Zusammenfassung Hintergrund Advance Care Planning (ACP) wird auch in Deutschland zunehmend praktiziert. Aus klinisch-ethischer Perspektive bietet ACP eine Möglichkeit, Vorausverfügungen zu konkretisieren und auf diese Weise die Entscheidungsfindung bei fehlender Selbstbestimmungsfähigkeit von Patient:innen zu unterstützen. Während es für Gesprächsangebote im Sinne des ACP in Pflegeeinrichtungen und Einrichtungen der Eingliederungshilfe seit 2015 Finanzierungsmöglichkeiten gibt und erste Studien zu Angeboten veröffentlich wurden, fehlt es in Deutschland bisher an publizierten Evaluationsstudien zu ACP-Angeboten im Krankenhaus. Intervention und Methoden Im vorliegenden Beitrag erfolgt die strukturierte (...) Darstellung von ACP als ein Element des klinisch-ethischen Unterstützungsangebotes am Universitätsklinikum Halle (Saale) (UKH). Es erfolgte eine quantitative Inhaltsanalyse der schriftlichen Dokumentation von durchgeführten ACP-Gesprächsprozessen für den Zeitraum der Pilotphase von 01/2020 bis 08/2021 (20 Monate). Ergebnisse Im Zeitraum wurden 93 ACP-Gespräche angefragt. Mit 79 Patient:innen konnten 110 Gespräche geführt werden. 46 % der Anfragen kamen von Palliative Care betreuten Patient:innen. Im Durchschnitt dauerten die Beratungen 45 min. Der Gesprächsprozess zur Erstellung einer Patientenverfügung benötigte durchschnittlich 122 min und 2,5 Gespräche. Bei 23 % der Patient:innen endete der ACP-Prozess nach dem Erstgespräch. Die Inhalte der ACP-Prozesse tangierten verschiedene Bereiche anderer Professionen im Krankenhaus, insbesondere die Entscheidungsfindung über aktuelle Diagnostik und Therapie zwischen Ärzt:innen und Patient:innen. Diskussion Die Einführung eines ACP-Angebotes im Krankenhaus zeigt neben einer Vielzahl an Chancen auch Herausforderungen auf, welche es im gemeinsamen Diskurs zu bewältigen gilt. Bei der Einbettung eines ACP-Angebots im Krankenhaus müssen die Besonderheiten der Klinik und insbesondere die Abgrenzung von ACP zu anderen Arbeitsfeldern der Ethikberatung, wie beispielsweise die Ethikfallberatung, bedacht werden. (shrink)

Single units that are not related to the desired task can become related to the task by conditioning their firing rates. We theorized that, during conditioning of firing rates to a tone, (a) unrelated single units would be recruited to the task; (b) the recruitment would depend on the phase of the task; (c) tones of different frequencies would produce different patterns of single unit recruitment. In our mute locked-in participant, we conditioned single units using tones of different frequencies emitted (...) from a tone generator. The conditioning task had three phases: Listen to the tone for 20 s, then silently sing the tone for 10 s, with a prior control period of resting for 10 s. Twenty single units were recorded simultaneously while feedback of one of the twenty single units was made audible to the mute locked-in participant. The results indicate that (a) some of the non-audible single units were recruited during conditioning, (b) some were recruited differentially depending on the phase of the paradigm (listen, rest, or silent sing), and (c) single unit firing patterns were specific for different tone frequencies such that the tone could be recognized from the pattern of single unit firings. These data are important when conditioning single unit firings in brain-computer interfacing tasks because they provide evidence that increased numbers of previously unrelated single units can be incorporated into the task. This incorporation expands the bandwidth of the recorded single unit population and thus enhances the brain-computer interface. This is the first report of conditioning of single unit firings in a human participant with a brain to computer implant. (shrink)

The motivation of someone who is locked-in, that is, paralyzed and mute, is to find relief for their loss of function. The data presented in this report is part of an attempt to restore one of those lost functions, namely, speech. An essential feature of the development of a speech prosthesis is optimal decoding of patterns of recorded neural signals during silent or covert speech, that is, speaking “inside the head” with output that is inaudible due to the paralysis of (...) the articulators. The aim of this paper is to illustrate the importance of both fast and slow single unit firings recorded from an individual with locked-in syndrome and from an intact participant speaking silently. Long duration electrodes were implanted in the motor speech cortex for up to 13 years in the locked-in participant. The data herein provide evidence that slow firing single units are essential for optimal decoding accuracy. Additional evidence indicates that slow firing single units can be conditioned in the locked-in participant 5 years after implantation, further supporting their role in decoding. (shrink)

