In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as need (...) assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are - within this context - guiding but not binding principles. -/- Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. -/- Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)

Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/snp associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for (...) methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of “health” and “disease”, this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2–3 million SNPs are identified and the journals are full of reported “significant” associations between disease and mutation, only a few can be replicated unequivocally. The ACCE -framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: Prevalence, genotype-/phenotype-relation. Clinical presentation: natural history; the different expressions of disease. Performance of the genetic test. Implications for therapy and prevention. Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach. (shrink)

Admixture, the genetic exchange between differentiated populations appears to be common in the history of species, but has not yet been comparatively studied across mammals. This limits the understanding of its mechanisms and potential role in mammalian evolution. The authors want to summarize the current knowledge on admixture in non‐human primates, and suggest that it is important to establish a comparative framework for this phenomenon in humans. Genetic observations in domesticated mammals and their wild counterparts are discussed, and a (...) brief global overview on other clades is presented. Based on this, some of the consequences of gene flow, including incompatibilities and their genomic footprint, as well as adaptive introgression are discussed, and suggestions for a functional genomics approach are made. It is proposed that the field is moving beyond descriptive observations in single species, to a comprehensive analysis of admixture and its impact. Admixture is becoming an integral part of mammalian evolution. (shrink)

Admixture, the genetic exchange between differentiated populations appears to be common in the history of species, but has not yet been comparatively studied across mammals. This limits the understanding of its mechanisms and potential role in mammalian evolution. The authors want to summarize the current knowledge on admixture in non‐human primates, and suggest that it is important to establish a comparative framework for this phenomenon in humans. Genetic observations in domesticated mammals and their wild counterparts are discussed, and a (...) brief global overview on other clades is presented. Based on this, some of the consequences of gene flow, including incompatibilities and their genomic footprint, as well as adaptive introgression are discussed, and suggestions for a functional genomics approach are made. It is proposed that the field is moving beyond descriptive observations in single species, to a comprehensive analysis of admixture and its impact. Admixture is becoming an integral part of mammalian evolution. (shrink)

Festzelte are the beer halls (actually tents) of German Oktoberfest style celebrations—generally called Volksfest. Being transient buildings, the tents can be massive and intimidating. 5,000 or more visitors may find a place to drink, eat, sing, dance and celebrate wildly. Chants proclaim the “Gemütlichkeit” [coziness/snugness] despite an atmosphere supercharged with wild behaviors and heavy drunkenness. Norm breaking, liminal behavior is not only tolerated but even expected and intended (up to a certain point).Victor Turner’s concept of cultural performance helps explain (...) the revelry in a beer tent. The tents with their specific rural and folkloristic decorations, spatial structure, and furnishings facilitate the joyous actions. Their staging, as well as the celebratory actions themselves, provide a sacred play-space for anti-structure and communitas, flow and performative reflexivity. The active celebratory participation creates a place where alterity reigns and enables a sense of belonging. (shrink)

After reviewing the literature on current knowledge about consciousness in humans, we present a state-of-the art discussion on consciousness and related key concepts in animals. Obviously much fewer publications are available on non-human species than on humans, most of them relating to laboratory or wild animal species, and only few to livestock species. Human consciousness is by definition subjective and private. Animal consciousness is usually assessed through behavioural performance. Behaviour involves a wide array of cognitive processes that have to (...) be assessed separately using specific experimental protocols. Accordingly, several processes indicative of the presence of consciousness are discussed: perception and cognition, awareness of the bodily-self, self-related knowledge of the environment (including social environment). When available, specific examples are given in livestock species. Next, we review the existing evidence regarding neuronal correlates of consciousness, and emphasize the difficulty of linking aspects of consciousness to specific neural structures across the phyla because high-level cognitive abilities may have evolved independently along evolution. Several mammalian brain structures (cortex and midbrain) are involved in the manifestations of consciousness, while the equivalent functional structures for birds and fishes would likely be the pallium/tectum and midbrain. Caution is required before excluding consciousness in species not having the same brain structures as the mammalian ones as different neural architectures may mediate comparable processes. Finally, specific neurophysiological mechanisms appear to be strongly linked to the emergence of consciousness, namely neural synchrony and neural feedback. Considering the limited amount of data available and the few animal species studied so far, we conclude that different manifestations of consciousness can be observed in animals but that further refinement is still needed to characterize their level and content in each species. Further research is required to clarify these issues, especially in livestock species. (shrink)

