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)

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)

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)

Self-fulfillment of theories is argued to be a threat to social science in at least two ways. First, a realist might worry that self-fulfillment constitutes a threat to the idea that social science is a proper science consistent with a realist approach that develops true and successful statements about the world. Second, one might argue that the potential self-fulfilling nature of social science theories potentially undermines the ethical integrity of social scientists. We argue that if one accepts that social science (...) theories are not based on laws akin to those that govern natural reality or acknowledges that if one can predict self-fulfillment via a meta-theory that explains the underlying regularities of the self-fulfilling change, the threat to realism is dismantled. Furthermore, on the basis of these arguments, we show that if one is unable to predict the consequences of a theory, it is difficult to ascribe moral responsibility at the individual level. It is, therefore, not the potential self-fulfillment of theories per se that poses an ethical challenge, in contrast to claims in the literature. (shrink)

The vital status of patients who are a part of controlled donation after circulatory death (cDCD) is widely debated in bioethical literature. Opponents to currently applied cDCD protocols argue that they violate the dead donor rule, while proponents of the protocols advocate compatibility. In this article, we argue that both parties often misinterpret the moral implications of the dead donor rule. The rule as such does not require an assessment of a donor’s vital status, we contend, but rather an assessment (...) of whether procurement of organs in cDCD cause the death of the donor or not. We then argue that commonly practiced cDCD protocols do not violate the dead donor rule, since the donation does not trigger or cause the death of the donors. (shrink)

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the (...) circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor. (shrink)

This is a book about the Hilbert space formulation of quantum mechanics and its measurement theory. It contains a synopsis of what became of the Mathematical Foundations of Quantum Mechanics since von Neumann's classic treatise with this title. Fundamental non-classical features of quantum mechanics-indeterminacy and incompatibility of observables, unavoidable measurement disturbance, entanglement, nonlocality-are explicated and analysed using the tools of operational quantum theory. The book is divided into four parts: 1. Mathematics provides a systematic exposition of the Hilbert space and (...) operator theoretic tools and relevant measure and integration theory leading to the Naimark and Stinespring dilation theorems; 2. Elements develops the basic concepts of quantum mechanics and measurement theory with a focus on the notion of approximate joint measurability; 3. Realisations offers in-depth studies of the fundamental observables of quantum mechanics and some of their measurement implementations; and 4. Foundations discusses a selection of foundational topics (quantum-classical contrast, Bell nonlocality, measurement limitations, measurement problem, operational axioms) from a measurement theoretic perspective. The book is addressed to physicists, mathematicians and philosophers of physics with an interest in the mathematical and conceptual foundations of quantum physics, specifically from the perspective of measurement theory. (shrink)

James Ladyman has recently proposed a view according to which all that exists on the level of microphysics are structures "all the way down". By means of a comparative reading of structuralism in philosophy of mathematics as proposed by Stewart Shapiro, I shall present what I believe structures could not be. I shall argue that, if Ladyman is indeed proposing something as strong as suggested here, then he is committed to solving problems that proponents of structuralism in philosophy of mathematics (...) such as Shapiro are trying to solve. Attempting to do so, however, brings out a tacit tension in Ladyman's position. I shall argue that the upshot of this is that the ontological import that Ladyman attributes to structures is rather epistemological import properly understood. (shrink)

Heisenberg's uncertainty principle is usually taken to express a limitation of operational possibilities imposed by quantum mechanics. Here we demonstrate that the full content of this principle also includes its positive role as a condition ensuring that mutually exclusive experimental options can be reconciled if an appropriate trade-off is accepted. The uncertainty principle is shown to appear in three manifestations, in the form of uncertainty relations: for the widths of the position and momentum distributions in any quantum state; for the (...) inaccuracies of any joint measurement of these quantities; and for the inaccuracy of a measurement of one of the quantities and the ensuing disturbance in the distribution of the other quantity. Whilst conceptually distinct, these three kinds of uncertainty relations are shown to be closely related formally. Finally, we survey models and experimental implementations of joint measurements of position and momentum and comment briefly on the status of experimental tests of the uncertainty principle. (shrink)

