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)
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)
We show that the variety of n -dimensional weakly higher order cylindric algebras, introduced in Németi [9], [8], 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 [13]. 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)
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 [2].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)
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 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)
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)
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.
Prompted by a recommendation of the two Christian hospital associations in Germany, the Neu-Mariahilf Hospital in Goettingen set up a health ethics committee in autumn 1998. It is the committee's task to give support to staff members, patients and their relatives in individual cases where ethical dilemmas arise. The following article descibes the committee's work by means of three cases.
The paper investigates the notion of friendship in Aristotle’s moral philosophy. The key issue here is what role Aristotle attributes to the ‘other’ as friend in the self-appreciation of the moral individual. The discussion proceeds in three main steps: first I chart the anthropological connections of the Aristotelian notion of friendship; then I delineate in detail the discussions of self-knowledge and self-cognition in the framework of Aristotle’s ontology and philosophy of perception; finally, I set out what consequences Aristotle’s repeated assertion (...) that ‘the friend is another self’ has for the self-understanding of the person. Through these steps I argue for the conclusion that the friend, as the ‘other’, plays an indispensable role, on the one hand in the formation of virtues which are required for right action, on the other in allowing the person to reach self-consciousness and freedom, both of them prerequisites for happiness in the full sense of the term. (shrink)
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.
We show the undecidability of the equational theories of some classes of BAOs with a non-associative, residuated binary extra-Boolean operator. These results solve problems in Jipsen [9], Pratt [21] and Roorda [22], [23]. This paper complements Andréka-Kurucz-Németi-Sain-Simon [3] where the emphasis is on BAOs with an associative binary operator.
We prove that the equational theory of a semigroups becomes undecidable if we add a semilattice structure with a ‘touch of symmetric difference’. As a corollary we obtain that the variety of all Boolean algebras with an associative binary operator has a ‘hereditarily’ undecidable equational theory. Our results have implications in logic, e.g. they imply undecidability of modal logics extending the Lambek Calculus and undecidability of Arrow Logics with an associative arrow modality.
We study the notion of H-dimension and the formally stronger k-variable property, as considered by Gabbay, Immerman and Kozen. We exhibit a class of flows of time that has H-dimension 3, and admits a finite expressively complete set of onedimensional temporal connectives, but does not have the k-variable property for any finite k.
The class $$\mathsf{TPA}$$ TPA 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 $$\mathsf{TPA}$$ TPA nor the first order theory of $$\mathsf{TPA}$$ TPA are decidable. Moreover, we show that the set of all equations valid in $$\mathsf{TPA}$$ TPA is exactly on the $$\Pi ^1_1$$ Π 1 1 level. We consider the class $$\mathsf{TPA}^-$$ (...) TPA - of the relation algebra reducts of $$\mathsf{TPA}$$ TPA ’s, as well. We prove that the equational theory of $$\mathsf{TPA}^-$$ TPA - is much simpler, namely, it is recursively enumerable. We also give motivation for our results and some connections to related work. (shrink)
Rights to life for unborn humans and to abortion with impunity are incompatible. This observation by the German legal philosopher Norbert Hoerster contains a fundamental criticism of the state regulation on abortion in Germany. The regulation regards abortion as unlawful, but declines to prosecute if the abortion is conducted within the first three months of pregnancy and the pregnant woman received counseling at least three days prior to terminating the pregnancy. In contrast to the German legislature, Hoerster is in favor (...) of setting the beginning of a right to life at birth. With this suggestion and the consequent demand for a general legalization of abortion, Hoerster himself has become the target of harsh criticism. The following article analyzes Hoerster's position and that of his opponents against the background of the current abortion debate in Germany. The consequences for dealing with the handicaps of Hoerster's suggested regulations will also be addressed. (shrink)
In Radical Enlightenment, J. I. Israel gives no attention to the critique of religion expounded by Hume in the second half of the 18th century. Nevertheless, Hume, in elaborating his criticism from the methodological standpoint of the “Moderate Enlightenment”, that of experience, provides an original foundation to the critique of religion in the context of “Radical Enlightenment”. What is more, the conclusion of his Dialogues Concerning Natural Religion leads one in thinking that “Radical Enlightenment” might have been caught in the (...) net of theological dialectic in its opposition to Christianity. (shrink)
