This mixed method study (Explanatory Design - the Participant Selection Model) investigated the use of joint drawing (the Family Squiggle) as a family climate assessment tool for hearing families who have a deaf / hard of hearing (D/HH) child. The goal was to evaluate the possibilities of applying a quantitative approach to characterize the pictorial phenomena produced by hearing families who have a D/HH child, and then apply qualitative research approaches to better understand the meaning of these phenomena. Twenty-eight hearing (...) families (parents and child) whose child was diagnosed as D/HH and used hearing devices (hearing aids, implant) were recruited along with 16 families with a hearing child of a similar age enrolled in a mainstream school. The sessions involved a joint drawing followed by a family interview. In the quantitative stage, pictorial phenomena for which there was a significant association between the phenomena and the group of families were defined. These were: (1) The number of dominant images, (2) Images occupying less than a quarter of the page. (3) Images with accentuated outlines. (4) Moderate colorfulness with four to five colors in each drawing. (5) Minimal representation of the face. (6) Concrete rather than creative titles. (7) Muting of conflictual themes. (8) Images reminiscent of hearing devices (hearing aids, implant). In the qualitative phase, interviews were conducted with the hearing families with a D/HH child to better understand the meaning of these pictorial phenomena. The findings suggest that each of these phenomena represent the preoccupation of the family with deafness / being hard of hearing, capture a certain aspect of family dynamics, and together provide a broader and deeper picture of the family climate and the interactions between the child's family and hearing. This assessment tool may thus be utilized when verbal tools cannot be easily applied. (shrink)

Clinical ethics consultation not only interprets moral issues at the bedside and is not restricted to giving support for the “technical” handling of these moral issues, but it has to substantively address moral values, norms, and conflicts in the process of discussing cases and problems. We call this the normative dimension and use normative in the sense of embracing moral values and convictions of persons and groups, norms, and relevant professional and ethical guidelines as well as legal frameworks. The roles (...) and activities of the consultant as a person and the quality of CEC as a process are discussed in the American Society of Bioethics and Humanities’ Core Competences for Healthcare Ethics Consultation. (shrink)

The Analytic of the Beautiful in Kant's Critique of Aesthetic Judgment is a text of unparalleled importance in the history of philosophical aesthetics. Its main claims are adopted by some and rejected by others. A significant number of responses, of both kinds, take the Analytic to apply to all experiences of beauty—most notably, to the beauty of both nature and fine art. Our principal claim is that this assumption is mistaken. The analysis in the misleadingly titled Analytic of the Beautiful (...) applies paradigmatically to judgments of natural beauty. The experience of the beauty of most artworks is different and requires a separate analysis. We detail the modifications required in all four moments of the Analytic and thereby explicate the experience of artistic beauty. This reveals that Kant holds an interesting and historically consequential account of the experience of artistic beauty, which is significantly different from the experience of natural beauty. The analysis further reveals that despite these significant differences, the experiences are both species of a single genus. (shrink)

The debate and implementation of Clinical Ethics Consultation is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop “technical”approaches, e.g., (...) in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the “parties” involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of “neutrality” versus “advocacy” in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of the patient or the relatives are formulated for the practice of CEC. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

Initiating clinical ethics support in psychiatry and maintaining its continuity appear to be easy. This is contradicted by the observed delay or lack of CESiP, e.g. ethics consultation. On the basis of a published literature search and the discussion of practical experiences over 2.5 years 10 tasks and relating challenges of initiating and maintaining CESiP are formulated and illustrated by examples. Referral to experiences is grounded on the systematic documentation of ca. 100 CESiP activities. The tasks and challenges illustrate how (...) CESiP was initiated and maintained in child and adolescent, adult and forensic psychiatry. Each example is followed by a “rule of thumb” that was found useful in our centre. Discussion: Suggestions I–III are of organisational nature, IV–X have explicit ethical content concerning the ethos or professionalism of the ethics consultant and CES practice. Their realisation requires a minimum of stability of CESiP and considerable consultancy experience. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

This interdisciplinary volume addresses the tension between illusion and appearance. The starting point is three differentiated forms of "Schein" in German: as a ray of light itself, as in "shine," or appearance as becoming visible or, finally, as an illusion – seeming to be so. The contributions analyze under which cultural-historical conditions and within which concrete forms aesthetic configurations are perceived and evaluated.

