English summary: Medicine is not only a technique or skill for obtaining or restoring health in the face of illness and death; it strives to be a component of life that has learned to deal with the inevitability of suffering and death. As meditatio vitae et mortis, it can become a field of reflection on being human par excellence. The increasing possibility of anti-aging, plastic surgery and enhancement procedures, however, again bring about questions of the limits of human medicine, even (...) moreso if, as in transhumanist utopia and cryonic practice, the possibility of postponement or even of overcoming human finitude becomes possible. Medicine, society and the presence of death and dying must respond to these challenges. Herein ies the focus of this volume: the authors reflect on finiteness and immortality in medicine from historical, philosophical, social science, and ethical perspectives. German text. German description: Die Medizin ist nicht nur Technik oder Kunst, das Leben und die Gesundheit angesichts von Krankheit und Tod zu erhalten bzw. wiederherzustellen, sondern strebt eine Praxis der Lebensfuehrung an, die mit der Unvermeidbarkeit von Leiden und Sterben umzugehen lernt. Als meditatio vitae et mortis kann sie zu einem Feld der Reflexion ueber das Menschsein par excellence werden. Die zunehmenden Moglichkeiten von Anti-Aging, Plastischer Chirurgie und Enhancement stellen dabei die Fragen nach Grenzen einer humanen Heilkunde wieder neu, noch dazu, wenn - wie in transhumanistischen Utopien und kryonischer Praxis - die Moglichkeit der Verschiebung oder gar Uberwindung menschlicher Endlichkeit in Aussicht gestellt wird. Medizin, Gesellschaft und Sterbekultur der Gegenwart muessen auf die Herausforderungen reagieren. In diesem Themenfeld liegt der Schwerpunkt des Bandes: Die Autoren reflektieren Endlichkeit und Unsterblichkeit in der Medizin aus historischer, philosophischer, sozialwissenschaftlicher wie auch ethischer Perspektive. (shrink)

The paper focuses on the possibilities to constitute meaning in the?borderline- situations? of the social sphere, such as the loss of validity of orientation within and experience of reality in the socially shared structures of the lifeworld. On the one hand, I will refer to A. Schutz? and his constitution-analysis of foreign understanding and of shared meaning; on the other hand, I bear onto I. Kert?sz literary project to narrate the biography of an Auschwitz-survivor as close to his experiential perspective (...) as possible. I will focus both on the concept of constitution and of interpretation with respect to their enabling of the transcending of a typologized everyday?s world which suppresses subjective meaning and its individual articulation. The main guideline is the problem how identity? i.e. a life-story? is configured out of subjective meaning without recourse to everyday reality. A. Schutz?s and Th. Luckmann?s note on a range of social transcendences and on biographical categories referring to the constitution of a socially shared meaning offer a theoretical perspective for dealing with constitutive differences within the reach of understanding social meaning; Kert?sz? narrative mode expandes this theoretical stance as it problematizes exemplary subjective experience. nema. (shrink)

My contribution interrogates how to conceive belonging and how to clarify conceptual connotations of this and other concepts as ›home‹ or a ›dwelling in a place‹ according to their meaning for orienting our social life and identities. Methodically, I start with the phenomenological consideration of ›operative concepts‹ and how these might be reflexively brought into work with experiencing loss of belonging, negation of a home to stay in, and infraction of identity as they are expressed in personal life-stories.

Dieser Band thematisiert Heideggers Verständnis der technischen Welt und deren Verhältnis zu Kunst, Politik und Sprache. Diskutiert wird dabei auch, wie Heideggers Denken der Technik von Philosophen der Gegenwart aufgegriffen und weiter entwickelt wird und wie es dabei helfen kann, Globalisierung, Digitalisierung und die Entwicklung in den Biotechnologien philosophisch zu verstehen. Im Dokumententeil wird die Urfassung von Die Zeit des Weltbildes veröffentlicht.