Laplace once argued that if one could “comprehend all the forces by which nature is animated,” it would be possible to predict the future and explain the past. The advent of analysis of large-scale data sets has been accompanied by newfound concerns about “Laplace’s Demon” as it relates to certain fields of science as well as management, evaluation, and audit. I begin by asking how statistical data are constructed, illustrating the hermeneutic acts necessary to create a variable. These include attributing (...) a certain characteristic to a particular phenomenon, isolating the characteristic of interest, and assigning a value to it. In addition, a population must be identified and a sample must be “taken” from that population. Next, I examine how statistical analyses are conducted, examining the interpretive acts there as well. In each case, I show how big data add new challenges. I then show how statistics are incorporated into audits and evaluations, emphasizing how alternative interpretations are concealed in the audit process. I conclude by noting that these issues cannot be “resolved” as Laplace suggested. His Demon, already banished from physics, needs to be banished from other fields of science, management, audits, and evaluations as well. (shrink)

Public opinion can affect the adoption of genome editing technologies. In food production, genome editing can be applied to a wide range of applications, in different species and with different purposes. This study analyzed how the public responds to five different applications of genome editing, varying the species involved and the proposed purpose of the modification. Three of the applications described the introduction of disease resistance within different species, and two targeted product quality and quantity in cattle. Online surveys in (...) Canada, the US, Austria, Germany and Italy were carried out with a total sample size of 3698 participants. Using a between-subject design, participants were confronted with one of the five applications and asked to decide whether they considered it right or wrong. Perceived risks, benefits, and the perception of the technology as tampering with nature were surveyed and were complemented with socio-demographics and a measure of the participants’ moral foundations. In all countries, participants evaluated the application of disease resistance in humans as most right to do, followed by disease resistance in plants, and then in animals, and considered changes in product quality and quantity in cattle as least right to do. However, US and Italian participants were generally more positive toward all scenarios, and German and Austrian participants more negative. Cluster analyses identified four groups of participants: ‘strong supporters’ who saw only benefits and little risks, ‘slight supporters’ who perceived risks and valued benefits, ‘neutrals’ who showed no pronounced opinion, and ‘opponents’ who perceived higher risks and lower benefits. This research contributes to understanding public response to applications of genome editing, revealing differences that can help guide decisions related to adoption of these technologies. (shrink)

The hypotheses of weak and strong objectification of quantum mechanical observables, as well as theoretical arguments and experimental evidence against these hypotheses, are systematically reviewed.

We investigated the causes and impact of procrastination on “slippery deadlines,” where the due date is ill-defined and can be autonomously extended, using the unique applied setting of grievance arbitration across two studies. In Study One, using 3 years of observed performance data derived from Canadian arbitration cases and a survey of leading arbitrators, we examined the effect of individual differences, self-regulatory skills, workloads and task characteristics on time delay. Observed delay here is a critical criterion, where justice is emphasized (...) to be swift and sure. Multilevel Modeling established trait procrastination as a substantive predictor of observed delay, equivalent to the environmental contributors of expediting the arbitration procedure or grievance complexity. Also, despite substantive negative consequence of delay for both arbitrators and their clients, arbitrators who scored one standard deviation above the mean in procrastination took approximately 83 days to write their decisions compared to the 26 days for arbitrators one standard deviation below the mean. In Study Two, we conducted a replication and extension survey with a much larger group of American arbitrators. Consistent with Temporal Motivation Theory, trait procrastination was largely explained by expectancy, value, and sensitivity to time related traits and skills, which together accounted for majority of the variance in trait procrastination, leaving little left for other explanations. For example, perfectionism connection to procrastination appears to be distal, being largely mediated by each of TMT’s core variables. Finally, procrastination was largely synonymous with a deadline pacing style, indicating that observed delay can be used as a proxy for procrastination as long as little or no prior work was done. In all, our results indicate that procrastination is rampant in the workplace and has seriously detrimental effects. (shrink)

Uncertainty relations and complementarity of canonically conjugate position and momentum observables in quantum theory are discussed with respect to some general coupling properties of a function and its Fourier transform. The question of joint localization of a particle on bounded position and momentum value sets and the relevance of this question to the interpretation of position-momentum uncertainty relations is surveyed. In particular, it is argued that the Heisenberg interpretation of the uncertainty relations can consistently be carried through in a natural (...) extension of the usual Hilbert space frame of the quantum theory. (shrink)

