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

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

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

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

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

We all know what a voluntary action is - we all think we know when an action is voluntary, and when it is not. Yet, performing and action and defining it are different matters. What counts as an action? When does it begin? Does the conscious desire to perform an action always precede the act? If not, is it really a voluntary action? This is a debate that crosses the boundaries of Philosophy, Neuroscience, Psychology, and Social Science. This book brings (...) together some to the leading thinkers from these disciplines to consider this deep and often puzzling topic. The result is a fascinating and stimulating debate that will challenge our fundamental assumptions about our sense of free-will. (shrink)

As everyone knows, physicists have proved that free will doesn’t exist. That’s because we are made of tiny particles which follow strict laws, and human behavior is really just a consequence of these particles’ laws. At least that’s what I used to think. But some years ago I stumbled over a gap in this argument. In this essay I want to tell you what made me rethink and why you should rethink, too.

Following decades of silence about the involvement of doctors, medical researchers and other health professionals in the Holocaust and other National Socialist (Nazi) crimes, scholars in recent years have produced a growing body of research that reveals the pervasive extent of that complicity. This interdisciplinary collection of studies presents documentation of the critical role medicine played in realizing the policies of Hitler's regime. It traces the history of Nazi medicine from its roots in the racial theories of the 1920s, through (...) its manifestations during the Nazi period, on to legacies and continuities from the postwar years to the present. (shrink)

Référence de la pensée critique contemporaine et de la lutte contre les discriminations sexuelles et « culturelles », Judith Butler passe pour une grande philosophe. En prise sur notre actualité, ce livre, dont le titre fait allusion à l'autorité usurpée des Jésuites moqués par Pascal dans Les Provinciales, questionne cette évidence, par une critique sévère et argumentée de la « pensée Butler ».

This work tells the story of the rise of the modern German environmental imagination, with particular emphasis on its narrative and visual components.

Recently, there has been a surge of interest in the lexicon. The demand for a fuller and more adequate understanding of lexical meaning required by developments in computational linguistics, artificial intelligence, and cognitive science has stimulated a refocused interest in linguistics, psychology, and philosophy. Different disciplines have studied lexical structure from their own vantage points, and because scholars have only intermittently communicated across disciplines, there has been little recognition that there is a common subject matter. The conference on which this (...) volume is based brought together interested thinkers across the disciplines of linguistics, philosophy, psychology, and computer science to exchange ideas, discuss a range of questions and approaches to the topic, consider alternative research strategies and methodologies, and formulate interdisciplinary hypotheses concerning lexical organization. The essay subjects discussed include: * alternative and complementary conceptions of the structure of the lexicon, * the nature of semantic relations and of polysemy, * the relation between meanings, concepts, and lexical organization, * critiques of truth-semantics and referential theories of meaning, * computational accounts of lexical information and structure, and * the advantages of thinking of the lexicon as ordered. (shrink)

ABSTRACTThe standard view in philosophy of mind is that the way to understand the difference between perception and misperception is in terms of accuracy. On this view, perception is accurate while...

What exactly is hope and how does it influence our decisions? In How We Hope, Adrienne Martin presents a novel account of hope, the motivational resources it presupposes, and its function in our practical lives. She contends that hoping for an outcome means treating certain feelings, plans, and imaginings as justified, and that hope thereby involves sophisticated reflective and conceptual capacities. Martin develops this original perspective on hope--what she calls the "incorporation analysis"--in contrast to the two dominant philosophical conceptions (...) of hope: the orthodox definition, where hoping for an outcome is simply desiring it while thinking it possible, and agent-centered views, where hoping for an outcome is setting oneself to pursue it. In exploring how hope influences our decisions, she establishes that it is not always a positive motivational force and can render us complacent. She also examines the relationship between hope and faith, both religious and secular, and identifies a previously unnoted form of hope: normative or interpersonal hope. When we place normative hope in people, we relate to them as responsible agents and aspire for them to overcome challenges arising from situation or character. Demonstrating that hope merits rigorous philosophical investigation, both in its own right and in virtue of what it reveals about the nature of human emotion and motivation, How We Hope offers an original, sustained look at a largely neglected topic in philosophy. (shrink)