Slurs are derogatory terms targeting individuals and groups of individuals on the basis of race, nationality, religion, gender or sexual orientation. The aim of my paper is to propose an account of appropriated uses of slurs – i.e. uses by targeted groups of their own slurs for non-derogatory purposes, as in the appropriation of ‘nigger’ by the African-American community, or the appropriation of ‘queer’ by the homosexual community. In my proposal appropriated uses are conceived as echoic, in Relevance Theory terms: (...) in-groups echo derogatory uses in ways and contexts that make manifest the dissociation from the offensive contents. I will show that the echoic strategy has interesting advantages over alternative theories, and especially over Anderson and Lepore’s deflationary strategy. (shrink)

What distinguishes evils from ordinary wrongs? Is hatred a necessarily evil? Are some evils unforgivable? Are there evils we should tolerate? What can make evils hard to recognize? Are evils inevitable? How can we best respond to and live with evils? Claudia Card offers a secular theory of evil that responds to these questions and more. Evils, according to her theory, have two fundamental components. One component is reasonably foreseeable intolerable harm -- harm that makes a life indecent and (...) impossible or that makes a death indecent. The other component is culpable wrongdoing. Atrocities, such as genocides, slavery, war rape, torture, and severe child abuse, are Card's paradigms because in them these key elements are writ large. Atrocities deserve more attention than secular philosophers have so far paid them. They are distinguished from ordinary wrongs not by the psychological states of evildoers but by the seriousness of the harm that is done. Evildoers need not be sadistic:they may simply be negligent or unscrupulous in pursuing their goals. Card's theory represents a compromise between classic utilitarian and stoic alternatives (including Kant's theory of radical evil). Utilitarians tend to reduce evils to their harms; Stoics tend to reduce evils to the wickedness of perpetrators: Card accepts neither reduction. She also responds to Nietzsche's challenges about the worth of the concept of evil, and she uses her theory to argue that evils are more important than merely unjust inequalities. She applies the theory in explorations of war rape and violence against intimates. She also takes up what Primo Levi called "the gray zone", where victims become complicit in perpetrating on others evils that threaten to engulf themselves. While most past accounts of evil have focused on perpetrators, Card begins instead from the position of the victims, but then considers more generally how to respond to -- and live with -- evils, as victims, as perpetrators, and as those who have become both. (shrink)

One way to silence the powerless, Langton has taught us, is to pre-emptively disable their ability to do things with words. In this paper I argue that speakers can be silenced in a different way. You can let them speak, and obscure the meaning of their words afterwards. My aim is to investigate this form of silencing, that I call retroactive distortion. In a retroactive distortion, the meaning of the words of a speaker is distorted by the effect of a (...) subsequent speech act by a different speaker. After introducing this notion, I explore some reasons why retroactive distortions can be difficult to challenge and argue that, besides constituting a communicative injustice, they can eliminate topics from public consideration and therefore erode public debate. (shrink)

Dorian Gray pays a hefty price for years of sin and vice in this completely unabridged edition of The Picture of Dorian Gray.

The article introduces the problematics of the classical two-valued logic on which Western thought is generally based, outlining that under the conditions of its logical assumptions the subject I is situated in a world that it cannot address. In this context, the article outlines a short history of cybernetics and the shift from first- to second-order cybernetics. The basic principles of Gordon Pask’s 1976 Conversation Theory are introduced. It is argued that this second-order theory grants agency to others through a (...) re-conception of living beings as You logically transcending the I. The key principles of Conversation Theory are set in relation to the poetic forms of discourse that played a key role in art as well as philosophical thinking in China in the past. Second-order thinking, the article argues, is essentially poetic. It foregoes prediction in favour of the potentiality of encountering tomorrow’s delights. (shrink)