Recently, ethical guidelines for clinical practice have gained increased popularity, but in order to become useful they require more pioneer’s work. Clinical-ethical guidelines need to be based on a scientific foundation and their practicability must be improved. We present and put to discussion the initial steps of the METAP Project about the development and practical implementation of a clinical-ethical guideline dedicated to a fair resource-allocation at the bedside. -/- With its methodological orientation, the project represents a guideline which is based (...) on both research and consensus-building, undergoing systematic evaluation and modification. In addition to the guideline, the project comes with a manual (a tool kit) including a procedural instrument for making decisions supporting deliberative aspects. It focuses on issues of micro-allocation; furthermore, it provides empirical, ethical and legal basics for making fair treatment decisions that should help to prevent overtreatment, undertreatment or discrimination in patient care. We propose an Escalation Model with various instruments serving as problem solving strategies that correspond to the respective needs; these instruments include a pocket-summary (“Leporello”) with the most important facts; further reading material; normative and procedural recommendations; ward-specific strategies, and also the option of clinical ethics consultation. -/- Clinical partners have been actively involved in the developmental process from the beginning and contributed to the practical applicability, acceptance and a valid need-orientation of the whole tool kit. This partnership and the participatory approach seem to have helped METAP to gain a foothold in the clinic. (shrink)

The paper describes how ethics consultation can be valuable to health professionals, patients and their families in understanding and evaluating ethical values and their consequences in a particular situation. Ethics consultation as it is practised at the university hospital of Freiburg is a special professional service offered by members of an academic institution.The practical approach and the goals are illustrated by a case study showing the difficulties of deciding about the limitation of intensive care medicine after heart surgery in the (...) setting of maximum treatment. Here, the ethics consultation was initiated by the relatives of the patient who wanted a decision to withhold further life-sustaining treatment.Following the experiences in Freiburg, it is concluded that clinical ethicists have to cover a variety of relevant fields of knowledge, need special analytical skills, and should have professional competence in counselling, including conflict mediation or crisis intervention. (shrink)

This paper analyzes the rhetoric surrounding the profession’s presentations of auditor independence. We trace the evolution of thecharacter of the auditor from Professional Man in the early years of the twentieth century to the more public and abstract figures of Judicial Man and Economic Man. The changing character of the auditor in the profession’s narratives of legitimation reflects changes in the role of auditing, in the economic environment, and in the values of American society. Economic man is a self-interested and (...) shallow character who offered the auditing profession little protection against involvement in corporate scandals. In the wake of recent accounting scandals, the profession is calling for a return to the character of Professional Man to restore trust in audits and the financial markets.We also analyze the philosophical bases of the metaphors surrounding auditor independence. These metaphors, particularly the metaphor of independence as separation, create problems in conceptualizing independence concepts. How can you discuss appropriate relationships when your basic concept is one of separation, or no relationship? On the other hand, relational concepts of independence are also flawed if they are not based on a firm moral foundation. We suggest how the profession can act to rebuildits moral foundation through recognition of collective responsibility. (shrink)

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another “committee”. One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The (...) most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (shrink)

