Objectives To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices. Design Cross-sectional postal survey. Setting Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument. Subjects All 1645 physician members of the German Society for Palliative Medicine. Main outcome measures Types (...) and frequencies of limitation of treatment and possible determinants. Results 901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death. Conclusion The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life. (shrink)

Die Medikalisierung des Sterbens hat dazu geführt, dass ein „guter Tod“ zunehmend auch von medizinischen Interventionen erwartet wird. Die Möglichkeiten einer „terminalen Sedierung“ bis zum Tode werden von vielen als Ausweg angesehen, wenn bei unerträglichem Leid und aussichtsloser Prognose der Wunsch nach aktiver Sterbehilfe angesprochen wird. Durch eine Sedierung können zwar bei schwerstkranken Patienten schwerste therapierefraktäre Leidenszustände effektiv gelindert werden. Diese Therapieoption kann aber auch in der Absicht angewendet werden, den Todeseintritt medizinisch zu beschleunigen, so dass im Zusammenhang mit der (...) Euthanasiedebatte auch das Thema der terminalen Sedierung kontrovers diskutiert wird. Richtlinien zu Indikation, Technik und Dokumentation sind notwendig, um Stellenwert und Grenzen der terminalen Sedierung im Rahmen der palliativen Betreuung am Lebensende zu verdeutlichen und durch Transparenz Fehlentwicklungen zu vermeiden. (shrink)

ZusammenfassungDie Medikalisierung des Sterbens hat dazu geführt, dass ein „guter Tod“ zunehmend auch von medizinischen Interventionen erwartet wird. Die Möglichkeiten einer „terminalen Sedierung“ bis zum Tode werden von vielen als Ausweg angesehen, wenn bei unerträglichem Leid und aussichtsloser Prognose der Wunsch nach aktiver Sterbehilfe angesprochen wird. Durch eine Sedierung können zwar bei schwerstkranken Patienten schwerste therapierefraktäre Leidenszustände effektiv gelindert werden. Diese Therapieoption kann aber auch in der Absicht angewendet werden, den Todeseintritt medizinisch zu beschleunigen, so dass im Zusammenhang mit der (...) Euthanasiedebatte auch das Thema der terminalen Sedierung kontrovers diskutiert wird. Richtlinien zu Indikation, Technik und Dokumentation sind notwendig, um Stellenwert und Grenzen der terminalen Sedierung im Rahmen der palliativen Betreuung am Lebensende zu verdeutlichen und durch Transparenz Fehlentwicklungen zu vermeiden. (shrink)

What is the cash value of Richard Rorty’s philosophy and politics of religion? This paper analyzes the political promise of Rorty’s shift from atheism to anticlericalism in the last decade of his life. It seeks to deliver primarily a concise summary of this shift, and of its transformative motivation. Then a critique of this shift is followed by the suggestion of a friendly amendment: its extension towards a pragmatic pluralism. The outlined Rortyan conception of a serene, and, at the same (...) time robust, politics of religion is proposed as a promising answer to the question of how secular liberal citizens should react to the “return of the gods.”. (shrink)

Increasingly, companies implement social and environmental standards as instruments towards corporate social responsibility in supply chains. This is based on the assumption that such standards increase legitimacy among stakeholders. Yet, a wide variety of standards with different requirement levels exist and companies might tend to introduce the ones with low exigencies, using them as a legitimacy front. This strategy jeopardizes the reputation of social and environmental standards among stakeholders and their long-term trust in these instruments of CSR, meaning that all (...) expenses for their implementation are of no avail for the companies. Therefore, this paper highlights which criteria are important for the selection, implementation and improvement in order to achieve a company's aim, but also to strengthen the legitimacy of social and environmental standards. This research is based on conceptual thought and some existing empirical research, comparing four different social and environmental standards, revealing weaknesses and strengths. It exposes the basic conditions for the success of such standards among stakeholders and identifies the need for more empirical data. (shrink)

I will argue for a novel variant of the knowledge norm for practical reasoning. In Sect. 2, I will look at current variations of a knowledge norm for practical reasoning and I will provide reasons to doubt these proposals. In Sects. 3 and 4, I develop my own proposal according to which knowledge is the norm of apt practical reasoning. Section 5 considers objections. Finally, Sect. 6 concerns the normativity of my proposed knowledge norm and its significance.