This article defends a theory of diffuse attention and distinguishes it from focal attention. My view is motivated by evidence from psychology and neuroscience, which suggests that we can deploy visual selective attention in at least two ways: by focusing on a small number of items, or by diffusing attention over a group of items taken as a whole. I argue that diffuse attention is selective and can be object‐based. It enables a subject to select an object to guide behavior, (...) albeit in a different way than focusing does. (shrink)

Fact-finding hearings may be held to determine disputed allegations of domestic violence in child contact cases in England and Wales, and can play a vital role for mothers seeking protection and autonomy from violent fathers. Drawing on the author’s empirical study, this article examines the implications for the holding of fact-finding hearings of judges’ and professionals’ understandings of domestic violence and the extent to which they perceive it to be relevant to contact. While more judges and professionals are developing their (...) understanding of domestic violence, the ambit of when and how it is considered relevant to contact has grown increasingly narrow, which suggests that many disputed allegations of domestic violence are disregarded and women and children continue to be put at risk from violent fathers. This bifurcated approach is likely to have significant implications for recent developments in this area of family law which are considered in this article. (shrink)

People with disabilities use more medical care and see health professionals more often than do those of the same age, ethnic group, or economic class who do not have impairments. An indisputable medical goal is.

In cases of identity crowding, a subject consciously sees items in a figure, even though they are presented too closely together for her to shift attention to each item. Block uses such cases to challenge the view that attention is necessary for consciousness. I argue that in identity crowding cases, subjects really do attend to the items. Specifically, they attend to the figure as a global object that contains the individual items as parts. To support this view, I provide evidence (...) that attention can be directed to a global object or a local object. My response helps to defend the view that attention is necessary for conscious perception. (shrink)

Attention seems to raise a problem for pure representationalism, the view that phenomenal content supervenes on representational content. The problem is that shifts of attention sometimes seem to bring about a change in phenomenal content without a change in representational content. I argue that the representationalist can meet this challenge, but that doing so requires a new view of the representational content of perception. On this new view, the representational content of perception is always relative to a way of attending. (...) I call this the attention-indexed view of perceptual content. (shrink)

Für ökonomische Evaluationen medizinischer Leistungen steht ein etabliertes Methodenspektrum zur Verfügung. Ziel der Arbeit ist, anhand ausgewählter Aspekte herauszuarbeiten, inwieweit diese Methoden für den derzeit viel diskutierten Bereich der Personalisierten Medizin anwendbar sind bzw. welche Besonderheiten dabei auftreten und wie diese adressiert werden können. Für die vorliegende Arbeit wurde eine explorative Literaturrecherche durchgeführt. In Abgrenzung zur herkömmlichen Medizin kann je nach Blickwinkel die Personalisierte Medizin entweder hinsichtlich der physiologischen Unterschiede oder hinsichtlich der individuellen Präferenzen der Beteiligten betrachtet werden. Je nach (...) Betrachtungsweise ergeben sich unterschiedliche methodische Herausforderungen an gesundheitsökonomische Evaluationen. Verbesserte Ausrichtung der Versorgung an physiologischen Unterschieden stellt die Evaluation beispielsweise vor das Problem, dass aufgrund des oftmals kleinen Stichprobenumfangs häufig Evidenz zur Parametrisierung von Entscheidungsmodellen fehlt. Informationswertanalysen können Hinweise über den potenziellen Nutzen weiterer Forschung geben. Das Konzept des „Expected Value of Individualized Care“ bietet einen den Informationswertanalysen sehr ähnlichen Ansatz, um den potenziellen Wert eines Einbezugs individueller Präferenzen in die Versorgung zu quantifizieren. Welfarismus und Extra-Welfarismus bieten unterschiedliche Lösungsansätze, wie Nutzen Biomarker-basierter Information im Sinne von „Empowerment“ in Evaluationen einbezogen werden können. Generell sind die Methoden der gesundheitsökonomischen Evaluation auch auf den Bereich der Personalisierten Medizin anwendbar. Es stellen sich jedoch eine Reihe spezifischer Herausforderungen, zu deren Lösung weiterer Forschungsbedarf besteht. (shrink)

