ZusammenfassungBedingt durch den demographischen Wandel wird der Anteil an alten Patienten in Kliniken und Arztpraxen zunehmen. Damit müssen sich Ärzte verstärkt auf die spezifischen Anforderungen der Behandlung von alten Patienten einstellen. Diese sind wesentlich durch die Faktoren Alter, Multimorbidität und Demenz geprägt. Die Abhandlung analysiert die hiermit gegebenen sozial- und personalethischen Implikationen für Ausbildung und Arbeitsalltag der Ärzte sowie für das Gesundheitssystem.

ZusammenfassungBedingt durch den demographischen Wandel wird der Anteil an alten Patienten in Kliniken und Arztpraxen zunehmen. Damit müssen sich Ärzte verstärkt auf die spezifischen Anforderungen der Behandlung von alten Patienten einstellen. Diese sind wesentlich durch die Faktoren Alter, Multimorbidität und Demenz geprägt. Die Abhandlung analysiert die hiermit gegebenen sozial- und personalethischen Implikationen für Ausbildung und Arbeitsalltag der Ärzte sowie für das Gesundheitssystem.

Bedingt durch den demographischen Wandel wird der Anteil an alten Patienten in Kliniken und Arztpraxen zunehmen. Damit müssen sich Ärzte verstärkt auf die spezifischen Anforderungen der Behandlung von alten Patienten einstellen. Diese sind wesentlich durch die Faktoren Alter, Multimorbidität und Demenz geprägt. Die Abhandlung analysiert die hiermit gegebenen sozial- und personalethischen Implikationen für Ausbildung und Arbeitsalltag der Ärzte sowie für das Gesundheitssystem.

Das Altern ist nicht nur eine biologische, sondern auch eine kulturelle Tatsache. Als Objekt der Verhandlungen zwischen Wissensdiskursen erscheint Alter als ein ebenso heterogenes wie problematisches Phanomen, das von Werturteilen und Weltanschauungen bestimmt wird. Des Weiteren sind Alter und Medizin in der offentlichen Meinung moderner Gesellschaften eng miteinander verbunden. Das interdisziplinare Forschungsprojekt "Kulturelle Variationen und Reprasentationen des Alters" geht von einem erweiterten, die geistes-, sozial- und medizinwissenschaftlichen Diskurse integrierenden Konzept von Alterskulturen und Potentialen des Alters aus. Dies bedeutet, Alter als (...) Gegenstand des Wissens und als Konzept zu begreifen. Alterskonzepte, das heisst Vorstellungen, Wertungen und, Bilder des Alters, sind Deutungsmuster fur elementare Bedurfnisse an der Schnittstelle von individuellem und kollektivem Leben. Mit Beitragen von David Blane und Gopalakrishnan Netuveli, Johannes Siegrist und Morten Wahrendorf, Peter Rusterholz, Anouk Janssen, Hiltrud Westermann-Angerhausen, Stefanie Knoll, Jean-Claude Schmitt, Gerd Gockenjan, Giovanna Pinna, Hans-Georg Pott, Monika Gomille, Miriam Seidler, Pat Thane, Simone Moses, Heiner Fangerau und Jorg Vogele, Anja Schonlau, Thomas Kupper". (shrink)

Several theorists argue that one does not experience something as being at or coming from a distance or direction in olfaction. In contrast to this, I suggest that there can be a variety of spatial aspects of both synchronic and diachronic olfactory experiences, including spatial distance and direction. I emphasise, however, that these are not aspects of every olfactory experience. Thus, I suggest renouncing the widespread assumption there is a uniform account of the nature, including the spatial nature, of what (...) is experienced in olfactory experience. (shrink)

An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)