Increasingly, companies implement social and environmental standards as instruments towards corporate social responsibility (CSR) in supply chains. This is based on the assumption that such standards increase legitimacy among stakeholders. Yet, a wide variety of standards with different requirement levels exist and companies might tend to introduce the ones with low exigencies, using them as a legitimacy front. This strategy jeopardizes the reputation of social and environmental standards among stakeholders and their long-term trust in these instruments of CSR, meaning that (...) all expenses for their implementation are of no avail for the companies. Therefore, this paper highlights which criteria are important for the selection, implementation and improvement in order to achieve a company's aim, but also to strengthen the legitimacy of social and environmental standards. This research is based on conceptual thought and some existing empirical research, comparing four different social and environmental standards, revealing weaknesses and strengths. It exposes the basic conditions for the success of such standards among stakeholders and identifies the need for more empirical data. (shrink)

This essay presents a novel approach to specifying the meaning of the concept of populism, on the political position it occupies and on the nature of populism. Employing analytic techniques of concept clarification and recent analytic ideology critique, it develops populism as a political kind in three steps. First, it descriptively specifies the stereotype of populist platforms as identified in extant research and thereby delimits the peculiar political position populism occupies in representative democracies as neither inclusionary nor fascist. Second, it (...) specifies on this basis analytically–normatively the particular stance towards liberal representative democracy (in particular towards popular sovereignty and democratic legitimacy) that unifies populism’s political position and explains how populist politics can be compelling for democratic citizens. The normative core (populist ideology) turns out to require no more than two general principles of legitimizing political authority by elections. Surprisingly, it does not need a separate anti-pluralist or exclusionary commitment: it entails it. Third, this normative model allows a response to a contested question in the theoretical discussion, namely, whether populism (properly specified) can be democracy-enhancing. The article defends the negative answer in virtue of the normative core alone and does so as much vis-à-vis a minimal (purely electoral) as vis-à-vis a normatively ambitious (liberal) conception of democracy. The reconstruction of the normative core of populist ideology enables a novel argument to show that populism is incompatible with the continued democratic legitimation of political authority even in the normatively most austere conception of ‘electoral democracy’, not just with ‘liberal democracy’. Assuming a normatively more ambitious concept of democratic legitimation in terms of political autonomy, the model also produces an extremely direct argument showing that populists cannot fulfil their promise of ‘taking back control’ over political decision-making to the population. (shrink)

Essays discuss reason and understanding, interpretation, language, meaning, the human sciences, social sciences, and general hermeneutic theory.

The past 20 years have seen dramatic rises in suicide rates in the U.S. and other countries around the world. These trends have been identified as a public health crisis in urgent need of new solutions and have spurred significant research efforts to improve our understanding of suicide and strategies to prevent it. Unfortunately, despite making significant contributions to the founding of suicidology – through Emile Durkheim’s classic Suicide (1897 [1951]) – sociology’s role has been less prominent in contemporary efforts (...) to address these tragic trends, though as we will show, sociological theories offer great promise for advancing our understanding of suicide and improving the efficacy of suicide prevention. Here, we review sociological theory and empirical research on suicide. We begin where all sociologists must: with Durkheim. However, we offer a more comprehensive understanding of Durkheim’s insights into suicide than the prior reviews provided by those in other disciplines. In so doing, we reveal the nuance and richness of Durkheim’s insights that have been largely lost in modern suicidology, despite being foundational to all sociological theories of suicide – even those that have moved beyond his model. We proceed to discuss broadly acknowledged limitations to Durkheim’s theory of suicide and review how more recent theoretical efforts have not only addressed those concerns, but have done so by bringing a larger swatch of sociology’s theoretical and empirical toolkit to bare on suicide. Specifically, we review how recent sociological theories of suicide have incorporated insights from social network theories, cultural sociology, sociology of emotions, and sociological social psychology to better theorize how the external social world matters to individual psychological pain and suffering. We conclude by making explicit bridges between sociological and psychological theories of suicide; by noting important limitations in knowledge about suicide – particularly regarding the roles of organizations, inequality, and intersectionality in suicide – that sociology is well situated to help address. (shrink)