"Religiös Wissen, so die Grundannahme des DFG-Graduirtenkollegs "Religiöses Wissen im vormodernen Europa (800-1800)", entsteht in der Auseinandersetzung mit dem in der Bibel offenbarten, aber nicht greifbaren Wissen. Im alltäglichen Umgang der religiösen Experten und Laien wird es jedoch immer wieder transformiert und an die zeitspezifischen Gegebenheiten angepasst. Die dabei entstehenden diskursiven Konkurrenzen zwischen religiösen Wissen und anderen Wissensfeldern stehen im Fokus des interdisziplinär angelegten Sammelbandes. Die Beiträge thematisieren die unterschiedlichen Verfahrensweeisen, durch die religiöses Wissen in den Bereichen der Naturforschung, Kunst (...) oder Literatur adaptiert und modelliert wird, sowie die dabei zu Tage tretenden Spannungen, Konkurrenzen oder Synergien." --. (shrink)

Although research on the benefits of problem construction within the creative process is expanding, research on team problem construction is limited. This study investigates the cognitive process of problem construction and identification at the team level through an experimental design. Furthermore, this study explores team social processes in relation to problem construction instructions. Using student teams solving a real-world problem, the results of this study revealed that teams that engaged in problem construction and identification generated more original ideas. Moreover, higher (...) satisfaction and lower conflict was observed among groups that engaged in problem construction. These findings highlight the utility of problem construction for teams engaging in creative problem-solving. (shrink)

What is the status of empirical contributions to bioethics, especially to clinical bioethics? Where is the empirical approach discussed in bioethics related to the ongoing debate about principlism versus casuistry? Can we consider an integrative model of research in medical ethics and which empirical methodology could then be valuable, the quantitative or the qualitative? These issues will be addressed in the first, theoretical part of the paper. The concept of the “embedded researcher” presented in this article was stimulated by the (...) two questions, (1) how can we safeguard that our research will yield valid and meaningful results to practice? and (2), how can we convince clinical colleagues that medical ethics offers relevant contributions to the analysis and solution of problems? One tentative answer has been our effort to elaborate a coherent methodological research approach in the field of end-of-life issues integrating qualitative and quantitative as well as casuistic methodologies. This development is characterized in the second part describing the ECOPE Study (short title)“Ethical Conditions Of Passive Euthanasia.” The achievements and limitations of the suggested approach of the “embedded researcher” are discussed referring to 3 examples of our joint studies about ethical issues concerning(1) critical decision-making in neonatology(2) limitation of treatment in intensive care(3) problems with doctor-patient conversation at the end of life in oncologyConclusions from our studies are put to discussion in the final part of the paper about how to further develop research in the field of end-of-life care and, maybe,clinical bioethics as a whole. (shrink)

Name der Zeitschrift: Kant-Studien Jahrgang: 109 Heft: 1 Seiten: 72-100.

Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with newly developed (...) or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International level. (shrink)

The global community is currently being confronted with an increasing urgent demand for dialogue among cultures and religions. The question arises with regards to efficient concepts or tools which will help to shape the encounter of the different religions and cultures of the world with one another. Indicative here is the cognition that hospitality has to do with a factor which is proven in almost all religions and cultures of the world. Hospitality is primarily an existential encounter and as such (...) it brings also the experience of difference in socio-religious traditions and in intercultural relations. Gegenwärtig wird in der Weltöffentlichkeit mit zunehmender Dringlichkeit die Forderung nach einem Dialog der Kulturen und der Religionen erhoben. Vor diesem Hintergrund stellt sich die Frage nach tragfähigen Konzepten, welche die Begegnung der Religionen und Kulturen der Welt gestalten helfen. Wegweisend hierfür ist die Erkenntnis, dass es sich bei der Gastfreundschaft um eine Gegebenheit handelt, welche in nahezu allen Religionen und Kulturen der Welt belegt ist. Gastfreundschaft ist zuallererst existentielle Begegnung und bringt als solche auch die Erfahrung der Differenz in die sozio-religiösen Traditionen und in die interkulturellen Beziehungen. (shrink)

