The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.

The distinquished American philosopher and historian of ideas, George H. Sabine, once remarked that the two great social ideals of liberty and equality, the subjects of this essay, are in effect but “shorthand for redressing quite definite grievances or bringing about quite definite results.” He went on to suggest that the social philosophies embodying these ideals are in large measure “occasional performances” which flourish in periods of social unrest where the “cake of custom” is broken and must be adjusted (...) to new contexts and problems. Sabine also suggested that for this reason history is an indispensable tool of analysis for most of the issues in social philosophy. (shrink)

The question of what characterizes feelings of being alive is a puzzling and controversial one. Are we dealing with a unique affective phenomenon or can it be integrated into existing classifications of emotions and moods? What might be the natural basis for such feelings? What could be considered their specifically human dimension? These issues are addressed by researchers from various disciplines, including philosophy of mind and emotions, psychology, and history of art. This volume contains original papers on the topic of (...) feelings of being alive by Fiorella Battaglia, Eva-Maria Engelen, Joerg Fingerhut, Thomas Fuchs, Alice Holzhey-Kunz, Matthias Jung, Tanja Klemm, Riccardo Manzotti, Sabine Marienberg, Matthew Ratcliffe, Arbogast Schmitt, Jan Slaby, and Achim Stephan. (shrink)

Was sind 'äußere' und 'innere' Bilder? Wie entstehen sie? Was sind ihre Korrelate? Seit der Antike bewegen diese Fragen Philosophie, Rhetorik, Literatur- und Kunstwissenschaft, gegenwärtig auch die Medien- und Intermedialitätsforschung und Neurowissenschaften. Als Beitrag zu Bild- und Literaturwissenschaften sowie Visual Studies bietet der Band interdisziplinäre Untersuchungen der Bewegung vom Sehen über das An-schauen zu Anschaulichkeit und Anschauung. Die Beiträge zeigen Verflechtungen zwischen Epistemologie und Ästhetik auf, erhellen Fragen von Imagination und Stil, stellen neue Bezüge zwischen unterschiedlichen Künsten, Medien und Ausdrucks-formen (...) her und bieten neue Einsichten in die visuell-imaginativen Dimensionen von Wissen, Erkenntnis und Erfahrung. (shrink)

On peut considérer que ce qui se produit dans le travail familial thérapeutique avec une famille dans une institution donnée est révélateur du fonctionnement de la famille tel que cette dernière le projette sur l’institution. Mais ce qui se passe dans cette thérapie peut aussi refléter le fonctionnement de l’institution à ce moment précis : ce qui se vit dans l’institution a souvent des répercussions sur les prises en charge thérapeutiques.

Este artículo estudia un corto tratado de polémica en contra del judaísmo escrito por el conocido erudito otomano Aḥmad Muṣṭafā Ṭāšhkubrīzāde. El autor utiliza los mismos argumentos que conocemos de la polémica religiosa medieval, tales como que la Torah, abrogada por el Islam, contenía referencias al Profeta Muḥammad a pesar de que su texto fue corrompido por los judíos. Además de la Biblia, Ṭāšhkubrīzāde cita una serie de fuentes judías tardías que añaden una importante dimensión a este trabajo. Después de (...) una breve introducción en que se discute la posibilidad de la deuda del autor respecto a la obra de Ibn Abī ‘Abd al-Dayyān, un converso del judaísmo al Islam, se presenta una edición y traducción del texto. (shrink)

A review of the scientific method. In the scientific method, results must be capable of being reproduced to be valid.

No one will deny that we live in a world where evil exists. But how are we to come to grips with human atrocity and its diabolical intensity? Martin Beck Matuštík considers evil to be even more radically evil than previously thought and to have become all too familiar in everyday life. While we can name various moral wrongs and specific cruelties, Matuštík maintains that radical evil understood as a religious phenomenon requires a religious response where the language of (...) hope, forgiveness, redemption, and love can take us beyond unspeakable harm and irreparable violence. Drawing upon the work of Kant, Schelling, Kierkegaard, Levinas, Derrida, and Marion, this work is written as a series of meditations. Matuštík presents a bold new way of dealing with one of humanity's most intractable problems. (shrink)

The central project of the Critique of Pure Reason is to answer two sets of questions: What can we know and how can we know it? and What can't we know and why can't we know it? The essays in this collection are intended to help students read the Critique of Pure Reason with a greater understanding of its central themes and arguments, and with some awareness of important lines of criticism of those themes and arguments.

YVES CHARLES ZARKA ET SABINE CHOQUET. — Est-ce qu’il y a un acte de naissance du souverainisme au Québec ? Et, si tel est le cas, est-il lié à la visite du général de Gaulle au Québec et à la célèbre phrase : « Vive le Québec libre ! » qu’il a prononcée à Montréal le 24 juillet 1967 ?JOSEPH FACAL. — On..