We review studies of an evolution operator ℒ for a discrete Langevin equation with a strongly hyperbolic classical dynamics and a Gaussian noise. The leading eigenvalue of ℒ yields a physically measurable property of the dynamical system, the escape rate from the repeller. The spectrum of the evolution operator ℒ in the weak noise limit can be computed in several ways. A method using a local matrix representation of the operator allows to push the corrections to the escape rate up (...) to order eight in the noise expansion parameter. These corrections then appear to form a divergent series. Actually, via a cumulant expansion, they relate to analogous divergent series for other quantities, the traces of the evolution operators ℒn. Using an integral representation of the evolution operator ℒ, we then investigate the high order corrections to the latter traces. Their asymptotic behavior is found to be controlled by sub-dominant saddle points previously neglected in the perturbative expansion, and to be ultimately described by a kind of trace formula. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

As competências cognitivas pressupostas pelas atualizações sociais (relações, discursos, interpretações) significam a atribuição aos seres humanos de uma certa racionalidade. Essa racionalidade pode ser concebida seja na perspectiva de uma filosofia da história de tipo evolucionista (Habermas), seja numa perspectiva da filosofia da mente (Pettit). Nas duas perspectivas, o tipo de questionamento é quase transcendental, no sentido de que se trata de revelar as condições de possibilidade das operações cognitivas reais efetuadas pelos agentes. Em última instância, as condições de possibilidade (...) devem ser entendidas como "natureza". A questão é a de saber se, metodologicamente, um monismo naturalista é possível, ou se um dualismo de perspectivas não seria imprescindível. Cognitive abilities presupposed by social performances (relations, speeches, interpretations) mean the attribution to human beings of a certain rationality. This rationality can be understood in terms of a type of evolutionary philosophy of history (Habermas), or in terms of the perspective of the philosophy of mind (Pettit). In both perspectives, the type of questioning is almost transcendental in the sense that it is able to reveal the possibility of cognitive operations performed by real actors. Ultimately, the conditions of possibility must be understood as "nature." The question is whether, methodologically, a naturalistic monism is possible, or if a dualism of perspectives would not be indispensable. (shrink)

