Die Zunahme der intensivmedizinischen Behandlungsverfahren ist mit einer Steigerung der Komplexität der Entscheidungen über Auswahl, Anwendung und Dauer der Therapiemaßnahmen verbunden. Ob im individuellen Fall ein Behandlungsziel erstrebenswert und der dafür notwendige Behandlungsweg akzeptabel ist, hängt von den persönlichen Wünschen, Werthaltungen und Lebensentwürfen der Patientinnen und Patienten ab. Häufig bestehen Unsicherheiten darüber, ob ein patientenzentriertes Behandlungsziel erreicht werden kann. Der Einsatz eines zeitlich begrenzten Therapieversuches (TLT) als eine verbindliche Übereinkunft zwischen dem Behandlungsteam und der Patientin/dem Patienten bzw. dem juristischen Stellvertretenden (...) zu einem Behandlungskonzept über einen definierten Zeitraum auf der Intensivstation kann hilfreich sein, um Unsicherheiten zu reduzieren und die Fortführung intensivmedizinischer Maßnahmen im Sinne des/der Patient/in besser einordnen und rechtfertigen zu können. (shrink)

Die Behandlungssituation in der Intensivmedizin ist durch eine starke Asymmetrie in der Begegnung gekennzeichnet: Patient:innen sind in besonderer Weise auf ihr Umfeld angewiesen, weisen häufig Beeinträchtigungen des Bewusstseins und der Willensbildung auf. Dies erleichtert die Anwendung von Zwang bzw. ermöglicht diesen und/oder ruft ihn hervor. Ziel dieser Handlungsempfehlung ist es, Wege aufzuzeigen, um Patient:innen mit ihren Wünschen und Bedürfnissen wahrzunehmen und sie in Behandlungskonzepte auf der Intensivstation einzubinden, um Zwang zu reduzieren und wann immer möglich zu vermeiden. Der Beitrag zeigt (...) die Vielfalt möglicher Formen von Zwang auf und diskutiert die im ethischen Abwägungsprozess zu berücksichtigenden moralischen Maßstäben sowie rechtliche Bedingungen zur Rechtfertigung seiner Anwendung. Es wird deutlich, dass Behandlungsmaßnahmen, die die Anwendung von Zwang beinhalten können, immer einer sorgfältigen und auch selbstkritischen Überprüfung der Maßnahmen im Verhältnis zur Indikation und zum Therapieziel bedürfen. Die Handlungsempfehlung möchte daher nicht prinzipiell die Anwendung von Zwang durch die interprofessionellen Teams missbilligen, sondern sie soll vielmehr zu einer sensiblen Wahrnehmung von Zwang und zu einem kritischen und fürsorglichen Umgang mit formellem und insbesondere informellem (indirektem) Zwang beitragen. (shrink)

Die Erfolge der modernen Medizin und die damit verbundene wachsende Zahl von älteren Patientinnen mit zunehmenden Komorbiditäten führt gerade in den letzten Jahren zu einer steigenden Inanspruchnahme der Behandlung auf Intensivstationen [1]. Das wachsende und scheinbar unbegrenzte Angebot einer technologisch fortschrittlichen Versorgung in der Intensivmedizin erzeugt den Eindruck unbegrenzter Möglichkeiten. Eine Überlebensperspektive wird auch in solchen Situationen eröffnet, in denen früher das Sterben unaufhaltbar und der Tod unvermeidlich war [2]. Im Erfolgsfall ermöglicht die Intensivmedizin das Überleben und die Rückkehr der (...) Patientin in ein möglichst unabhängiges und selbstbestimmtes Leben. (shrink)