To reduce global greenhouse gas emissions in order to limit global warming to 1.5°C, individuals and households play a key role. Behavior change interventions to promote pro-environmental behavior in individuals are needed to reduce emissions globally. This systematic literature review aims to assess the a) evidence-based effectiveness of such interventions and b) the content of very successful interventions without limiting the results to specific emitting sectors or countries. Based on the “PICOS” mnemonic and PRISMA statement, a search strategy was developed, (...) and eligibility criteria were defined. Three databases were searched to retrieve and review potential literature. As a result, 54 publications from 2010 to 2021 were included in the analysis. The results show that most interventions only have small positive effects or none at all. A total of 15 very successful interventions focused on the sectors of mobility, energy, and waste and incorporated improved structures, education, feedback, enablement or made the sustainable option the default. Six evidence-based recommendations for content, timing, and setting are deducted and given for interventions on enhancing pro-environmental behavior. In summary, although the various interventions and intervention types to promote PEB differ in their effectiveness, very successful interventions have common elements. Future research should focus on high-/low-impact and high-/low-cost behavior to develop interventions that aim at high-impact but low-cost behavior changes, or avoid low-impact but high-cost behavior. (shrink)

In this paper, we are interested in the effects of institutional context on public attitudes towards climate policies, where institutions are defined as the conventions, norms and formally sanctioned rules of any given society. Building on a 2014 survey experiment, we conducted thirty qualitative interviews with car-owners in Oslo, Norway, to investigate the ways in which institutional context and political-value orientation affect public attitudes towards emissions policies. One context (presented as a text treatment) highlighted individual rationality, emphasising the ways in (...) which local pollution impacts the individual citizen; the other highlighted social rationality, emphasising the wider significance of carbon emissions and global responsibility for climate change. We analysed the effects of these contexts on attitudes, finding that institutional context influenced individuals' perspectives as well as their attitudes towards climate policies. Groups with different value orientations differed in terms of their evaluations but not their interpretations of these contexts. (shrink)

This paper outlines a ‘perceptual account’ of depiction. It centrally contrasts with experiential accounts of depiction in that seeing something in a picture is understood as a visual experience of something present in the picture, rather than as a visual experience of something absent. The experience of a picture is in this respect akin to a veridical rather than hallucinatory perceptual experience on a perceptual account. Thus, the central selling-point of a perceptual account is that it allows taking at face (...) value the intuitive claim that we see things in pictures. Preserving this claim has a potential cost, however: we need to postulate that some kind of thing, T, is present in the realm of the picture, and it is not straightforward to find a plausible type of entity to play this role. The paper examines three alternative choices of T; T may be a material object, a visual appearance or a universal. (shrink)

Abordagem do protagonismo social, analisando sua relação com a informação, concluindo pela compreensão deste como objetivo do trabalho informacional, situando a mediação da informação como sua ação central. Parte da apresentação das origens conceituais em torno do protagonismo, buscando, à medida que debate as referências acerca do tema, demonstrar a relação do desenvolvimento do protagonismo social com o trabalho informacional, assim como sua posição de meta da atividade da mediação da informação, executada nas suas cinco dimensões e na condição de (...) elemento central desse trabalho. As assertivas apresentadas são resultado do estudo crítico da bibliografia da área da Ciência da Informação que aborda o protagonismo e a mediação da informação, assim como de estudos de filósofos e pensadores que abordam os aspectos sociais e políticos da comunicação e da formação de sujeitos socialmente ativos, permitindo a identificação das relações entre protagonismo e mediação da informação, como também que a mediação consciente favorece o primeiro, concluindo que o apoio ao seu desenvolvimento representa a principal responsabilidade social do trabalho com a informação. (shrink)

Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

Fred. L. Polak explored the mechanisms of social change in terms of “future—visions” held by a community. The future, says Polak, participates actively in the present, providing part of the context within which today's decisions are made. Barbara McClintock acquired her insights in maize genetics by developing “a feeling for the organism.” New insights, she maintains, emerge through a mutual relationship between researcher and subject. Though scholars in different fields, both acknowledge the power of images in the creative process. There (...) is a difference in the extent to which each scientist perceives this power to be available to create new ideas. (shrink)

ABSTRACT The paper addresses an underexplored puzzle about pictorial representation, a puzzle about how depiction of movement is possible. One aim is to clarify what the puzzle is. It might seem to concern a conflict between the nature of static surfaces and the dynamic things that they can depict. But the real conflict generating the puzzle is between the pictorial mode of presentation and what can be seen in pictures. A second aim of the paper is to solve the puzzle. (...) While many take it that depicting movement is to make visible something that has duration, I suggest that it is to make visible something atemporal. (shrink)

