolle der Ethikberatung bei der Bewältigung der vielfachen Heraus- forderungen durch die COVID-19-Pandemie zu führen und professionelle Hinweise zu geben. Mit dem vorliegenden Diskussionspapier möchte die AEM einen Beitrag zur Beantwortung wesentlicher Fragen leisten, die sich für die Ethikberatung in den verschiedenen Bereichen des Gesundheitswesens stellen. Sie regt an, diesen Dis- kurs weiter zu führen und hat ein Online-Forum (s. unten) eingerichtet, in dem Ethikberater*innen ihre Erfahrungen teilen und die professionelle Selbstreflexion der Ethikberatung in Pandemiezeiten mit Anregungen fördern können. (shrink)
The Hannover qualifying programme ‘ethics consultation in hospitals’, conducted by a four-institution cooperation partnership, is an interdisciplinary, scientifically based programme for healthcare professionals interested in ethics consultation services and is widely acknowledged by hospital managements and healthcare professionals. It is unique concerning its content, scope and teaching format. With its basic and advanced modules it has provided training and education for 367 healthcare professionals with 570 participations since 2003 (until February 2010). One characteristic feature is its attractiveness for health professionals (...) from different backgrounds. Internationally, the Hannover programme is one of the few schedules with both academics and non-academics as target groups and a high participation rate of physicians. The concept of the Hannover programme is in great demand, and its schedule is continuously optimised through evaluation. The goals of enabling healthcare professionals from different professional backgrounds to define and reflect ethical problems, to facilitate and support the process of decision-making and to work out structures for their own institutions seem to have been achieved. However, in order to obtain effective and sustainable results, participation in the programme should be supplemented regularly by in-house training sessions or individual expert consultations. Future challenges include new thematic courses and providing a network for former participants, especially when they come from non-academic hospitals. The network is a reasonable platform to discuss participants' experiences, successes and pitfalls. A further task will be research on how the programme's concept can support the sustainability of ethics structures in the various institutions. (shrink)
The interdisciplinary Hannover Qualification Programme on ethics consultation has trained hospital staff to operate clinical ethics services in their respective hospitals since 2003. To evaluate Hannover Qualification Programme, all former participants were contacted using an online questionnaire including four domains: status quo before attending Hannover Qualification Programme, present status, impact of Hannover Qualification Programme, future challenges. Research objectives were the long-term satisfaction with Hannover Qualification Programme and its impact on clinical ethics services. The response rate was 45%. Hannover Qualification Programme (...) was evaluated as helpful and the responders were capable of applying their acquired skills. Most participants could contribute to the implementation of clinical ethics services. They were satisfied with Hannover Qualification Programme and with the degree of changes in their hospitals. In conclusion, clinical ethics education had long-term effects on trainees and on their respective hospitals. Problems were mentioned rather in the field of utilisation than with implementation or quality of clinical ethics services. (shrink)
We show that the variety of n -dimensional weakly higher order cylindric algebras, introduced in Németi , , is finitely axiomatizable when n > 2. Our result implies that in certain non-well-founded set theories the finitization problem of algebraic logic admits a positive solution; and it shows that this variety is a good candidate for being the cylindric algebra theoretic counterpart of Tarski’s quasi-projective relation algebras.