The editorial introduces issue 21.1 of Technoetic Arts via a critical reflection on the artificial intelligence hype (AI hype) that emerged in 2022. Tracing the history of the critique of Large Language Models, the editorial underscores that there are substantial ethical challenges related to bias in the training data, copyright issues, as well as ecological challeges which the technology industry has consistently downplayed over the years. -/- The editorial highlights the distinction between the current AI technology’s reliance on extensive pre-existing (...) human-generated data for pattern recognition and the performative process inherent in art practice. Patterns of creative output can be replicated without a thorough understanding of underlying concepts. In contrast, the performative process of art practice, as explored through the conceptual frameworks of creativity by Noam Chomsky, Charles Sanders Peirce, and Roger T. Ames and with reference to an earlier publication of the editorial’s author, creates concepts and continually ‘strives to extend itself towards the unknown.’ -/- Following this introductory section, the editorial provides an overview of the ten articles featured in this issue of Technoetic Arts. The first four texts engage with emerging technologies from various perspectives in art and design. The subsequent six articles, part of a special section titled 'Perspectives from Chandigarh,' reflect a quest for meaningful existence within colonial, patriarchal, and biopolitical structures that frame everyday practices of exclusion and oppression. (shrink)

Statements such as “X is beautiful but I don’t like how it looks” or “I like how X looks but it is not beautiful” sound contradictory. How contradictory they sound might however depend on the object X and on the aesthetic adjective being used (“beautiful”, “elegant”, “dynamic”, etc.). In our study, the first sentence was estimated to be more contradictory than the latter: If we describe something as beautiful, we often intend to evaluate its appearance, whereas it is less counterintuitive (...) to appreciate an appearance without finding it beautiful. Furthermore, statements including “beautiful” appeared more contradictory than those including “elegant” and “dynamic”, pointing to its greater evaluative component. When related to artworks, sentences could appear less contradictory due to readers’ consideration of the divergence between conventional beauty and art-related sensory pleasures that can even include negative valence. Such ambivalence might be more frequent in art-objects than in other artefacts. Indeed, in our study, sentences referring to artworks were estimated to be less contradictory compared to sentences referring to other artefacts. Meanwhile, an additional small group of graphic design students showed a less clear difference between art-related and non-art-related sentences. We discuss the potential influence of art experience and interest as well as theoretical and methodological challenges like the conceptualization of beauty. (shrink)

El artículo realiza una exploración inicial acerca de las políticas archivísticas en la provincia de La Pampa, que –en el periodo considerado– guardan una estrecha relación con las políticas culturales. En primer lugar se repasan los conceptos de política cultural y política archivística; en segundo lugar se presentan rápidamente algunas características de las políticas culturales en la provincia de La Pampa y en tercer lugar nos detenemos en las instancias referidas a las prácticas, disposiciones e iniciativas en relación al Archivo (...) Histórico Provincial, principal espacio de desarrollo de las escasas políticas existentes en la materia en la provincia. Se sostiene que en general la gestión del AHP surgió en vinculación a políticas culturales que a principios de la década de 1970 adherían a una noción antropológica de la cultura y se asociaron a una serie de prácticas y políticas destinadas a desarrollar investigaciones para identificar procesos históricos específicos y supuestos rasgos que caracterizarían a la identidad regional, o pampeanidad. En la provincia, las prácticas y políticas archivísticas han permanecido asociadas a esa mirada y con cada vez menor cantidad de recursos para su funcionamiento. (shrink)

Addressing studying as a distinct educational concept and phenomenon in its own right, the essays in this volume consider study and studying from a range of perspectives. Countering dominant educational discourses, which place a heavy emphasis on learning and instruction, the contributors explore questions such as: What does it mean to study something? How is studying something different from being taught about it, or learning something about it? What does the difficulty demanded by study mean for the one who studies (...) and for the teacher? What mode of existence does study induce? The book highlights the significance of study not only, or even primarily, for its educational outcome, but as a human activity. (shrink)