“A stubborn problem of Catalonian urban history” is how Stephen Bensch recently characterized the question of why Catalonia's first communal magistracies were created so late and lasted so briefly. While consulates appeared in Italian towns circa 1100 and in the Midi circa 1130, the first sure attestations to Catalonian consulates date to the 1180s. Charters recording the establishment of consulates exist for Cervera , Perpignan , and Lleida . Barcelona's consuls are first mentioned in 1183, but, since no consular charter (...) survives for Barcelona , the date and the circumstances of the consulate's creation there remain unknown. There was an attempt to establish a consulate at Vic between 1175 and 1185, probably at a date closer to the latter year than the former. As Philippe Wolff has pointed out, the lapse of approximately half a century between the arrival of the consulate in the Midi and in Catalonia cannot be attributed to earlier and more complete urbanization in the Midi. Commercial development proceeded more quickly at Barcelona than at Toulouse, yet the consulate appeared at Toulouse before Barcelona. André Gouron has argued influentially that the chronology of the spread of Roman law determined the chronology of the consulate's diffusion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.1 (2003) 231-240 [Access article in PDF] Rescuing the Rescuers in Philip Hallie's Ethical Sublime Patrick Henry "Only stories or visions of transcending personal isolation and indifference can move me... hope, joy lie only in the transcendence of self-absorption—in expansion." —Philip Hallie I THROUGHOUT HIS LIFE, Philip Hallie expressed strong distrust for abstract philosophy. He wanted his own philosophy constituted of flesh and (...) blood, and he believed in the centrality of narration in ethical writing. The personality of stories, the irrefutable nature of the individual's account had to form the essential basis in the teaching of ethics. It is no surprise, then, that in his posthumous Tales of Good and Evil, Help and Harm 1 Hallie leaves us with a series of powerful stories, biographical and autobiographical, as the final expression of his lifelong agonizing struggle to come to terms with his own ethical beliefs. There are no general proofs here. No abstract principles. No definitions of goodness and evil. Only stories that depict the being referred to by e. e. cummings as "manunkind" mysteriously achieving the "realizable ideal" of rescuer of strangers.Given Hallie's major work on the rescuers of Jews in the village of Le Chambon-sur-Lignon, Lest Innocent Blood Be Shed. The Story of the Village of Le Chambon and How Goodness Happened There, 2 it seems appropriate that he begin this particular account of "tales of good and evil" in that same [End Page 231] village. Thus, the first biography he presents is that of Magda Trocmé, the wife of the pastor of the Protestant Church in Le Chambon-sur-Lignon, André Trocmé, who, with his fellow pastor Edouard Theis, is said to have inspired the rescue mission in the village. Hallie underscores the communal nonviolent effort by clergy and villagers alike in this "city of refuge." While he admires both André and Magda as practitioners of the "great virtues," he more readily identifies with Magda's secularism than with her husband's piety. He celebrates her generosity, her refusal to turn anyone away from her door, her "quiet habit of efficacious compassion," and her terse explanation as to why the rescuers in the village did what they had done: "What do you mean? It had to be done, that's all."As much as Hallie related to Magda's secularism, he was unable to identify fully with her because he felt tainted by the killing he had done as an artillery man in the United States Army during World War II. "I was a helpful killer who violated the negative demand against killing ["Thou shalt not kill"] in order to obey the positive one to spread life. But Magda and her villagers! Their ethical purity was beyond me. They obeyed the negative demands of ethics by hating and hurting no one even while they obeyed the positive demands of ethics by saving [thousands of refugees]." Compared to Magda and the villagers, Hallie clearly saw himself as someone operating in the grey zone.With the introduction of Joshua James and the community of Hull, Massachusetts, we ascend from Hallie's personal quagmire of moral ambiguity to the realm of the "ethical sublime." Here the author relates the story of James, whose mother and sister died at sea in 1837 when he was 11 years old, and who would go on to a career of life-saving activity on the Massachusetts coast. James founded the Life-Saving Rescue Service, an organization that evolved into the Coast Guard (or more specifically The Search and Rescue Service of the Coast Guard). He spent his entire life in Hull (1826-1902) and over the course of nearly sixty years saved hundreds of sailor's lives and tens of thousands of dollars worth of property.Many coastal villages around the world, Hallie explains, profited greatly from shipwrecks. Their cargoes and the stuff the ships were made of were highly valuable to the generally poor people who inhabited such villages. Yet the village of Hull, the smallest village in the state, having roughly... (shrink)

_Criticism and Conviction_ offers a rare opportunity to share personally in the intellectual life and journey of the eminent philosopher Paul Ricoeur. Internationally known for his influential works in hermeneutics, theology, psychoanalysis, and aesthetics, until now, Ricoeur has been conspicuously silent on the subject of himself. In this book--a conversation about his life and work with François Azouvi and Marc de Launay--Ricoeur reflects on a variety of philosophical, social, religious, and cultural topics, from the paradoxes of political power to the (...) relationship between life and art, and life and death. In the first of eight conversations, Ricoeur traces the trajectory of his life, recounting the origins of his convictions and the development of his intellect against the tragic events of the twentieth century. Declaring himself the "son of a victim of the First World War," Ricoeur, an orphan, sketches his early years in the house of stern but loving grandparents, and the molding of his intellect under the tutelage of Roland Dalbiez, Gabriel Marcel, and André Philip. Ricoeur tells the intriguing story of his capture and five-year imprisonment by the Germans during World War II, where he and his compatriots fashioned an intellectual life complete with a library and lectures, and where he, amazingly, was able to continue his dissertation research. Elegantly interweaving anecdotal with philosophical meditations, Ricoeur recounts his relationships with some of the twentieth century's greatest figures, such as Heidegger, Jaspers, and Eliade. He also shares his views on French philosophers and explains his tumultuous relationship with Jacques Lacan. And while expressing his deepest respect for the works of Claude Lévi-Strauss and Michel Foucault, Ricoeur reserves his greatest admiration for the narratologist Algirdas Julien Greimas. Ricoeur also explores the relationship between the philosophical and religious domains, attempting to reconcile the two poles in his thought. And readers who have struggled with Ricoeur's work will be grateful for these illuminating discussions that provide an invaluable key to his writings on language and narrative, especially those on metaphor and time. Spontaneous and lively, _Criticism and Conviction_ is a passionate confirmation of Ricoeur's eloquence, lucidity, and intellectual rigor, and affirms his position as one of this century's greatest thinkers. It is an essential book for anyone interested in philosophy and literary criticism. (shrink)