Ungeachtet der sozialgesetzlichen Vorgaben existieren im deutschen Gesundheitssystem in der Patientenversorgung nebeneinander Unter-, Fehl- und Überversorgung. Überversorgung bezeichnet diagnostische und therapeutische Maßnahmen, die nicht angemessen sind, da sie die Lebensdauer oder Lebensqualität der Patienten nicht verbessern, mehr Schaden als Nutzen verursachen und/oder von den Patienten nicht gewollt werden. Daraus können hohe Belastungen für die Patienten, deren Familien, die Behandlungsteams und die Gesellschaft resultieren. Dieses Positionspapier erläutert Ursachen von Überversorgung in der Intensivmedizin und gibt differenzierte Empfehlungen zu ihrer Erkennung und Vermeidung. (...) Zur Erkennung und Vermeidung von Überversorgung in der Intensivmedizin erfordert es Maßnahmen auf der Mikro-, Meso- und Makroebene, insbesondere die folgenden: 1) regelmäßige Evaluierung des Therapieziels im Behandlungsteam unter Berücksichtigung des Patientenwillens und unter Begleitung von Patienten und Angehörigen; 2) Förderung einer patientenzentrierten Unternehmenskultur im Krankenhaus mit Vorrang einer qualitativ hochwertigen Patientenversorgung; 3) Minimierung von Fehlanreizen im Krankenhausfinanzierungssystem gestützt auf die notwendige Reformierung des fallpauschalbasierten Vergütungssystems; 4) Stärkung der interdisziplinären/interprofessionellen Zusammenarbeit in Aus-, Fort- und Weiterbildung; 5) Initiierung und Begleitung eines gesellschaftlichen Diskurses zur Überversorgung. (shrink)

Farmers’ markets (FMs) represent a crucial player in urban food systems, being the interconnection of local agricultural production and consumption, and serving as spaces for both economic exchange and community building. Despite their transformative potential, there is a scarcity of research that comprehensively investigates the dynamics of FMs network structure and the influence of the actors shaping FMs. The present article delves into the network of relationships within FMs in the Italian city of Bologna. This study adopts the Social Network (...) Analysis (SNA) methodology applied with the Net-Map tool. The research objectives are to visualise the underlying network structure, map the dynamics, and identify the key actors who play pivotal roles in Bologna’s FMs and their level of influence. The research carried out interviews with ten FMs stakeholders, revealing the network of relationships between 54 actors, divided into three categories—civil society, food economy and public administration. Actors were linked by a total of 428 relationships across three types of networks: support, economic, and hindering. Findings indicate a strong support network structure characterised by varying degrees of centrality among different actors. Farmers emerge as a central node due to their pivotal role in providing fresh, local produce. Additionally, local institutions contribute significantly to FMs resilience and growth. Our research demonstrates the importance of recognising the embeddedness of FMs within the local context. By understanding the network structure and influential actors in FMs, policymakers can devise more effective policies for promoting local agriculture, and enhancing the sustainability of urban–rural exchanges. In conclusion, the present study offers valuable insights into the network dynamics of FMs, highlighting their crucial role in the sustainable development of urban and local food systems. (shrink)

Mobile social media have become a widespread means to participate in everyday social and professional life. These platforms encourage the disclosure and exchange of personal information, which comes with privacy risks. While past scholarship has listed various predictors and consequences of online privacy concerns, there has been to date no empirical investigation of a conceivable relationship with perceived stress. Using a longitudinal panel study, we examined the reciprocal relationship between mobile social media privacy concerns and perceived stress. Results supported the (...) hypothesis that mobile social media privacy concerns at T1 are associated with higher perceived stress at T2. However, we found no evidence for the reverse association, that is, perceived stress at T1 was not related to mobile social media privacy concerns at T2. The findings are discussed based on two models—the “Antecedents privacy concerns outcomes” model and the “Privacy calculus” model. (shrink)

In this chapter, we critically examine the most important extant ways of understanding and motivating the idea that reasons for belief are normative. First, we examine the proposal that the distinction between explanatory and so-called normative reasons that is commonly drawn in moral philosophy can be rather straightforwardly applied to reasons for belief, and that reasons for belief are essentially normative precisely when they are normative reasons. In the course of this investigation, we explore the very nature of the reasons-for-belief (...) relation, as well as the ontology of such reasons. Second, we examine the idea that the normativity derives from the internal connection between reasons for belief and epistemic justification, distinguishing between two distinct normativist accounts of justification, a weaker and a stronger one. We argue that neither line of argument is compelling. Pending further arguments, we conclude that normativism about reasons for belief is not supported. (shrink)