In recent times, phenomena of conversational asymmetry have become a lively object of study for linguists, philosophers of language and moral philosophers—under various labels: illocutionary disablement and silencing, discursive injustice :440–457, 2014; Lance and Kukla in Ethics 123:456–478, 2013), illocutionary distortion. The common idea is that members of underprivileged groups sometimes have trouble performing particular speech acts that they are entitled to perform: in certain contexts, their performative potential is somehow undermined, and their capacity to do things with words is (...) distorted or even annulled. In this paper I will assess this idea, focusing on Rebecca Kukla’s and Rae Langton’s accounts; in particular, I will criticize the role the notion of uptake plays in their accounts, and claim that it may ultimately undermine the very idea of discursive injustice. While, according to Kukla and Langton, members of disadvantaged groups are victims of a kind of uptake failure, leading to illocutionary disablement and even silencing, in the account I present they are victims of a kind of communicative disablement. My overall aim is to develop a notion of discursive injustice that is more plausible and more effective for our broader purposes of criticising the structures of power and oppression. (shrink)

Clinical Ethics Consultation (CEC) has grown significantly in the last decade, and efforts are being made to professionalize the practice. The American Society for Bioethics and Humanities (ASBH) has been instrumental in this process, having published the _Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ and founded and endorsed the creation of the _Healthcare Ethics Consultant Certified (HCEC) Certification Commission._ The ASBH also published “core competencies” for healthcare ethics consultants and has delineated a clear identity and role of (...) such consultants distinct from that other healthcare professionals. In addition, more enter the field armed with advanced degrees (MA and PhD) or certification in clinical ethics consultation. While some have questioned the trend toward professionalization, the momentum is clearly in its favor. This paper explores three questions: Does the professionalization of healthcare ethics consultation expose those engaged in the field to the types of liability claims faced by professionals in other fields? What specific liabilities could affect a healthcare ethics consultant? And finally, what should healthcare ethics consultants do to protect themselves against liability claims? We conclude that while the risk of liability remains low, those engaged in the field should accept that risk just as part of their status as professionals and, like those in allied professions, seek appropriate protection in the form of liability insurance. (shrink)

Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels and Sabin, is indeterminate where concrete properties of rationing (...) institutions are concerned. Such properties inscribe substantial norms into institutions. These norms can derive validity only from democratic majority decisions, which must be seen as an instance of pure procedural justice. We therefore have to move the discussion to a meta-level and ask how concrete properties of institutions are being chosen. I suggest four criteria for sufficiently democratic institutional design choice and conclude that as institutional properties are likely to have effects on the resulting distribution of health care, design choices should be empirically informed and taken both democratically and deliberately. (shrink)

This book, originally published in 1948 by Harper and Row, provides the student and general reader with a sympathetic introduction to the basic concepts and principles of classical, realistic philosophy. Topics include: the perfection of human nature; irresponsibility and its causes; intellectual virtue and moral virtue; the rational guidance of action and the happy life; social ethics; and the philosophy of nature among others.

Das ethische Prinzip des Respekts vor der Autonomie des Patienten/Probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

Following the traces of Margaret Mead’s statement that emphasized that the first photographic images of the Earth from space presented notions of fragility, the article contextualizes the recent critique of the dominant representation of the Earth as a globe that emerged in conjunction with the discourse on the Anthropocene. It analyses the globe as an image and the sentiments that accompanied it since the first photographs of our planet from space were published in 1968. The article outlines how the cultural (...) meaning of the whole Earth representation changed in parallel with the appropriation of the image by the large technological enterprises that emerged from America’s counterculture. It returns to the possibility of a coexistence of ‘views from within’ and ‘views from without’ following a detour with Gregory Bateson via Bali and proposes a Cybernetics of Grace as a practice of resistance against pure exteriority. The article concludes by linking the Cybernetics of Grace with the second-order conversations of Gordon Pask. (shrink)