ABSTRACT The paper addresses an underexplored puzzle about pictorial representation, a puzzle about how depiction of movement is possible. One aim is to clarify what the puzzle is. It might seem to concern a conflict between the nature of static surfaces and the dynamic things that they can depict. But the real conflict generating the puzzle is between the pictorial mode of presentation and what can be seen in pictures. A second aim of the paper is to solve the puzzle. (...) While many take it that depicting movement is to make visible something that has duration, I suggest that it is to make visible something atemporal. (shrink)

It is widely accepted that pictures can only depict visible things. The paper criticises this ‘visibility constraint’ on the objects of depiction. The constraint is shown to imply that the range of visibilia is settled prior to an investigation of what can be seen in pictures. By contrast to this, I suggest that settling what can be seen in pictures is relevant to settling the range of visibilia. It is what we experience in pictures, and not the objects of depiction, (...) that is subject to a visibility constraint, I propose. After criticising the widely accepted visibility constraint in the first half of the paper, I outline an account of what we experience in pictures in the second half of the paper. (shrink)

The author traces the ways in which various patients and collective associations of patients come to regard themselves as the users of future stem cell technologies. The author uses Althusser’s notion of interpellation, whereby an identity is the result of the situated encounter of a subject and an authority, to analyze the ways in which patient associations’ current involvement with basic research is related to the enactment of science as a series of technology development projects. The author argues that this (...) ‘‘project-ness’’ forms a certain privileged logic that interpellates patients and their associations in specific ways. Through the listings of illnesses circulated in the mass media, which are hoped to be treatable or curable with stem cell therapies, patients come to recognize themselves as the projected users of stem cell technologies. The author fleshes out the process of this userfication and the various responses made by patients and their associations when hailed by the entrepreneurial projects of stem cell research. (shrink)

The relationship between music and dance can sometimes be a ‘match’, a remarkable fit between the audible manifestation that music is and the visual or kinaesthetic manifestation that dance is. A match between two things seems to require a common measure with respect to which the match obtains. What can this be for two so different phenomena as music and dance? I argue that the most promising answer is: movement. This answer will not be satisfactory unless the movement of music (...) and the movement of dance are the same on some level. I suggest that they are: there are qualities of movement that guide both dancers and musicians when producing dance and music as perceptible phenomena. But the match in qualities is elusive, since the qualities are instantiated in different ways in music and dance, respectively. (shrink)

When unknowingly experiencing a perceptual hallucination, a subject can attempt to think specifically about what is, as far as he or she can tell, the perceived object. Is the subject then deceived about his or her cognitive situation? I answer negatively. Moreover, I argue that this answer is compatible with holding that thought specifically about a certain object – singular thought – is object-dependent. By contrast, both critics and advocates of the view that singular thought is object-dependent have assumed this (...) view to be committed to postulation of illusions of object-dependent thought in cases like that mentioned. The core ingredient in my illusion-free version of the view is a special form of disjunctivism. Alleged cases of illusion are not considered parasitic on ‘the good case’ where the object thought about is perceived. (shrink)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant (...) discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. (shrink)

Deliberative processes provide an important alternative input to environmental politics as they may, in contrast to often used market simulations, provide an arena for 1) discussion of lay participants' values, 2) articulating arguments grounded in other values than consequentialistic, and 3) capturing weakly comparable values. A case study of a Citizens' Jury (CJ) on genetically modified plants was used to investigate how the framing of the process affected the attitude formation among the citizens. The formal set up of this specific (...) CJ made value discussions less relevant. While it opened for value plurality, it failed to facilitate the articulation of weakly comparable values. (shrink)

Background:Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual.Objectives:The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway’s renamed and revised Patients’ and Service Users’ Rights Act (originally Patients’ Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian (...) Ministry of Health and Care Service.Research design:A constructivist design was used, and Fairclough’s critical discourse approach was adopted to analyze the text of the Patients’ and Service Users’ Rights Act and comments.Findings:The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients’ trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as “troublesome.”Conclusion:Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient. (shrink)