Band 13 der psycho-logik widmet sich aus fächerübergreifendem Blickwinkel dem Thema Identität, das in den Sozial- und Geisteswissenschaften zu einem Schlagwort des 20. und 21. Jahrhunderts geworden ist. Gerade die moderne und liberale Gesellschaftsordnung, die uns ungeahnt viel Freiheit ermöglicht hat, charakterisiert ein Patchwork aus Identifikationsangeboten, das zugleich die kollektive und personale Identitätsfindung problematisch macht. Aktuell hat die narrative Theorie die erinnerte und erzählte Lebensgeschichte zum Gründungsort des Selbst erhoben. Sie spielt auch in den Beiträgen dieses Bandes eine prominente Rolle. (...) Es zeigt sich, dass die Identitätskonstruktion ein Prozess ist, in dem sich Identität als etwas Fragiles und Plurales offenbart. Identität ist ein tragisches Spiel zwischen Einheit und Mannigfaltigkeit: Identität(en). Forscher*innen aus Deutschland, Irland und den USA mit ihren Beiträgen aus Literaturwissenschaft, Theologie, Philosophie und Psychologie diskutieren u. a. das Band zwischen Identität und Erinnerung bei Marcel Proust, transsexuelle Identitätskonstruktionen in US-amerikanischen Biopics, den Film als Identitätsbildungsmedium des Publikums, Identitätspolitik(en) am Beispiel des Zugangs zu US-amerikanischen Hochschulen, die Identitätsfindung in Lebensgeschichten und den psychotherapeutischen Umgang mit gebrochenen Identitäten. Fotoarbeiten des Künstlers Hermann Recknagel runden den Band ab. Mit Beiträgen von Michaela I. Abdelhamid, Carsten Albers, Paul Clogher, Katherine Duval, Winfried Eckel, Fiona Ennis, Annette Hilt, Christopher A. Nixon, Paul Nnodim, Hermann Recknagel, Patricia Rehm-Grätzel, Martin Reker, Annika Schlitte und Hartwig Wiedebach. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that (1) results as part of a social process that (...) systematically gives rise to racial injustice, and (2) is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that results as part of a social process that systematically (...) gives rise to racial injustice, and is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

Disagreement persists about when, if at all, disenfranchisement is a fitting response to criminal wrongdoing of type X. Positive retributivists endorse a permissive view of fittingness: on this view, disenfranchising a remarkably wide range of morally serious criminal wrongdoers is justified. But defining fittingness in the context of criminal disenfranchisement in such broad terms is implausible, since many crimes sanctioned via disenfranchisement have little to do with democratic participation in the first place: the link between the nature of a criminal (...) act X (the ‘desert basis’) and a fitting sanction Y is insufficiently direct in such cases. I define a new, much narrower account of the kind of criminal wrongdoing which is a more plausible desert basis for disenfranchisement: ‘political wrongdoing’, such as electioneering, corruption, or conspiracy with foreign powers. I conclude that widespread blanket and post-incarceration disenfranchisement policies are overinclusive, because they disenfranchise persons guilty of serious, but non-political, criminal wrongdoing. While such overinclusiveness is objectionable in any context, it is particularly objectionable in circumstances in which it has additional large-scale collateral consequences, for instance by perpetuating existing structures of racial injustice. At the same time, current policies are underinclusive, thus hindering the aim of holding political wrongdoers accountable. (shrink)

It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely (...) available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty. (shrink)

The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

This excerpt from our collective biography emerges from a dialogue that commenced when Noel interjected the concept of ‘becoming-cyborg’ into our conversations about Annette’s experiences of breast cancer, which initially prompted her to interpret her experiences as a ‘chaos narrative’ of cyborgian and environmental embodiment in education contexts. The materialisation of Donna Haraway’s figuration of the cyborg in Annette’s changing body enabled new appreciations of its interpretive power, and functioned in some ways as a successor project to Noel’s (...) earlier deployment of cyborgs in what he now recognises as a ‘posthumanising’ of curriculum inquiry. Noel’s subsequent experiences with throat cancer drew us towards exploring the possibilities that concepts such as Deleuze and Guattari’s machinic assemblage and Karen Barad’s ontoepistemology offer as a mean of thinking the meetings of bodies and technologies in educational inquiry beyond Haraway’s hybrid cyborg. Through both collective biography and playfully scripted conversations with other theorists we explore what it means to perform diffractive interpretations and analyses in posthumanist educational inquiry. Our essay also contributes to contemporary conversations about the uses of collaborative biographical writing as a method of inquiry in educational research. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

The paper investigates whether it is plausible to hold the late stage demented criminally responsible for past actions. The concern is based on the fact that policy makers in the United States and in Britain are starting to wonder what to do with prison inmates in the later stages of dementia who do not remember their crimes anymore. The problem has to be expected to become more urgent as the population ages and the number of dementia patients increases. This paper (...) argues that the late-stage demented should not be punished for past crimes. Applicable theories of punishment, especially theories with an appropriate expressivist, or communicative element, fail to justify the imprisonment of the late-stage demented. Further imprisonment would require a capacity for comprehension on the part of the punished, and, under certain narrowly specified conditions, even a capacity to be at least in principle capable of recalling the crime again. (shrink)