Examining variation in reasoning about sustainability between diverse populations provides unique insight into how group norms surrounding resource conservation develop. Cultural institutions, such as religious organizations and formal schools, can mobilize communities to solve collective challenges associated with resource depletion. This study examined conservation beliefs in a Western industrialized (Austin, Texas, USA) and a non‐Western, subsistence agricultural community (Tanna, Vanuatu) among children, adolescents, and adults (N = 171; n = 58 7–12‐year‐olds, n = 53 13–17‐year‐olds, and n = 60 18–68‐year‐olds). (...) Participants endorsed or rejected four types of justifications for engaging in land and animal conservation: sustainability, moral, religious, or permissible. In both populations, participants endorsed sustainability justifications most frequently. Religious justifications increased with age in Tanna and decreased with age in Austin. Tannese participants were also more likely to endorse multiple justifications for conservation than Austin participants. Data across all justification types show a main effect of age in both communities; endorsement of conservation decreased with age in Austin, but increased with age in Tanna. Across age groups, participants were more likely to endorse the conservation of animals than land in Austin, yet equally as likely to endorse the conservation of land and animals in Tanna. Overall, these results reveal similarities and differences in the beliefs that support the conservation of natural resources across populations. (shrink)

Confirmational holism is central to a traditional formulation of the indispensability argument for mathematical realism (IA). I argue that recent strategies for defending scientific realism are incompatible with confirmational holism. Thus a traditional formulation of IA is incompatible with recent strategies for defending scientific realism. As a consequence a traditional formulation of IA will only have limited appeal.

It has recently been suggested by Shaw (2007) that the distinction between voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, and voluntary passive euthanasia, such as removing a patient from a ventilator, is much less obvious than is commonly acknowledged in the literature. This is argued by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations. The argument is simply that if we consider the (...) body of a mentally competent patient who wants to die, a kind of ‘unwarranted’ life support, then the distinction collapses. We argue that all Shaw has provided is a perspective that makes the conclusion that there is little distinction between voluntary active euthanasia and voluntary passive euthanasia only seemingly more palatable. In doing so he has yet to convince us that this perspective is superior to other perspectives and thus more accurately reflects the moral features of the situations pertaining to this issue. (shrink)

In scholarship on the history of philosophy, it is widely assumed that Charles Fourier was a utopian socialist who could not have exerted a significant influence on the development of Karl Marx's thought. Indeed, both Marx and Engels seem to have advanced this view. In contrast, I argue that in 1844 when Marx was developing his anthropology and social critique, he relied upon Fourier's thought to supply a key assumption. After establishing this connection, I explain why Marx's tacit reliance on (...) Fourier creates a problematic undercurrent in his thought. (shrink)

It has recently been suggested by Shaw that the distinction between voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, and voluntary passive euthanasia, such as removing a patient from a ventilator, is much less obvious than is commonly acknowledged in the literature. This is argued by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations. The argument is simply that if we consider the body (...) of a mentally competent patient who wants to die, a kind of ‘unwarranted’ life support, then the distinction collapses. We argue that all Shaw has provided is a perspective that makes the conclusion that there is little distinction between voluntary active euthanasia and voluntary passive euthanasia only seemingly more palatable. In doing so he has yet to convince us that this perspective is superior to other perspectives and thus more accurately reflects the moral features of the situations pertaining to this issue. (shrink)