Nous avons cherché à identifier un aspect du refoulement du cosmopolitismel'des Lumières, complémentaire de la fabrique des identités nationales enl'Europe au XIXe siècle et dans l'entre-deux-guerres. L'idée de civilisation communel'serait maintenue par la capacité réciproque de traduction des langues nationales, dul'fait de leurs origines communes indo-européennes. L'utopie de la langue remplaceraitl'le parcours matériel des Lumières. C'est l'échec de la construction du mythe indianistel'européen et non pas son succès qui explique le dévoiement idéologique des relationsl'entre langue et nation. La promotion manquée (...) de la langue tsigane dans le mondel'académique illustre bien cet échec. Après la Première Guerre mondiale, la transformationl'du principe des nationalités en ethnopolitique fit disparaître jusqu'au souvenirl'de cette ambition commune. (shrink)

This exciting collection offers a range of perspectives from some of the most prominent feminist voices of our time, including Rosi Braidotti, Judith Butler, Claire Colebrook, Elizabeth Grosz, and Jack Halberstam. Employing experimental modes of thinking and writing, the contributors remain faithful to the feminist tradition of subversion and resistance, while refusing to submit to its political tradition of a loving sisterhood or dutiful daughterhood. Through productive disagreement and cognitive dissonance, the essays presented here reflect the specific circumstances of our (...) present, and attempt to dream and envision possible alternatives for the future. The volume thus invites us to think of the becoming of feminism itself, and the possibilities of future feminisms-to-come. (shrink)

It is not unusual in the philosophy of perception to use empirical research to build arguments against or in favour of a certain philosophical view (see Phillips 2016 for a scrutinizing discussion). This methodology is what Barwich uses in her book entitled Smellosophy (2020) when criticizing an approach to olfaction according to which ‘truthful perception is an accurate mental representation of physical properties’ (Barwich 2020: 310). Furthermore, Barwich would like neuroscience to set the agenda for philosophical questions about olfaction, so (...) that empirical evidence is not just used to adjudicate between existing philosophical theories but instead inspires new ones, such as Barwich’s own. Thus, while her main focus is first-order theories of olfaction, she also aims to exemplify a methodology for developing and assessing such theories that ‘break[s] down the silos of institutionalized disciplinarity that are neatly dividing philosophical from neuroscientific inquiry’ (Barwich 2020: 311). The ways in which Barwich arrives at and justifies claims about olfaction give rise to various questions about the relationship between philosophical discussion of perception and neuroscientific results concerning how the brain works. In part 1 of this critical notice, I look at the approach to olfaction that Barwich criticizes and raise a few of these questions. This leads to a query about exactly how the approach differs from Barwich’s own view of olfaction. Part 2 discusses selected aspects of her view. I examine how her claim that olfaction is both exteroceptive and interoceptive and the associated idea that the brain creates odours relate to the empirical research she presents. This leads to a query concerning her methodology, which uses empirical research about brain processing to arrive at conclusions concerning a subject’s experience. (shrink)

Ever decreasing numbers of applicants arrive in language departments at UK universities. In the face of this decline, and against the backdrop of higher education languages departments being reduced across the UK, it is important to investigate the supply chain of languages undergraduates in the pre-entry sector. This article reports on a collaborative action research project between Language Networks for Excellence, University of Wolverhampton, and King Edward VI College, Stourbridge. The objective was to investigate how the HE sector can effectively (...) influence and support linguists and post-16 establishments in enhancing progression to studying languages at university and how the post-16 sector can ensure they meet language students’ needs in progression to HE. The research presents a number of conclusions and recommendations, not least that, whilst support from HE for 17—18-year-old school students and their institutions is welcome and contributes to students’ confidence and skills, there may be merit in targeting students much further down the supply chain, encouraging progression to HE through tailored linguistic and motivational support strategies. (shrink)

In the summer of 2017, wildflower seeds were spread on a large, empty open space close to a motorway flyover just outside Copenhagen, Denmark. This was an effort to use non-mechanical methods to prepare the soil for an ‘urban forest’ to be established on the site, since the flowers’ roots would penetrate the ground and enable the planned new trees to settle. As a result, the site was transformed into a gorgeous meadow, and all summer long Copenhageners were invited to (...) come and pick the flowers. In this article, I critically examine different aspects of this project – including the role of design, the perception of nature–culture relationships, climate change, and flower-picking as an event – in relation to my personal experience of visiting this meadow both on-site and on social media. The different temporalities that clash at the site give rise to conflicting interpretations, and I suggest that the meadow can be seen as a living plant archive of the Anthropocene, both physically and digitally. In doing so, I introduce and critique key conceptual pairs, including archive/death and bloom/decay, suggested by Lee Edelman’s queer cross-reading of Jacques Derrida’s ‘Archive Fever’ and Shakespeare’s Hamlet. I thereby contrast flower motifs pertaining to the cycles of blooming, decay, and nature’s (failed) eternal return in the meadow with the expansive futurity of the digitally mediated archive. (shrink)