Before the trains of thought have been firmly laid down, we ask in this article about the very nature and histories of the speculative of the speculative-materialist turn. We do this from the intertwined interfaces of curious feminist materialisms, foregrounding sexual difference, post-positivist critique and posthumanist performativity such as is being done in various strands of feminist theory today. The question of speculation plays a constitutive role in feminist critique and in several new or neo-materialist traditions. In fact, many interesting (...) materialisms—Marxism, French feminism—can be named ‘speculative’. We argue that in spite of what the recent ‘speculative turn’ professes, speculative materialisms have a complex genealogy. Speculation functions transversally in a materialist genealogy -connecting the archive of feminist approaches in particular. In order to be able to imagine a different world we need to think through a stifled and sexually differentiated present from which a qualitative shift and political breakthrough can be formulated, and hopefully achieved. However, in what is currently called ‘speculative realism’ or ‘object-oriented ontologies’ neither speculation nor the speculative are reflected upon as a heritage from and alliance with feminist and politically materialist positions. What are the onto-epistemological stakes of this body of work? And what ethico-political horizons are drawn here? We stand speculative before such turn. (shrink)

We have claimed that truth norms cannot provide genuine guidance for belief formation. Asbjørn Steglich-Petersen argues that our ‘no guidance argument’ fails because it conflates certain psychological states an agent must have in order to apply the truth norm with the condition under which the norm prescribes forming certain beliefs. We spell out the no guidance argument in more detail and show that there is no such conflation.

In natural language, looks-talk is used in a variety of ways. I investigate three uses of ‘looks’ that have traditionally been distinguished – epistemic, comparative, and phenomenal ‘looks’ – and endorse and develop considerations in support of the view that these amount to polysemy. Focusing on the phenomenal use of ‘looks’, I then investigate connections between its semantics, the content of visual experience, and the metaphysics of looks. I argue that phenomenal ‘looks’ is not a propositional attitude operator: We do (...) not use it to ascribe propositional attitudes to subjects, but to directly ascribe looks to objects, where looks are relational properties. However, I go on to argue that, given the way we use phenomenal ‘looks’, these relational properties are ultimately best understood as phenomenal relational properties, i.e. in terms of relations involving experiences. Along the way, I endorse Byrne’s argument against Jackson’s claim that phenomenal ‘looks F’ only takes predicates for colour, shape, and distance, and raise the issue of compositionality for the resulting view according to which phenomenal ‘looks F’ is context-dependent in a way that allows it to take a vast range of predicates. I conclude by arguing that these considerations concerning the natural language use of ‘looks’, and in particular its phenomenal use, are water on the mills of phenomenal intentionalism, a position in the philosophy of perception according to which experiences are propositional attitudes with phenomenal looks-contents. (shrink)

The project of this chapter is to explore some relations between the rule-following considerations and radical interpretation. I spell out the sense in which the rule-following considerations are about meaning determination, and investigate whether the principle of meaning determination used in the early Davidson's account of meaning determination - the principle of charity - provides an answer to what I shall call "Wittgenstein's paradox". More precisely, I am interested in one aspect of the paradox: the "problem of objectivity". My question (...) then is whether meaning, as determined by charity, is such that the correctness of the applications of meaningful expressions is an objective matter. After running us through the basics of the radical interpretation account of meaning determination I argue that the principle of charity does seem to fall prey to the problem of objectivity. After unsuccessfully trying to rescue objectivity by means of Lewisian natural properties, this is the verdict I in the end endorse. (shrink)