Für ökonomische Evaluationen medizinischer Leistungen steht ein etabliertes Methodenspektrum zur Verfügung. Ziel der Arbeit ist, anhand ausgewählter Aspekte herauszuarbeiten, inwieweit diese Methoden für den derzeit viel diskutierten Bereich der Personalisierten Medizin anwendbar sind bzw. welche Besonderheiten dabei auftreten und wie diese adressiert werden können. Für die vorliegende Arbeit wurde eine explorative Literaturrecherche durchgeführt. In Abgrenzung zur herkömmlichen Medizin kann je nach Blickwinkel die Personalisierte Medizin entweder hinsichtlich der physiologischen Unterschiede oder hinsichtlich der individuellen Präferenzen der Beteiligten betrachtet werden. Je nach (...) Betrachtungsweise ergeben sich unterschiedliche methodische Herausforderungen an gesundheitsökonomische Evaluationen. Verbesserte Ausrichtung der Versorgung an physiologischen Unterschieden stellt die Evaluation beispielsweise vor das Problem, dass aufgrund des oftmals kleinen Stichprobenumfangs häufig Evidenz zur Parametrisierung von Entscheidungsmodellen fehlt. Informationswertanalysen können Hinweise über den potenziellen Nutzen weiterer Forschung geben. Das Konzept des „Expected Value of Individualized Care“ bietet einen den Informationswertanalysen sehr ähnlichen Ansatz, um den potenziellen Wert eines Einbezugs individueller Präferenzen in die Versorgung zu quantifizieren. Welfarismus und Extra-Welfarismus bieten unterschiedliche Lösungsansätze, wie Nutzen Biomarker-basierter Information im Sinne von „Empowerment“ in Evaluationen einbezogen werden können. Generell sind die Methoden der gesundheitsökonomischen Evaluation auch auf den Bereich der Personalisierten Medizin anwendbar. Es stellen sich jedoch eine Reihe spezifischer Herausforderungen, zu deren Lösung weiterer Forschungsbedarf besteht. (shrink)

This article addresses an issue overlooked in most of the literature on judicial review: the legitimacy of judicial review of a constitution's federal and structural provisions. Debates about the legitimacy of judicial review—at least as conducted throughout the Commonwealth—are usually focussed on rights. These debates appear to assume that the power of courts like the Australian High Court and the Canadian Supreme Court to interpret and enforce federal and structural provisions is unproblematic. This article tests that assumption and concludes that (...) those who hold democracy-based objections to constitutional rights should seriously reconsider, and perhaps oppose, federal and structural judicial review as well. (shrink)

Not all countries do their fair share in the effort of preventing dangerous climate change. This presents those who are willing to do their part with the question whether they should 'take up the slack' and try to compensate for the non-compliers' failure to reduce emissions. There is a pro tanto reason for doing so given the human rights violations associated with dangerous climate change. The article focuses on fending off two objections against a duty to take up the slack: (...) that it is unfair and ineffective. We grant that it is unfair if some have to step in for others but argue that this does not amount to a decisive objection under conditions of partial compliance. With regard to the charge of emission reductions being ineffective, we argue that the empirical case for this claim is missing and that even if it were not, there still remains the option of taking up the slack in other forms. (shrink)

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

Der Band gibt einen exemplarischen Überblick über die Geschichte feministischer Theorie in den Sozialwissenschaften. Er verfolgt eine doppelte Zielsetzung: Die vertiefende Einführung in feministisches Denken soll zugleich eine Einübung in eine kritische wissenschaftliche Praxis der Historisierung von Problemen, Objekten und Denkwerkzeugen in der sozialwissenschaftlichen Frauen- und Geschlechterforschung sein. Feministische Theorie entwickelte sich aus einer Reihe von kritischen Analysen und Haltungen gegenüber geschlechtlich organisierten sozialen Ungleichheiten und Ausschlüssen, dominanten Diskursen und Repräsentationen, aber auch in ständiger selbstkritischer Reflexion des eigenen Denkens. Es (...) ist dieser an Widersprüchen und Paradoxien geschulte Blick, der feministisches Denken im Kern ausmacht. (shrink)

Before we can answer what society owes the psychopaths, we have to know wherein society's putative sin against psychopaths might consist. Is the society really responsible for the development of so...