The opportunities to become a good person are not the same for everyone. Modern European ethical theory, especially Kantian ethics, assumes the same virtues are accessible to all who are capable of rational choice. Character development, however, is affected by circumstances, such as those of wealth and socially constructed categories of gender, race, and sexual orientation, which introduce factors beyond the control of individuals. Implications of these influences for morality have, since the work of Williams and Nagel in the seventies, (...) raised questions in philosophy about the concept of moral luck. In The Unnatural Lottery, Claudia Card examines how luck enters into moral character and considers how some of those who are oppressed can develop responsibility. Luck is often best appreciated by those who have known relatively bad luck and have been unable to escape steady comparison of their lot with those of others. The author takes as her paradigms the luck of middle and lower classes of women who face violence and exploitation, of lesbians who face continuing pressure to hide or self-destruct, of culturally Christian whites who have ethnic privilege, and of adult survivors of child abuse. How have such people been affected by luck in who they are and can become, the good lives available to them, the evils they may be liable to embody? Other philosophers have explored the luck of those who begin from privileged positions and then suffer reversals of fortune. Claudia Card focuses on the more common cases of those who begin from socially disadvantaged positions, and she considers some who find their good luck troubling when its source is the unnatural lottery of social injustice. (shrink)

This article discusses whether it is rational and valuable to have hope in the face of the climate crisis. The aim is to explore a distinctive Kantian perspective characterized by three main elements. First, hope is not seen primarily as a means of sustaining action, but action is viewed as a condition for rational hope. Second, the value of certain ‘fundamental’ hopes is not merely instrumental but derives from their constitutive role in our practical identity. Here, I focus on Kantian (...) hope in the compatibility of our fundamental ends, happiness and morality. Third, the rationality of such a hope presupposes trust – in particular, trust that our conceptions of morality and the good life are sufficiently flexible to adapt to drastically new circumstances. (shrink)

Das ethische Prinzip des Respekts vor der Autonomie des Patienten/Probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

Dieser Beitrag diskutiert „kulturelle Fragen“ in klinischer Ethik am Beispiel der Hymenrekonstruktion. Zunächst werden drei grundsätzliche Argumente genannt: 1) Wenn „kultur-sensitive“ Themen in klinischer Ethik explizit als solche diskutiert werden, kann das zu einem essentialistischen Verständnis von Kultur beitragen. Stattdessen wird in diesem Beitrag für ein dynamisches Verständnis von Kultur argumentiert und für eine grundsätzlich kontextsensitive, pluralistische klinische Ethik. 2) Klinische Ethik fokussiert häufig auf die individuelle Arzt-Patienten-Beziehung. Public Health Ethik und Globale Bioethik sind dagegen eher mit den strukturellen Bedingungen (...) von Gesundheit und Gesundheitsversorgung befasst. Der Beitrag argumentiert für eine systematischere Verknüpfung dieser verschiedenen Ebenen. 3) „Migration“ als bioethisches Thema wird häufig unter „Kultur“ subsumiert. Doch diese beiden Themen sind nicht koextensiv, stattdessen umfassen beide Bereiche jeweils unterschiedliche Fragestellungen. Insbesondere im Bereich von „Migration“ bestehen in der Bioethik noch Forschungslücken. Auf diesen Ausgangsüberlegungen aufbauend wird die Hymenrekonstruktion aus ethischer Sicht diskutiert und dafür argumentiert, sie nur als ultima ratio durchzuführen. Zugleich sollte über die Unmöglichkeit eines Jungfräulichkeitsnachweises aufgeklärt werden. Es bleibt eine Herausforderung, „kultursensitive“ Gesundheitsversorgung zu leisten, dabei jedoch ein essentialistisches Kulturverständnis und Stereotypisierung zu vermeiden. Dieser Beitrag argumentiert für eine grundsätzliche Kontextsensitivität in einer globalisierten, heterogenen Welt, in der die Verbindung zwischen individuellem Handeln und strukturellen Gegebenheiten bewusst wird. (shrink)