Aristotle famously held that objects are comprised of matter and form. That is the central doctrine of hylomorphism (sometimes rendered “hylemorphism”—hyle, matter; morphe, form), and the view has become a live topic of inquiry today. Contemporary proponents of the doctrine include Jeffrey Brower, Kit Fine, David Hershenov, Mark Johnston, Kathrin Koslicki, Anna Marmodoro, Michael Rea, and Patrick Toner, among others. In the wake of these contemporary hylomorphic theories the doctrine has seen application to various topics within mainstream analytic (...) metaphysics. Here, appeals to form and matter are used to shed light on problems about ontology, personal identity, philosophy of mind, and philosophy of religion. The current entry documents this resurgence of interest in hylomorphism, the ways it has been applied, and its reception. (shrink)

As an analogy, triangulation was introduced into the philosophy of mind and language in Donald Davidson's 1982 paper ‘Rational animals’. The analogy is used to support the claim that linguistic communication not only suffices to show that a creature is a rational animal in the sense of having propositional thoughts, but that it is necessary as well: ‘rationality is a social trait. Only communicators have it’. The triangulation argument employs the premise that in order to have any propositional thought whatsoever, (...) a creature needs to have the concept of objective truth. To have this concept, however, it must stand in certain relations of interaction not only with objects or events in the world but also with other creatures sufficiently like itself. The most simple such situation involves a ‘triangle’ of two creatures interacting with each other and an object or event in the world. (shrink)

In previous work, I have suggested a doxastic account of perceptual experience according to which experiences form a kind of belief: Beliefs with what I have called “phenomenal” or “looks-content”. I have argued that this account can not only accommodate the intuitive reason providing role of experience, but also its justificatory role. I have also argued that, in general, construing experience and perceptual beliefs, i.e. the beliefs most directly based on experience, as having different contents best accounts for the defeasibility (...) of experiential reasons. In this paper, I shall have a closer look at the evidential or inferential relation between looks-propositions and the contents of perceptual beliefs and argue for a form of what I shall call “Pollockianism” about experiential reasons: such reasons are good unless defeated. Questions to be investigated include: Does the resulting picture of perceptual justification contain an externalist element? Is it compatible with Bayesianism? And how does it do with respect to problems that have been raised for other forms of Pollockianism such as dogmatism or phenomenal conservatism? (shrink)

Name der Zeitschrift: Das Mittelalter Jahrgang: 23 Heft: 1 Seiten: 1-6.

When you look at a circular plate at an angle, it looks circular. But there also is a certain sense in which its look can be described as oval. When you move, the plate’s look changes with your perspective on it—nevertheless, it continues to look circular. This chapter investigates whether these “constancy in variation” phenomena can be explained in terms of the representational content of visual experience, and whether constancy in variation provides special, phenomenological, reasons to construe experience as having (...) centered contents. Concentrating on shape, it argues that due to warring phenomenological demands, all views construing constancy in variation as representation of both objective and perspectival properties or features have limited explanatory powers, and that centering does not provide any advantage. By contrast, adopting the non-standard intentionalism called phenomenal intentionalism, we get rather natural explanations of the phenomenology of constancy in variation. (shrink)

Objective: Body checking (BC) and avoidance (BA) form the behavioral component of body image disturbance. High levels of BC/BA have often been documented to hold a positive and potentially reinforcing relationship with eating pathology. While some researchers hypothesize, that patients engage in BC/BA to prevent or reduce levels of anxiety, little is known about the mediating factors. Considering the great comorbidity between eating disorders and in particular social anxieties, the present study investigated whether socially relevant types of anxiety mediate the (...) relationship between eating pathology and BC/BA. Method: 83 participants reporting an eating disorder and 323 healthy participants (14-25 years) took part in an online survey. Eating pathology was measured with the Eating Disorder Examination Questionnaire and Body Checking and Avoidance Questionnaire. Trait and social anxiety were assessed by means of the State Trait Anxiety Inventory (STAI-T), the Fear of Negative Evaluation (FNE) and the Social Appearance and Anxiety Scale (SAAS). Separate mediation analyses were carried out with eating pathology as independent variable, BC/BA as dependent variable and STAI, FNE and SAAS as mediating variables. Results: Anxieties correlated highly positive with eating pathology in both groups. SAAS mediated the relationship between ED pathology and BC/BA in participants with ED and mediated the relationship between ED pathology and BA in healthy participants. FNE mediated the relationship between eating pathology and BA for participants with eating pathology. Discussion: SAAS mediated the relationship between eating pathology and BC/BA. Being afraid of bodily evaluations may represent a particular relevant fear that triggers safety behaviors. (shrink)