It's been 41 years since the publication of Ernst Mayr's Cause and Effect in Biology wherein Mayr most clearly develops his version of the influential distinction between ultimate and proximate causes in biology. In critically assessing Mayr's essay I uncover false statements and red-herrings about biological explanation. Nevertheless, I argue to uphold an analogue of the ultimate/proximate distinction as it refers to two different kinds of explanations, one dynamical the other statistical.

Moral reasoning typically informs environmental decision-making by measuring the possible outcomes of policies or actions in light of a preferred ethical theory. This method is subject to many problems. Environmental pragmatism tries to overcome them, but it suffers also from some pitfalls. This paper proposes a new method of environmental pragmatism that avoids the problems of both the traditional method of environmental moral reasoning and of the general versions of environmental pragmatism. We call it ‘justificatory moral pluralism’ – it develops (...) the intuition that normative ethical theories need not be mutually exclusive. This leaves room for important forms of pluralist environmental ethics that do not require a once-and-for-all prior commitment to an ethical theory when deciding about policies or courses of action related to the protection of the environment. Justificatory moral pluralism offers a viable solution to the recurrent conflicts between efficient environmental decisions and the need for moral reasoning. (shrink)

Do citizens have an obligation to obey the law? This book differs from standard approaches by shifting from the language of obedience to that of deference. The popular view that law claims authority but does not have it is here reversed on both counts: law does not claim authority but has it. Though the focus is on political obligation, the author approaches that issue indirectly by first developing a more general account of when deference is due to the view of (...) others. Two standard practices that political theorists often consider in exploring the question of political obligation - fair-play and promise-keeping - can themselves be seen as examples of a duty of deference. In this respect the book defends a more general theory of ethics whose scope extends beyond the question of political obligation to questions of duty in the case of law, promises, fair play and friendship. (shrink)

Argues i) that part of what it is to understand what is being asked, when we ask whether something is good, is being able to distinguish stopping points in a series of "Why?" questions, and ii) that this ability explains how we can reason from observable facts to conclusions about value.

In the spirit of James and Dewey, I ask what one might want from a theory of knowledge. Much Anglophone epistemology is centered on questions that were once highly pertinent, but are no longer central to broader human and scientific concerns. The first sense in which epistemology without history is blind lies in the tendency of philosophers to ignore the history of philosophical problems. A second sense consists in the perennial attraction of approaches to knowledge that divorce knowing subjects from (...) their societies and from the tradition of socially assembling a body of transmitted knowledge. When epistemology fails to use the history of inquiry as a laboratory in which methodological claims can be tested, there is a third way in which it becomes blind. Finally, lack of attention to the growth of knowledge in various domains leaves us with puzzles about the character of the knowledge we have. I illustrate this last theme by showing how reflections on the history of mathematics can expand our options for understanding mathematical knowledge. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

Drawing on a half century of scholarship, of Polish studies of Copernicus and Cracow University, and of Copernicus's sources, this book offers a comprehensive re-evaluation of Copernicus's achievement, and explains his commitment to the ...

The idea that there should be no limits on freedom of discussion receives passionate defenses from some of the most thoughtful and eloquent writers in our language, for example, Milton's evidential transparence condition and Mill's condition of equal benefit. My interest lies in exposing the consequences of this view for the derivative value of free discussion. I'm going to be particularly concerned with those instances in which these conditions are problematic.

O presente artigo tem por objetivo discutir pressupostos inquestionáveis do comunicar e do compreender, pressupostos que, tais como um imperativo ético, pretendem prescrever, para ambos os filósofos, modos inequívocos de interação intelectual entre autor e leitor, prescrever modelos inflexíveis para qualquer comunicação que pretenda trazer à linguagem uma verdade.