For Kant the definitive end of art is the expression of aesthetic ideas that are sensible counterparts of rational ideas. But there is another type of aesthetic idea: ‘Beauty can in general be called the _expression_ of aesthetic ideas: only in beautiful nature the mere reflection on a given intuition, without a concept of what the object ought to be, is sufficient for arousing and communicating the idea of which that object is considered as the _expression_.’ What are these aesthetic (...) ideas? I argue that Kant is drawing on the idealist conception of art, associated with Vasari, Bellori and Winckelmann, as presenting idealized spatial forms characteristic of natural kinds. He incorporates this conception into his analysis of the beauty of nature and adds that we have non-conceptual access to it. These idealized forms he names aesthetic normal ideas of natural species. §51 of Kant’s Critique of the Aesthetic Power of Judgment opens with an unexpected claim, described by readers as ‘puzzling’, ‘perplexing’ and even as a ‘notorious mystery’.1 1 Beauty can in general be called the _expression_ of aesthetic ideas: only in beautiful art this idea must be occasioned by a concept of the object, but in beautiful nature the mere reflection on a given intuition, without a concept of what the object ought to be, is sufficient for arousing and communicating the idea of which that object is considered as the _expression_. 2 2 I will argue that, in this passage, Kant states that there are two types of aesthetic ideas—namely, aesthetic ideas expressed in beautiful art and aesthetic ideas expressed by beautiful nature. This distinction is surprising for, before this juncture, there is no explicit claim that there are different types of aesthetic ideas. In fact, although Kant offers several seemingly general characterizations of aesthetic ideas, in none of them does he indicate that there is a subdivision of the genus. Noteworthy, too, is the claim that the distinct pleasure we take in beautiful nature is independent of concepts; for strikingly, it can be considered as the expression of what the passage above expressly calls ideas. In his analysis of fine art, Kant draws the distinction between natural and artistic beauty—a distinction that is succinctly repeated in the passage above.3 3 But when he goes on to explicate the notion of an aesthetic idea, he refers only to aesthetic ideas expressed in art. This fact is taken to support the assumption that aesthetic ideas are connected solely to art. This is the heart of the mystery of the passage, for in it, Kant explicitly talks about aesthetic ideas expressed by beautiful nature. This raises a crucial question: Does the explication of aesthetic ideas in the sections on art apply to aesthetic ideas of beautiful nature?I maintain that the answer is negative. Although, in the passage above, Kant uses the same term in relation to both kinds of beauty, he has a clear distinction in mind: Beauty in art is an aesthetically or sensuously unified expression of the conceptual richness of an idea of reason; beauty in nature is an expression of a purely aesthetically or sensuously unified richness. Obviously, this distinction is connected to other significant differences between the two kinds of beauty. But it is important to point out at the outset that the two types of aesthetic ideas have in common only the quality of being a sensuously unified richness. It is in this sense that they are both species of a single genus. But what more precisely does Kant mean by aesthetic ideas expressed by beautiful nature, and what unified richness do they express and how precisely do they express it? It is to the historical genealogy of this notion of aesthetic ideas of beautiful nature and its implications for Kant’s theory of beauty that this paper is devoted. This historical genealogy will reveal a sense of the notion of aesthetic ideas that we easily overlook but would have been familiar to Kant and his contemporaries. (shrink)

Supermaxes are technologically advanced prisons designed to keep individuals in long-term solitary confinement, structurally eliminating all physical, human contact for months, years, and sometimes decades at a time. Supermax designers and prison administrators explain that supermax prisons contain “the worst of the worst prisoners”—those too violent and dangerous to live in a general prison population. This article explores and challenges the legally and publicly accepted idea that supermaxes control violence. Drawing on interviews with and the writings of former supermax prisoners, (...) I document the often-invisible ways supermax prisoners experience violence. I argue supermaxes should be viewed not just as tools of violence control, but as tools of violence production. Supermaxes are a novel and uniquely modern form of state violence, and their legal and ethical implications should be reconsidered. (shrink)