The project of this chapter is to explore some relations between the rule-following considerations and radical interpretation. I spell out the sense in which the rule-following considerations are about meaning determination, and investigate whether the principle of meaning determination used in the early Davidson's account of meaning determination - the principle of charity - provides an answer to what I shall call "Wittgenstein's paradox". More precisely, I am interested in one aspect of the paradox: the "problem of objectivity". My question (...) then is whether meaning, as determined by charity, is such that the correctness of the applications of meaningful expressions is an objective matter. After running us through the basics of the radical interpretation account of meaning determination I argue that the principle of charity does seem to fall prey to the problem of objectivity. After unsuccessfully trying to rescue objectivity by means of Lewisian natural properties, this is the verdict I in the end endorse. (shrink)

On peut dégager chez Schelling deux types ou deux manières de penser le conflit. Le premier de ces types se trouve modélisé dans la tragédie grecque : c’est le type d’une lutte sans vainqueur ni vaincu, d’un combat qui débouche sur l’égale victoire et l’égale défaite de la nécessité et de la liberté. Schelling le thématise dès ses premiers écrits et le développe ensuite dans ses leçons sur l’art. La deuxième manière de penser le conflit consiste à le placer dans (...) la substance divine pour le situer ensuite dans la conscience humaine : c’est le type d’une lutte dont l’aiguillon aveugle est contraint au retrait par son propre opposé. Ce type est développé à partir des Recherches de 1809 et permet de comprendre le processus complexe de la mythologie. Mais, s’il y a un vainqueur, c’est bien à la faveur d’une loi d’équité qui, à chacune des forces, et d’abord au fondement finalement surmonté, reconnaît un droit propre qui est inaliénable. (shrink)

Eating disorders (EDs) are characterized by marked cognitive distortions and maladaptive schemas. Cognitive models of EDs highlight the direct impact of cognitive dysfunctions on eating-related disturbances, insofar as specific cognitive contents such as thoughts about diet rules and food or loss of control may trigger disturbed eating behavior. Moreover, early maladaptive schemas that reflect perfectionist standards and relate to achievement and performance seem to be associated with disturbed eating, e.g. via their impact on situation-specific appraisals. However, so far, no study (...) has investigated these assumptions. Hence, the present study sought to demonstrate whether and how cognitive content exerts an impact on eating behavior in daily life, and whether maladaptive core schemas impact the occurrence of binge eating via dysfunctional ED cognitions in eating-related contexts. N = 29 females with Bulimia Nervosa (BN), n = 31 females with Binge Eating Disorder (BED) and n = 30 female controls without EDs (NC) participated in the study. All participants received a handheld computer for a 48-hour period to capture antecedents of disturbed eating behavior in daily life. Event-sampling (meals, binge eating, purging, stressful situations) and signal-sampling (five times a day) methods were applied. EMA included a short questionnaire to assess dysfunctional cognitions and level of craving and to capture information about situational contexts. Early maladaptive schemas were assessed using a short version of the Young Schema Questionnaire at baseline. The main results showed specific patterns of dysfunctional eating-related cognitions for BED and BN. Binge eating was predicted by thoughts about loss of control (positively) and dietary restraint (negatively). For meal situations, no significant differences between the two ED groups emerged. All three domains exerted indirect effects on craving via thoughts about ‘eating/loss of control’, whereas neither a direct nor an indirect effect emerged regarding thoughts about ‘dietary restraint’. These results fit well with previous studies and support cognitive models of EDs; schema therapeutic approaches may be a valuable contribution to enhance treatment of EDs. Further studies should explore whether the findings from emerging adulthood can be generalized to younger age groups. (shrink)