Dieser Beitrag diskutiert „kulturelle Fragen“ in klinischer Ethik am Beispiel der Hymenrekonstruktion. Zunächst werden drei grundsätzliche Argumente genannt: 1) Wenn „kultur-sensitive“ Themen in klinischer Ethik explizit als solche diskutiert werden, kann das zu einem essentialistischen Verständnis von Kultur beitragen. Stattdessen wird in diesem Beitrag für ein dynamisches Verständnis von Kultur argumentiert und für eine grundsätzlich kontextsensitive, pluralistische klinische Ethik. 2) Klinische Ethik fokussiert häufig auf die individuelle Arzt-Patienten-Beziehung. Public Health Ethik und Globale Bioethik sind dagegen eher mit den strukturellen Bedingungen (...) von Gesundheit und Gesundheitsversorgung befasst. Der Beitrag argumentiert für eine systematischere Verknüpfung dieser verschiedenen Ebenen. 3) „Migration“ als bioethisches Thema wird häufig unter „Kultur“ subsumiert. Doch diese beiden Themen sind nicht koextensiv, stattdessen umfassen beide Bereiche jeweils unterschiedliche Fragestellungen. Insbesondere im Bereich von „Migration“ bestehen in der Bioethik noch Forschungslücken. Auf diesen Ausgangsüberlegungen aufbauend wird die Hymenrekonstruktion aus ethischer Sicht diskutiert und dafür argumentiert, sie nur als ultima ratio durchzuführen. Zugleich sollte über die Unmöglichkeit eines Jungfräulichkeitsnachweises aufgeklärt werden. Es bleibt eine Herausforderung, „kultursensitive“ Gesundheitsversorgung zu leisten, dabei jedoch ein essentialistisches Kulturverständnis und Stereotypisierung zu vermeiden. Dieser Beitrag argumentiert für eine grundsätzliche Kontextsensitivität in einer globalisierten, heterogenen Welt, in der die Verbindung zwischen individuellem Handeln und strukturellen Gegebenheiten bewusst wird. (shrink)

What distinguishes evils from ordinary wrongs? Are some evils unforgivable? How should we respond to evils? Card offers a secular theory of evil--representing a compromise between classic utilitarian and stoic approaches--that responds to these and other questions.

This article considers the question ‘What makes hope rational?’ We take Adrienne Martin’s recent incorporation analysis of hope as representative of a tradition that views the rationality of hope as a matter of instrumental reasons. Against this tradition, we argue that an important subset of hope, ‘fundamental hope’, is not governed by instrumental rationality. Rather, people have reason to endorse or reject such hope in virtue of the contribution of the relevant attitudes to the integrity of their practical identity, which (...) makes the relevant hope not instrumentally but intrinsically valuable. This argument also allows for a new analysis of the reasons people have to abandon hope and for a better understanding of non-fundamental, ‘prosaic’ hopes. (shrink)

ObjectivePhysical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.MethodsWe conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical (...) and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach.ResultsConcerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures.ConclusionPerceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health—a basic principle of medical ethics. (shrink)

The paper emphasizes the inadequacy of formal semantics, the classical paradigm in semantics, in treating contextual dependence. Some phenomena of contextual dependence threaten one central assumption of the classical paradigm, namely the idea that linguistic expressions have a fixed meaning, and utterances have truth conditions well defined. It is possible to individuate three forms of contextual dependence: the one affecting pure indexicals, the one affecting demonstratives and "contextual expressions", and the one affecting all linguistic expressions. The third type of dependence (...) is top-down: context, and not only linguistic material, shows which variables must be instantiated, relying on context itself. The generalization of underdetermination to all linguistic expressions is in fact a kind of metadependence: the mode of dependence itself depends on context. (shrink)

I argue for a novel answer to the question “What is hope?”. On my view, rather than aiming for a compound account, i.e. analysing hope in terms of desire and belief, we should understand hope as an irreducible concept. After criticizing influential compound accounts of hope, I discuss Segal and Textor's alternative of describing hope as a primitive mental state. While Segal and Textor argue that available developments of the standard definition do not offer sufficient conditions for hope, I question (...) the deep‐seated idea that desire and belief are even necessary conditions for hope. My suggestion is that we should take seriously the fact that we hope in a great variety of ways and should question the search for elements that are common to all cases. A promising alternative follows the Wittgensteinian idea that cases of hope are related in terms of family resemblance, i.e. are multiply realizable on the ontological level while falling under the non‐definable concept of hope. (shrink)

This essay argues that current advocacy of lesbian and gay rights to legal marriage and parenthood insufficiently criticizes both marriage and motherhood as they are currently practiced and structured by Northern legal institutions. Instead we would do better not to let the State define our intimate unions and parenting would be improved if the power presently concentrated in the hands of one or two guardians were diluted and distributed through an appropriately concerned community.