Erkenntnistheorie Und Verständnistheorie

Ohne Zusammenfassung     

The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

Timeout postponement without increased reinforcement frequency

Three experiments were conducted to examine pigeons' postponement of signaled extinction periods (timeouts) from a schedule of food reinforcement when such responding neither decreased overall timeout frequency nor increased the overall frequency of food reinforcement. A discrete-trial procedure was used in which a response during the first 5 s of a trial postponed an otherwise immediate 60-s timeout to a later part of that same trial but had no effect on whether the timeout occurred. During time-in periods, responses on a second key produced food according to a random-interval 20-s schedule. In Experiment 1, the response-timeout interval was 45 s under postponement conditions and 0 s under extinction conditions (responses were ineffective in postponing timeouts). The percentage of trials with a response was consistently high when the timeout-postponement contingency was in effect and decreased to low levels when it was discontinued under extinction conditions. In Experiment 2, the response-timeout interval was also 45 s but postponement responses increased the duration of the timeout, which varied from 60 s to 105 s across conditions. Postponement responding was maintained, generally at high levels, at all timeout durations, despite sometimes large decreases in the overall frequency of food reinforcement. In Experiment 3, timeout duration was held constant at 60 s while the response-timeout interval was varied systematically across conditions from 0 s to 45 s. Postponement responding was maintained under all conditions in which the response-timeout interval exceeded 0 s (the timeout interval in the absence of a response). In some conditions of Experiment 3, which were designed to control for the immediacy of food reinforcement and food-correlated (time-in) stimuli, responding postponed timeout but the timeout was delayed whether a response occurred or not. Responding was maintained for 2 of 3 subjects, suggesting that behavior was negatively reinforced by timeout postponement rather than positively reinforced by the more immediate presentation of food or food-correlated (time-in) stimuli.     

The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

Ministry to the chronic hemodialysis patient

The beginning point of ministry to those persons suffering from renal failure and turning to hemodialysis in order to sustain life is a sensitive understanding of the total dialysis experience. The minister or chaplain who visits a hemodialysis unit only occasionally will be more effective in bringing his skills to the task by understanding the unique dynamics of the physical, emotional and spiritual adjustment of those who depend on this relatively new therapy. The specific elements of this ministry in terms of those closely involved, professional care givers, families, and patients, are discussed with attention to the factors that tend to make ministry to the hemodialysis patient unique.This article is the result of a one-year chaplain residency at the Veterans Administration Hospital in Nashville, Tennessee, in partial fulfillment of clinical requirements for the D. Min. degree in Pastoral Theology and Counseling at the Divinity School, Vanderbilt University, Nashville, Tennessee.     

Explizite und implizite psychoanalytische Behandlungspraxis

Zusammenfassung  Die Psychoanalyse wurde mit dem Ziel konzipiert, Verdrängungen dem Bewusstsein zugänglich zu machen und dadurch die Kindheitsamnesie aufzuheben (Freud 1937). Mit der Ausweitung des psychoanalytischen Behandlungsspektrums auf präödipale Störungen und Verbreitung der Objektbeziehungstheorie entwickelte sich allerdings eine alternative Behandlungsstrategie, die Therapie der emotionalen Erfahrung. Der damit verknüpfte Dualismus führte lange zu einer Kontroverse über eine einheitliche psychoanalytische Behandlungstechnik. Nur langsam setzte sich die Erkenntnis durch, dass angemessene Deutungen und ein entwicklungsfördernder Umgang mit der Übertragung zwei therapeutische Ansätze darstellen, die nicht voneinander zu trennen sind.Vor dem Hintergrund der neueren Gedächtnisforschung zeigt sich, dass beide Ansätze sich einerseits ergänzen, andererseits aber auch gegensätzliche Pole im Indikationsspektrum der psychoanalytischen Praxis repräsentieren. Die Einsichtstherapie der klassischen Analyse hat das episodische, explizite Gedächtnis als Bezugspunkt und in dieser Weise auch weiterhin Gültigkeit. Demgegenüber bezieht sich die Therapie der emotionalen Erfahrung auf implizites Erfahrungswissen, das den Kern der Patienten mit einer Entwicklungspathologie ausmacht.In dieser Arbeit wird die implizite psychoanalytische Behandlungspraxis im Umgang mit archaischen Ich-Zuständen erläutert. Dabei wird die Bedeutung der bekannten Behandlungskonzepte Objektverwendung, Metabolisierung und containment hervorgehoben.

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Explicit and implicit psychoanalytical practice

Psychoanalysis was conceived with the aim of making suppressed experiences available to the consciousness and by means of this, reversing childhood amnesia. In the course of the extension of the psychoanalytical treatment spectrum to pre-oedipal disturbances and the increasing influence of the object relation theory an alternative therapeutic strategy, the therapy of emotional experience, was developed. The related dualism led to a long-lasting controversy about a uniform psychoanalytical technique. The insight that adequate interpretations and beneficial handling of the relationship are two therapeutical approaches which have not to be separated from each other, has been accepted slowly.Against the background of recent memory research it turns out that on the one hand both approaches supplement each other, but on the other hand they are contrasting poles in the indication spectrum of psychoanalytical practice. The therapy of insight of classical psychoanalysis has the explicit memory as a reference point and is therefore still valid. On the contrary, the therapy of emotional experience refers to implicit experience which is the core of developmental pathology.In this paper the implicit psychoanalytical practice, dealing with archaic ego states, is discussed, referring to such well-known concepts as object use, metabolization and containment.

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Nach einem Vortrag zum 50-jährigen Bestehen des Lou Andreas-Salomé Instituts in Göttingen am 30.10.04.

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