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2015
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(2015): Reconsidering Respect for Persons in a Globalizing World. In: Developing world bioethics 15 (2), S. 98-106. DOI: 10.1111/dewb.12045
DOI: http://www.ncbi.nlm.nih.gov/pubmed/24720355 Abstract: Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making - one from the developed and one from the developing world - in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world.
Keywords: Beneficence, Bewertung von sozialem Verhalten (/sozialer Angemessenheit), Clinical Decision-Making/ethics, Cultural Characteristics, culture specific, Decision Making, Developed Countries, Developing Countries, Ethical Analysis, Ethics, Medical, Family/ethnology/psychology, Humans, Internationality, Interviews as Topic, Islam, kulturspezifisch, Medizin, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Pakistan, Personal Autonomy, Personhood, Physician-Patient Relations/ethics, Principle-Based Ethics, respect, Respekt, Transcultural Nursing, United States 2008
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(2008): Inverse zombies, anesthesia awareness, and the hard problem of unconsciousness. In: Consciousness and cognition 17 (4), S. 1163-1168. DOI: 10.1016/j.concog.2008.06.004
DOI: http://www.ncbi.nlm.nih.gov/pubmed/18635380 Abstract: Philosophical (p-) zombies are constructs that possess all of the behavioral features and responses of a sentient human being, yet are not conscious. P-zombies are intimately linked to the hard problem of consciousness and have been invoked as arguments against physicalist approaches. But what if we were to invert the characteristics of p-zombies? Such an inverse (i-) zombie would possess all of the behavioral features and responses of an insensate being, yet would nonetheless be conscious. While p-zombies are logically possible but naturally improbable, an approximation of i-zombies actually exists: individuals experiencing what is referred to as "anesthesia awareness." Patients under general anesthesia may be intubated (preventing speech), paralyzed (preventing movement), and narcotized (minimizing response to nociceptive stimuli). Thus, they appear--and typically are--unconscious. In 1-2 cases/1000, however, patients may be aware of intraoperative events, sometimes without any objective indices. Furthermore, a much higher percentage of patients (22% in a recent study) may have the subjective experience of dreaming during general anesthesia. P-zombies confront us with the hard problem of consciousness--how do we explain the presence of qualia? I-zombies present a more practical problem--how do we detect the presence of qualia? The current investigation compares p-zombies to i-zombies and explores the "hard problem" of unconsciousness with a focus on anesthesia awareness.
Keywords: Advance Directives/ethics, Anesthesia, General, Awareness, Bewusstsein, Brain Death, Cognition, Comprehension, Emotions, Ethics, Medical, Ethik, Fähigkeit, sich auszudrücken/mitzuteilen, Humans, Im (wissenschaftlichen) Diskurs, Intention, Kommunikation, Menschsein als Voraussetznug für soziale Angemessenheit?, Mensch-Technik-Relationen (MTR), Models, Psychological, Ontologische Differenzierungen: Tier, Mensch, Maschine, Persistent Vegetative State/psychology, Personal Construct Theory, philosophical zombie, Philosophy, philosophy of mind, p-zombie, p-zombies, p-zombies vs i-zombies, Reflexionen über MTR, Unconsciousness
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