Henkin and Tarski proved that an atomic cylindric algebra in which every atom is a rectangle must be representable . This theorem and its analogues for quasi-polyadic algebras with and without equality are formulated in Henkin, Monk and Tarski . We introduce a natural and more general notion of rectangular density that can be applied to arbitrary cylindric and quasi-polyadic algebras, not just atomic ones. We then show that every rectangularly dense cylindric algebra is representable, and we extend this result (...) to other classes of algebras of logic, for example quasi-polyadic algebras and substitution-cylindrification algebras with and without equality, relation algebras, and special Boolean monoids. The results of op. cit. mentioned above are special cases of our general theorems. We point out an error in the proof of the Henkin-Monk-Tarski representation theorem for atomic, equality-free, quasi-polyadic algebras with rectangular atoms. The error consists in the implicit assumption of a property that does not, in general, hold. We then give a correct proof of their theorem. Henkin and Tarski also introduced the notion of a rich cylindric algebra and proved in op. cit. that every rich cylindric algebra of finite dimension satisfying certain special identities is representable. We introduce a modification of the notion of a rich algebra that, in our opinion, renders it more natural. In particular, under this modification richness becomes a density notion. Moreover, our notion of richness applies not only to algebras with equality, such as cylindric algebras, but also to algebras without equality. We show that a finite dimensional algebra is rich iff it is rectangularly dense and quasi-atomic; moreover, each of these conditions is also equivalent to a very natural condition of point density . As a consequence, every finite dimensional rich algebra of logic is representable. We do not have to assume the validity of any special identities to establish this representability. Not only does this give an improvement of the Henkin-Tarski representation theorem for rich cylindric algebras, it solves positively an open problem in op. cit. concerning the representability of finite dimensional rich quasi-polyadic algebras without equality. (shrink)
The class \ of t rue p airing a lgebras is defined to be the class of relation algebras expanded with concrete set theoretical projection functions. The main results of the present paper is that neither the equational theory of \ nor the first order theory of \ are decidable. Moreover, we show that the set of all equations valid in \ is exactly on the \ level. We consider the class \ of the relation algebra reducts of \ ’s, (...) as well. We prove that the equational theory of \ is much simpler, namely, it is recursively enumerable. We also give motivation for our results and some connections to related work. (shrink)
Objectives: To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process.Design: The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process.Participants: 727 doctors in three federal states and 469 judges dealing with guardianship matters all over Germany.Main measurements: Comparisons of means, analyses of (...) variance, pivot tables and factor analyses .Results: Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days.Conclusions: A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue. (shrink)
This paper is a survey of recent results concerning connections between relation algebras , cylindric algebras and polyadic equality algebras . We describe exactly which subsets of the standard axioms for RA are needed for axiomatizing RA over the RA-reducts of CA3's, and we do the same for the class SA of semi-associative relation algebras. We also characterize the class of RA-reducts of PEA3's. We investigate the interconnections between the RA-axioms within CA3 in more detail, and show that only four (...) implications hold between them . In the other direction, we introduce a natural CA-theoretic equation MGR+, generalization of the well-known Merrry-Go-Round equation MGR of CA-theory. We show that MGR+ is equivalent to the RA-reduct being an SA, and that MGR+ implies that the RA-reduct determines the algebra itself, while MGR is not sufficient for either of these to hold. Then we investigate how different CA's a single RRA can 'generate' in the general case. We solve the first part of Problem 11 from the 'Problem Session Paper' of .While proving some of the statements, for others we give only outline of proof. The paper contains several open problems. A full version of this paper is under preparation.Keywords: relation algebras, cylindric algebras, polyadic algebras, algebraic logic, arrow logic, proof theory, finite variable fragments, provability with 3 variables, non-finitizability, twisting, non-standard models, neat reducts, representability. (shrink)
La présente contribution propose une étude de la périphérie gauche au sein d’un corpus oral multigenres, représentant douze activités de communication orale, annoté syntaxiquement et prosodiquement. La segmentation discursive du corpus en unités de base du discours (BDU) résulte d’une coïncidence entre unités syntaxiques et prosodiques, correspondant à des encodages linguistiques distincts mais complémentaires. Partant du postulat selon lequel ces unités discursives remplissent une fonction cognitive dans la planification et l’interprétation du discours, nous nous intéressons à l’étude de leur périphérie (...) gauche. Ce lieu, qui constitue le point d’ancrage du message, joue en effet un rôle important dans la négociation de la structure discursive. Dans l’objectif d’étudier les stratégies discursives à l’œuvre dans les différents genres du corpus, nous faisons l’inventaire des types formels observés et étudions finalement les fonctions discursives que ces éléments périphériques peuvent revêtir. (shrink)
ZusammenfassungDer Beitrag untersucht mögliche Kriterien für die normative Bewertung der künstlichen Ernährung bei nichteinwilligungsfähigen Patienten. Der in der aktuellen Diskussion immer wieder unternommene Versuch, den verpflichtenden Charakter bestimmter Formen der Ernährung aufgrund ihrer Zuordnung zu den Kategorien „Basisbetreuung“ oder „Remedia ordinaria“ zu begründen, erweist sich als naturalistischer Fehlschluss. Die Rechtfertigung der künstlichen Nahrungs- und Flüssigkeitszufuhr setzt vielmehr—wie die jeder anderen medizinischen Maßnahme—voraus, dass ihre Durchführung medizinisch begründet und vom Patienten gewollt ist. Dies trifft grundsätzlich auch auf den nicht mehr einwilligungsfähigen (...) Patienten zu; bei diesem kommt es auf den früher erklärten oder mutmaßlichen Willen an. (shrink)
We give an overview of decidability results for modal logics having a binary modality. We put an emphasis on the demonstration of proof-techniques, and hope that this will also help in finding the borderlines between decidable and undecidable fragments of usual first-order logic.