Cognitive control processes are advantageous when routines would not lead to the desired outcome, but this can be ill-advised when automated behavior is advantageous. The aim of this study was to identify neural dynamics related to the ability to adapt to different cognitive control demands – a process that has been referred to as ‘metacontrol.’ A sample of N = 227 healthy subjects that was split in a ‘high’ and ‘low adaptability’ group based on the behavioral performance in a task (...) with varying control demands. To examine the neurophysiological mechanisms, we combined event-related potential (ERP) recordings with source localization and machine learning approaches. The results show that individuals who are better at strategically adapting to different cognitive control demands benefit from automatizing their response processes in situations where little cognitive control is needed. On a neurophysiological level, neither perceptual/attentional selection processes nor conflict monitoring processes paralleled the behavioral data, although the latter showed a descriptive trend. Behavioral differences in metacontrol abilities were only significantly mirrored by the modulation of response-locked P3 amplitudes, which were accompanied by activation differences in insula (BA13) and middle frontal gyrus (BA9). The machine learning result corroborated this by identifying a predictive/classification feature near the peak of the response-locked P3, which arose from the anterior cingulate cortex (BA24; BA33). In short, we found that metacontrol is associated to the ability to manage response selection processes, especially the ability to effectively downregulate cognitive control under low cognitive control requirements, rather than the ability to upregulate cognitive control. (shrink)

Contributing Authors: Lilli Alanen & Frans Svensson, David Alm, Gustaf Arrhenius, Gunnar Björnsson, Luc Bovens, Richard Bradley, Geoffrey Brennan & Nicholas Southwood, John Broome, Linus Broström & Mats Johansson, Johan Brännmark, Krister Bykvist, John Cantwell, Erik Carlson, David Copp, Roger Crisp, Sven Danielsson, Dan Egonsson, Fred Feldman, Roger Fjellström, Marc Fleurbaey, Margaret Gilbert, Olav Gjelsvik, Kathrin Glüer & Peter Pagin, Ebba Gullberg & Sten Lindström, Peter Gärdenfors, Sven Ove Hansson, Jana Holsanova, Nils Holtug, Victoria Höög, Magnus Jiborn, Karsten Klint (...) Jensen, Sigurður Kristinsson, Isaac Levi, Kasper Lippert-Rasmussen, David Makinson, Anna-Sofia Maurin, Philippe Mongin, Kevin Mulligan, Lennart Nordenfelt, Jonas Olson, Erik J. Olsson, Ingmar Persson, Johannes Persson, Björn Petersson, Philip Pettit, Hans Rott, Toni Rønnow-Rasmussen, Krister Segerberg, John Skorupski, Howard Sobel, Fredrik Stjernberg, Fred Stoutland, Caj Strandberg, Pär Sundström, Folke Tersman, Torbjörn Tännsjö, Peter Vallentyne, Bruno Verbeek, Stella Villarmea, and Michael J. Zimmerman. (shrink)

In _Form, Matter, Substance_, Kathrin Koslicki defends a hylomorphic analysis of concrete particular objects (e.g., living organisms). The Aristotelian doctrine of hylomorphism holds that those entities that fall under it are compounds of matter (hulē) and form (morphē or eidos). Koslicki argues that a hylomorphic analysis of concrete particular objects is well-equipped to compete with alternative approaches when measured against a wide range of criteria of success. A successful application of the doctrine of hylomorphism to the special case of (...) concrete particular objects, however, hinges on how hylomorphists conceive of the matter composing a concrete particular object, its form, and the hylomorphic relations which hold between a matter-form compound, its matter and its form. Through the detailed answers to these questions Koslicki develops in this book, matter-form compounds, despite their metaphysical complexity, emerge as occupying the privileged ontological status traditionally associated with substances, due in particular to their high degree of unity. (shrink)