Die Frage, ob ein Grundeinkommen für jede Bürgerin und jeden Bürger eine gerechte Institution ist, wird unter Philosophen seit gut 20 Jahren verstärkt diskutiert. Zur Begründung der Institution des Grundeinkommens wird von vielen Denkern eine Überlegung geltend gemacht, die von links-libertären Philosophen entwickelt wurde. Sie beruht auf der Annahme, dass von Natur aus gegebene Dinge und Ressourcen ursprünglich das gemeinsame Eigentum aller Menschen sind und dass private Aneigner derartiger Dinge und Ressourcen deshalb aus Gerechtigkeitsgründen gegenüber den anderen Menschen zur Zahlung (...) einer Entschädigung verpflichtet sind, deren Höhe dem ökonomischen Wert der von ihnen angeeigneten Güter entspricht. In der vorliegenden Untersuchung wird gezeigt, dass diese Begründung des Grundeinkommens auch dann nicht überzeugen kann, wenn man die eigentumstheoretischen Grundannahmen des Links-Libertarismus akzeptiert. Hierfür sind werttheoretische Defizite verantwortlich, die es fraglich erscheinen lassen, ob sich die Größe des ökonomischen Werts der von Natur aus gegebenen Dinge und Ressourcen im Rahmen der links-libertären Philosophie überhaupt überzeugend bestimmen lässt. For a good twenty years now, philosophers have been increasingly discussing whether or not a basic income for every citizen is a just institution. Some of these thinkers ground the institution of basic income on a notion that was developed by left-libertarian philosophers. This notion is based on the claims that things and resources that are naturally given are originally the common possession of all of mankind and that, out of reasons of justice, whoever privately appropriates such things or resources is therefore liable to paying compensation of an amount corresponding to the economic value of the appropriated items. The aim of the present study is to show that even if one accepts the basic assumptions made by left-libertarians about property rights, the above justification of basic income does not hold. This is due to deficits in the theory of value, which render it questionable whether the magnitude of the economic worth of things and resources given in nature can ever be convincingly determined within the framework of left-libertarianism. (shrink)

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches−for example, sensory shielding strategies (...) versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson’s disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of new sensory information, relative to the precision of predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors. (shrink)

The role of completely positive mappings in quantum dynamics and measurement theory is reanalyzed in light of the possibility of a generalized dynamics.

What is death: a process or a specific declaration? Is it a biological continuum of events or a decision based on medical, ethical, and legal criteria? In our view, it is both, and there are philos...

This article argues for the value of working with conflicts in social practice as resources for collaboration, learning and development. The interest in conflicts in social practice is rooted in a preoccupation with social power relations and how to understand and analyse power relations from a subject-science perspective. Following this interest, a methodological framework, best described as a kind of ‘mobile ethnography’, is discussed and exemplified through an empirical example. A preliminary conceptual framework for understanding power as a capacity for (...) action is presented. The overarching ambition of the article is to consider what democratic collaboration and coexistence entails and how it might be supported conceptually and analytically by the notion of conflicts as heuristics for social inquiry and by the notion of power as a capacity for action and social participation. (shrink)

This is an entry to the Compendium of Quantum Physics, edited by F Weinert, K Hentschel and D Greenberger, to be published by Springer-Verlag.

The weak objectification of physical properties is shown to yield the same probabilistic implications as strong objectification and can therefore be refuted on the basis of suitable interference experiments. An alternative test of hypothetical objectification statements, as they occur in the EPR experiment, is based on joint probabilities and the ensuing Bell inequalities. Quantum mechanics turns out to be partially compatible with Bell's inequalities even in cases where weak objectification is excluded by interference.

Für die zeitgenössische Philosophie ist das Vererben ein Vermögenstransfer, der unter Gesichtspunkten sozialer Gerechtigkeit zu behandeln ist. Diese Untersuchungsperspektive ist angesichts der massiven Verteilungseffekte, die das Vererben zeitigt, ohne Frage sehr wichtig. Allerdings lässt sie einen Punkt unberücksichtigt: Das testamentarische Vererben kann wichtige Beiträge dazu leisten, dass wir Verstorbene, denen wir zu Lebzeiten nahestanden, in Erinnerung behalten und wertschätzen. Hierbei ist der monetäre Wert der vererbten Güter nicht entscheidend. Wie ich in meinem Aufsatz darlege, lässt sich mit diesem Befund erklären, (...) warum die (von einer wachsenden Zahl von Gerechtigkeitstheoretikerinnen und -theoretikern geforderte) Abschaffung des Rechts zu vererben nicht nur von Vorteil sein würde, sondern auch mit ethischen Kosten verbunden wäre. Ein adäquater philosophischer Diskurs hätte diesen Befund (mit dem sich neoliberale oder rechtslibertaristische erbrechtliche Positionen nicht rechtfertigen lassen) angemessen zu berücksichtigen. (shrink)