Was ist Kunst? Was leistet Kunst? Warum bewegt uns Kunst? Und warum kommt ästhetischen Fragestellungen gerade heute wieder eine besondere Relevanz zu? Diesen Fragen geht der seit 2019 von der DFG eingerichtete Tübinger Sonderforschungsbereich 1391 Andere Ästhetik nach. Dabei möchte er die historische Tiefenschicht eines Perspektivwechsels aufarbeiten, der sich darauf richtet, Kunst und Künste nicht in autonomen Sonderräumen zu situieren. Hierfür bringt das Forschungsprojekt die 2000-jährige europäische Kunst- und Kulturgeschichte vor dem 18. Jahrhundert neu in Anschlag. Der Band erläutert, worin (...) der Gewinn der Konzentration auf die Vormoderne besteht, welche Neujustierung der Analyseinstrumentarien damit verbunden ist und welche grundsätzlichen Konsequenzen für Fragen der Ästhetik sich hieraus ergeben. Die Beiträge, die von den Philologien über die Kunstgeschichte, Archäologie und Musikwissenschaft bis hin zur Geschichtswissenschaft, Theologie und den Digital Humanities reichen, bieten hierfür konkrete Beispiele. Ziel ist es, von den ästhetischen Reflexionen der Vormoderne aus Impulse auch und gerade für die Diskussionen in der Gegenwart zu gewinnen. Der Band rückt Fragen der Ästhetik in neuer Weise von der Vormoderne aus in den Blick bietet gegenüber autonomieästhetisch orientierten heuristischen Ansätzen eine grundlegende Alternative an profiliert einen Perspektivwechsel mit interdisziplinärem Gewinn. (shrink)

In this chapter, we explore the question of on what grounds reports of clinical ethics support in general, including especially clinical ethics consultation, can or should be evaluated when using a peer review system. It is our contention that to evaluate clinical ethics consultation within a peer review system aiming at transparency and fairness, a defined and shared criteria of evaluation, i.e. an evaluation standard is required. When evaluating a performed ethics consultation, we can roughly distinguish between an internal standard, (...) which refers to the conceptualization of clinical ethics consultation held by the respective consultant or by the assessed clinical ethics support service themselves, and external standards. Most important is the way how an external standard is being defined: Is it just the standard of another service or colleague? Or is it the result of a larger consensus-building process of a relevant body representing a larger group of colleagues, such as the ASBH? Or does it even rely on the “evidence” of related research? An external standard, however, may rest on criteria that are not – or not fully – accepted by the evaluated CESS or individual ethics consultant. Identifying the internal standard of an observed ethics consultant’s work may also be challenging. From the evaluator’s perspective the responsibility for making an internal standard known and unequivocal lies with the “author” of the material. The potential gap between internal and external standards marks a methodological difficulty that as such has to be addressed within peer review evaluation. (shrink)

My original dilemma claimed that the transcendental argument for God’s existence is either superfluous (if the goal is to establish the actual existence of God) or inadequate (if the goal is to establish the necessary existence of God). In this rejoinder to James Anderson, I begin by noting some important points of agreement. I then clarify the differences between pattern-I, pattern-II, and pattern-III theistic arguments. I comment on each of Anderson’s three proposed lines of response and defend by original dilemma, (...) on the assumption that TAG is formulated as a pattern-II argument. (shrink)

Journal of Philosophy of Education, EarlyView.