This essay presents a novel approach to specifying the meaning of the concept of populism, on the political position it occupies and on the nature of populism. Employing analytic techniques of concept clarification and recent analytic ideology critique, it develops populism as a political kind in three steps. First, it descriptively specifies the stereotype of populist platforms as identified in extant research and thereby delimits the peculiar political position populism occupies in representative democracies as neither inclusionary nor fascist. Second, it (...) specifies on this basis analytically–normatively the particular stance towards liberal representative democracy that unifies populism’s political position and explains how populist politics can be compelling for democratic citizens. The normative core turns out to require no more than two general principles of legitimizing political authority by elections. Surprisingly, it does not need a separate anti-pluralist or exclusionary commitment: it entails it. Third, this normative model allows a response to a contested question in the theoretical discussion, namely, whether populism can be democracy-enhancing. The article defends the negative answer in virtue of the normative core alone and does so as much vis-à-vis a minimal as vis-à-vis a normatively ambitious conception of democracy. The reconstruction of the normative core of populist ideology enables a novel argument to show that populism is incompatible with the continued democratic legitimation of political authority even in the normatively most austere conception of ‘electoral democracy’, not just with ‘liberal democracy’. Assuming a normatively more ambitious concept of democratic legitimation in terms of political autonomy, the model also produces an extremely direct argument showing that populists cannot fulfil their promise of ‘taking back control’ over political decision-making to the population. (shrink)

Nietzsche and Shaw are famous and infamous: famous for their innovative and influential forms of writing, but infamous for their apparent support of totalitarianism and Nazism. However, while it has long been shown that Nietzsche’s provocative language about “breeding” and “masters and slaves” was intended to enhance culture through competition, it is still an open question how and when Shaw supported biological eugenics. Via Nietzsche’s “philosophical breeding,” this article presents a new reading of Shaw’s Man and Superman: on the one (...) hand, it contrasts Nietzsche’s philosophical Übermensch with Shaw’s eugenic Superman; and on the other hand, it connects Nietzsche’s agonistic enhancement of culture with Shaw’s philosophical reflections in “Don Juan in Hell.” In contrast to Tanner’s support of eugenic breeding in his Revolutionist’s Handbook, Shaw’s Don Juan remarkably resembles Nietzsche’s notion of “philosophical breeding” toward a more competent, truthful, and autonomous orientation that is needed in increasingly complex global politics. (shrink)

ABSTRACT In its attempt to prove that voters, politicians, and bureaucrats are motivated by the public interest, Self-Interest and Public Interest in Western Politics overlooks a great deal of public-choice research, to which much has been added during the two decades since it was published. The importance of self-interest at both the micro and macro levels of politics becomes clear once one looks not simply at the ?inputs? of a democracy but at its ?outputs? as well. The prevalence of interest (...) groups, the dysfunction of the United States tax code, the lobbying by unions for their members? self-interest, the earmarks in the Patriot Act, the numerous cases of corruption in Western democracies, and the dissatisfaction of citizens with their governments? failings all point to the importance of self-interest in politics. (shrink)

In its attempt to prove that voters, politicians, and bureaucrats are motivated by the public interest, Self-Interest and Public Interest in Western Politics overlooks a great deal of public-choice research, to which much has been added during the two decades since it was published. The importance of self-interest at both the micro and macro levels of politics becomes clear once one looks not simply at the “inputs” of a democracy but at its “outputs” as well. The prevalence of interest groups, (...) the dysfunction of the United States tax code, the lobbying by unions for their members’ self-interest, the earmarks in the Patriot Act, the numerous cases of corruption in Western democracies, and the dissatisfaction of citizens with their governments’ failings all point to the importance of self-interest in politics. (shrink)