Au début du xxe siècle, les chansons populaires françaises font une large place à l’érotisme et décrivent sur le ton du comique ou de la grivoiserie les pratiques amoureuses. Construites autour de représentations du corps des femmes et faisant directement allusion à la séduction et à la sexualité, elles témoignent des attentes et des désirs des couples dans une société en pleine évolution.
The volume explores the hitherto uncharted late medieval religious landscape of Northern Germany. Through discussion of a rich, varied selection of mystical and devotional texts, also translated into English, a fascinating regional "mystical culture" with a far-reaching impact is revealed.
Acquaintance with the Absolute is the first collected volume of essays devoted to the thought of Yves r. Simon, a thinker widely regarded as one of the great teachers and philosophers of our time. Each piece in this collection of essays thoughtfully complements the others to offer a qualifiedly panoramic look at the work and thought of philosopher Yves R. Simon. The six essays presented not only treat some major areas of Simon’s thought, pointing out their lucidity and originality, but (...) also his underpinning metaphysics, so central to his thought. Rather than attempt to present all aspects of this patient, careful, and penetrating thinker, these essays select enough to situate Simon’s philosophical excavations – especially his moral, political and action theory – among contemporary Thomistic philosophy. In defending philosophy as a valid way of knowing, Simon gives us an approach we can use to avoid contemporary dilemmas in the philosophy of science. Simon holds that philosophical truths both justify scientific method as a way of knowing the real and provide a basis for distinguishing what is ontologically significant in a scientific theory from what is not. This view allows us to avoid the apparently irrational conclusions of quantum mechanics without reducing scientific theories to being mere projections of our conceptual systems. Though aspects of some of the essays are suited for students of Simon’s thought, the essays as a whole introduce the less familiar reader to this great thinking and, further, invite him or her to pursue Simon’s own texts. The volume is enhanced by the inclusion of a definitive Yves R. Simon bibliography 1923-1996. The annotated bibliography is cross-reference in detail, revealing the astonishing variety of topics Simon treated. (shrink)
Acquaintance with the Absolute is the first collected volume of essays devoted to the thought of Yves r. Simon, a thinker widely regarded as one of the great teachers and philosophers of our time. Each piece in this collection of essays thoughtfully complements the others to offer a qualifiedly panoramic look at the work and thought of philosopher Yves R. Simon. The six essays presented not only treat some major areas of Simon's thought, pointing out their lucidity and originality, but (...) also his underpinning metaphysics, so central to his thought. Rather than attempt to present all aspects of this patient, careful, and penetrating thinker, these essays select enough to situate Simon's philosophical excavations - especially his moral, political and action theory - among contemporary Thomistic philosophy. In defending philosophy as a valid way of knowing, Simon gives us an approach we can use to avoid contemporary dilemmas in the philosophy of science. Simon holds that philosophical truths both justify scientific method as a way of knowing the real and provide a basis for distinguishing what is ontologically significant in a scientific theory from what is not. This view allows us to avoid the apparently irrational conclusions of quantum mechanics without reducing scientific theories to being mere projections of our conceptual systems. Though aspects of some of the essays are suited for students of Simon's thought, the essays as a whole introduce the less familiar reader to this great thinking and, further, invite him or her to pursue Simon's own texts. The volume is enhanced by the inclusion of a definitive Yves R. Simon bibliography 1923-1996. The annotated bibliography is cross-reference in detail, revealing the astonishing variety of topics Simon treated. (shrink)