ZusammenfassungIn der Erfahrung, Kommunikation und Bewältigung von Krankheit spielen Metaphern eine wichtige Rolle: Als Denkkonzepte spiegeln sie zugrundeliegende Haltungen gegenüber den durch sie beschriebenen Vorgängen wider. Susan Sontag hat mit ihrem Essay „Illness as Metaphor“ nachhaltig die moralisch kritischen Implikationen einer unreflektierten Metaphernverwendung im Umgang mit Erkrankung aufgezeigt, indem sie deren stigmatisierende und hierin zusätzlich belastende Wirkung für Erkrankte reflektiert.In der gegenwärtigen Situation der Covid-19-Pandemie trifft ein bisher unbekanntes Virus mit der Macht und Dynamik der Globalisierung auf die hierauf nicht (...) vorbereiteten spätmodernen Gegenwartsgesellschaften, die nun nach Erklärung und Sinnzuschreibung suchen. Auch hier fungieren Metaphern als Denkkonzepte und Vehikel von Interpretation. Im Rückgriff auf die Perspektive Susan Sontags und ihren Appell für einen entmystifizierten Umgang mit Krankheit geht dieser Beitrag folgenden Fragen nach: Welche Bilder werden in der Berichterstattung über CoV‑2 vermittelt? Welche Einstellung gegenüber Gesundheit und Krankheit wird mit den Metaphern transportiert, und welche Lebenshaltung liegt dieser zugrunde? Welche Einsichten für einen gesunden Umgang mit Covid-19 und Krankheit generell ergeben sich, wenn man die Pandemie aus ihren Metaphern und zugrundliegenden Denkkonzepten herausschält? (shrink)

During the last two years several committees discussed the question of enlarging patients' autonomy in living wills. The problern is to tind a way to grant patients' wishes without violating the state's duty to preserve human life. One basic question in the debate is the meaning of human dignity. Deducing from the Christian image of man the author describes chances and Iimits of living wills and presents a way of handling them. In her opinion living wills represent a chance for (...) a succeeding, trusting physician-patient- relationship in the age of high-tech medicine. (shrink)

Personal health technologies such as apps and wearables that generate health and behavior data close to the individual patient are envisioned to enable personalized healthcare - and self-care. And yet, they are consumer devices. Proponents of these devices presuppose that measuring will be helpful, and that data will be meaningful. However, a growing body of research suggests that self-tracking data does not necessarily make sense to users. Drawing together data studies and digital health research, we aim to further research on (...) data ambivalence, a term we use to refer to the ambiguities and uncertainties people experience when interpreting their own data, as well as the critical obligation towards cultivating ethically sound uses and responses to such data in context. We develop the relationship between data, interpretation, and context as a central theoretical and practical problem in the datafication of healthcare. We then show how interpretation and context matter for data ambivalence through an empirical study of heart patients with an implanted advanced pacemaker who were offered a Fitbit wristband for self-tracking as part of a research project. We argue that the hope, anxiety, and doubt connected to the promise and accuracy of data are tempered by the context and purpose of self-tracking, and by individual circumstances. Finally, we link the findings on context-sensitivity in data interpretation to questions about response-ability in cloud-based care infrastructures. We discuss the ethical dilemmas associated with the use of commercial wellness-technologies in healthcare, and with researching such emerging practices. (shrink)

"One might say that 'chance' is anything but blind in forking-path narratives."Fictional worlds attract the attention of debaters in particular when they are supposed to activate the viewers' reflections in a special way. Thus, movies that are most likely to irritate the audience and seem to animate people to reflect on their own personality and life are of major interest. In the following, I want to discuss a certain type of movie that meets these criteria: forking-path or multiple-draft narratives. On (...) the one hand they rely on well-known narrative schemata, and on the other hand they comprise something that is actually impossible: alternative futures. One central thesis raised by spokespersons of the .. (shrink)