I present three versions –Grimm, Offe and Streeck—of a general argument that is often used to establish that the EU-institutions meets a legitimacy-disabling condition, the so called “no demos” argument (II), embedding them in the context of the notorious “democratic deficit” suspicions against the legal system and practice of the EU (I). After examining the logical structure behind the no-demos intuition considered as an argument (III), I present principled reasons by Möllers and Habermas that show why the “no demos” argument (...) fails to have bite in discussions of the legitimacy and status of the supranational level in the multi-level EU-architecture. These are complemented by another principled reason arising from John Dewey’s conception of the “public” as a clearer alternative for the “popular” requirement of democratic legitimation (IV). I conclude that all three conceptions together suggest that the hunt after pre-politically existing peoples as foundations of democratic legitimacy expresses no more than methodological nationalism without any footing in the material and conceptual requirements of democratic legitimation. Given the absence of a principled problem with the legitimacy of the priority and interference of supranational EU-law in the national legal and political orders, there are thus also no principled reasons to abandon or discredit the European project in the absence of a European nation or society. (shrink)

Abstractabstract:Long before COVID-19 made social distancing familiar, people with cystic fibrosis (CF) already practiced such behaviors. CF is held up as a classic example of genetic disease, yet people with CF are also susceptible to bacteria from the environment and from other CF patients. Starting in the 1980s, a bacterial epidemic in the CF population highlighted clashing priorities of connection, physical safety, and environmental protection. Policymakers ultimately called for the physical separation of people with CF from one another via recommendations (...) that reconfigured the CF community. Simultaneously, medical researchers recognized that one highly transmissible CF pathogen called cepacia was being developed for environmental applications and got the EPA to limit cepacia's environmental deployment. Environmental regulations speak to the challenge of useful microbes that harm a minority, but CF cross-infection also involves legal implications for microbial and genetic discrimination, social consequences for CF communities, and ethical questions about balancing autonomy, harms, and benefits. As scientists increasingly study connections between host genetics, microbial genetics, and infectious risks, CF is a vital referent. (shrink)

Marx’s theory of ground rent has been widely used to help understand the trinity of land, labor, and capital. However, limited attention has been paid to the role of water within the Marxian rent framework. This lack of attention proves troubling due to the role of surface waters as an essential means of production throughout capitalism. Here I restate Marxian ground rent in the form of water rent and discuss the function of water-rent in the two dominant surface water rights (...) doctrines of the United States—the riparian doctrine and the doctrine of prior appropriation. In doing so, I revise the distinction between differential rent 1 and differential rent 2 to provide more analytically useful categories. Paying special attention to issues of drought and scarcity, I fully articulate the function of Marxian rent and its four forms for both surface water rights doctrines, while clearly stating where they do and do not differ. (shrink)

Since the collapse of the Soviet Union, there is a wide consensus in society and science that a modern society cannot do without a market economy. The current political and academic debate revolves primarily around the question of what kind of social system a modern society needs. This question includes important normative as well as instrumental aspects. In this essay, we want to pursue the question of how modern societies can best achieve progress in both dimensions. The standard response — (...) both politically and academically — is that we can improve our social system best through piecemeal engineering. According to the standard view, the improvements of our social system should be both democratically legitimizced and put into effect nationwide. In this essay, we want to oppose this consensus and raise the question whether a competition between decentralized social systems would not be a more apt means to reach shared goals. The motivating idea behind this essay is not to pesent a fully-fledged theory, but to question some of the standard presumptions for piecemeal engineering that is often directed against institutional compctition in the realm of social systems. (shrink)

ABSTRACTTimothy Williamson recently argued that the notion of epistemic rationality is ambiguous between a Content-oriented schema and a Disposition-oriented schema. I argue that the Disposition-oriented schema suggested by Williamson is not faithful to the main idea behind it and that it should be replaced with the Disposition-Manifestation schema. This replacement suffices for avoiding Williamson's ambiguity thesis.

The ability to process center‐embedded structures has been claimed to represent a core function of the language faculty. Recently, several studies have investigated the learning of center‐embedded dependencies in artificial grammar settings. Yet some of the results seem to question the learnability of these structures in artificial grammar tasks. Here, we tested under which exposure conditions learning of center‐embedded structures in an artificial grammar is possible. We used naturally spoken syllable sequences and varied the presence of prosodic cues. The results (...) suggest that mere distributional information does not suffice for successful learning. Prosodic cues marking the boundaries of the major relevant units, however, can lead to learning success. Thus, our data are consistent with the hypothesis that center‐embedded syntactic structures can be learned in artificial grammar tasks if language‐like acoustic cues are provided. (shrink)