Mylan Engel, Jr. has proposed a straightforward and attractive explanation of the internalism-externalism controversy (IEC) in contemporary epistemology. Engel's explanation posits that there are two distinct kinds of epistemic justification, and the IEC has arisen because epistemologists have inadvertently overlooked the fact that they are not all concerned with the same subject matter (internalists are concerned with one kind of epistemic justification while externalists are concerned with another kind). In this paper, I will explain two difficulties with Engel's proposed explanation. (...) The first difficulty concerns the claim that there are two kinds of epistemic justification. The second difficulty concerns whether Engel's proposed explanation is adequate to explain internalist concerns. (shrink)

Wittgenstein’s private language argument claims that language and meaning generally are public. It also contends with our appreciation of artworks and reveals the deep connection in our minds between originality and the temptation to think of original meaning as private. This problematic connection of ideas is found in Kant’s theory of fine art. For Kant conceives of the capacity of artistic genius for imaginatively envisioning original content as prior to and independent of finding the artistic means of communicating this content (...) to others. This raises the question of whether we can conceive of art as both original and meaningful without succumbing to privacy. (shrink)

Supermaxes are technologically advanced prisons designed to keep individuals in long-term solitary confinement, structurally eliminating all physical, human contact for months, years, and sometimes decades at a time. Supermax designers and prison administrators explain that supermax prisons contain “the worst of the worst prisoners”—those too violent and dangerous to live in a general prison population. This article explores and challenges the legally and publicly accepted idea that supermaxes control violence. Drawing on interviews with and the writings of former supermax prisoners, (...) I document the often-invisible ways supermax prisoners experience violence. I argue supermaxes should be viewed not just as tools of violence control, but as tools of violence production. Supermaxes are a novel and uniquely modern form of state violence, and their legal and ethical implications should be reconsidered. (shrink)

Ethische Leitlinien für die klinische Praxis erfreuen sich zunehmender Beliebtheit. Damit klinisch-ethische Leitlinien aber überhaupt erfolgreich wirksam werden können, ist noch Pionierarbeit zu leisten. Solche Leitlinien müssen wissenschaftlich stärker fundiert und ihre praktische Anwendbarkeit muss verbessert werden. In dieser Arbeit werden die ersten Schritte des Projekts METAP zur methodischen Entwicklung und praktischen Implementierung einer Leitlinie für eine patientengerechte Versorgung am Krankenbett beschrieben und zur Diskussion gestellt. Das Projekt orientiert sich methodisch an der Entwicklung medizinischer Leitlinien und generiert damit eine forschungs- (...) und konsensgestützte Leitlinie, die systematischer Evaluation und Modifikation unterliegt und Rechenschaft über ihre wissenschaftliche Fundierung gibt. Zusätzlich zur Leitlinie bietet das Projekt in der Form eines Handbuchs ein Entscheidungsfindungsverfahren an, welches unter anderem deliberative Aspekte unterstützt. Das Handbuch konzentriert sich auf ethische Fragen der Mikroallokation und liefert darüber hinaus Informationen über empirische, ethische und rechtliche Grundlagen für Therapieentscheidungen. Anhand eines Eskalationsmodells können unterschiedliche Instrumente nach Bedarf als ethische Lösungsstrategien eingesetzt werden, von der Kurzfassung im Kitteltaschenformat („Leporello“) mit den wichtigsten Fakten, weiterführenden Texten und Empfehlungen mit normativen und prozeduralen Hinweisen, über stationsinterne Lösungsversuche bis hin zum Ethikkonsil. Klinische Partner sind von Beginn an aktiv in den Entwicklungsprozess eingebunden und verbessern so die Praxistauglichkeit und Akzeptanz sowie die Ausrichtung des Instrumentariums an den tatsächlichen Bedürfnissen. Dieses partnerschaftliche, partizipative Vorgehen scheint eine wichtige Voraussetzung dafür zu sein, dass METAP in der Klinik Fuß fassen konnte. (shrink)

In this paper I explore and defend an interpretation of Calvin’s doctrine of the sense of divinity which implies the following claim: (CSD) All sane cognizers know that God exists. I argue that externalism about knowledge comports well with claim CSD, and I explore various questions about the character of the theistic belief implied by CSD. For example, I argue that CSD implies that all sane cognizers possess functionally rational theistic belief. In the final sections of the paper, I respond (...) to two main objections and argue that CSD is consistent with the existence of various kinds of atheists and agnostics. (shrink)