Norman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the (...) latter claim. Does accountability for reasonableness result in fair limit-setting decisions? It is argued that the answer to this question is not a clear yes. Daniels is remarkably unclear about the criterion of fairness that accountability for reasonableness satisfies. The paper discusses different options for resolving this lack of clarity and examines how they apply to Daniels’ accountability for reasonableness framework. It is concluded, first, that accountability for reasonableness is not a paradigm case of any of the classic notions of procedural justice; second, that what might be called "constrained pure procedural justice" best reflects how accountability for reasonableness results in fair limit-setting decisions; and third, that the procedural conditions of accountability for reasonableness must be further specified and amended to better achieve a fair process, and hence fair limit-setting decisions. (shrink)

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions (...) for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

The democratic boundary problem raises the question of who has democratic participation rights in a given polity and why. One possible solution to this problem is the all-affected principle, according to which a polity ought to enfranchise all persons whose interests are affected by the polity’s decisions in a morally significant way. While AAP offers a plausible principle of democratic enfranchisement, its supporters have so far not paid sufficient attention to economic participation rights. I argue that if one commits oneself (...) to AAP, one must also commit oneself to the view that political participation rights are not necessarily the only, and not necessarily the best, way to protect morally weighty interests. I also argue that economic participation rights raise important worries about democratic accountability, which is why their exercise must be constrained by a number of moral duties. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks to (...) subjects” be “reasonable in relation to anticipated benefits, if any, to subjects and the importance of the knowledge” to be gained from the .. (shrink)

When patients cannot make their own treatment decisions, surrogates typically step in to do it for them. Surrogate decision‐making is far from ideal, of course, as the surrogate may not know what the patient prefers or what best promotes her interests. One way to improve it would be to arm surrogates with information about what patients in similar circumstances tend to prefer, allowing them to make empirically grounded predictions about what their patient would want.

The term ‘environment’ is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of (...) health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a _health resource_ (as well as a source of health risks). Secondly, we subdivide the concept of environment into four _health-oriented environmental categories_ (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health ‘environment’ should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing _individual health environments_ as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing. (shrink)

ZusammenfassungDie aktuellen Entwicklungen und Anforderungen in der pflegeberuflichen Bildung, das Ausbildungsziel im Pflegeberufegesetz vom 17. Juli 2017 und die Explikationen in der dazugehörigen Ausbildungs- und Prüfungsverordnung für die Pflegeberufe fordern eine stärkere Ausrichtung auf die Entwicklung ethischer Kompetenzen explizit ein. Bislang liegen tendenziell übergreifende Definitionen und Darlegungen zu ethischen Kompetenzen in der Pflege vor, deren Verdienst es ist, das Spezifische der Pflegeethik zu konturieren und erstmals ethische Kompetenzen für das Feld zu konkretisieren. In methodischer und didaktischer Hinsicht ist indes eine (...) spezifische Differenzierung gemäß unterschiedlicher Bildungsniveaus relevant. Lehrende werden ihre Lehre nicht mehr nur im Sinne einer allgemeinen Förderung ethischer Kompetenz entwickeln können, sondern müssen dabei den jeweiligen Verantwortungsbereich und das angezielte Qualifikationsniveau der Lernenden berücksichtigen. Ziel der Darlegungen ist es, konkrete Kompetenzniveaus für die Anbahnung professionsethischer Kompetenzen zu operationalisieren, die einerseits die Anforderungen aus dem zukünftigen Pflegeberufegesetz aufgreifen und andererseits anstehende curriculare Entwicklungsprozesse unterstützen. (shrink)

Several influential ethical guidelines and frameworks endorse the view that research with human participants is ethically acceptable only when it has “social value,” meaning that it generates knowledge which can be used to benefit society. For example, the Nuremberg Code requires that medical experiments on human beings “yield fruitful results for the good of society, unprocurable by other methods or means of study”. The Council for International Organizations of Medical Sciences guidelines hold that “health-related research with humans... must have social (...) value” or the “prospect of generating the knowledge and the means necessary to protect and promote people’s health” (CIOMS... (shrink)

In controlled human infection (CHI) studies, investigators deliberately infect healthy individuals with pathogens in order to study mechanisms of disease or obtain preliminary efficacy data on investigational vaccines and medicines. CHI studies offer a fast and cost‐effective way of generating new scientific insights, prioritizing investigational products for clinical testing, and reducing the risk that large numbers of people are exposed to ineffective or harmful substances in research or in practice. Yet depending on the pathogen, CHI studies can involve significant risks (...) or burdens for participants, pose risks to individuals or communities not involved in the research, and lead to public controversy. It is therefore essential to ensure that the risks of CHI studies are justified by their social value—that is, their potential to generate benefits for society—and that public trust can be maintained. In this paper, we aim to clarify how research sponsors, research ethics committees and other reviewers should judge the social value of CHI studies. We develop a list of relevant considerations for making social value judgments based on the standard view of social value. We then use this list to discuss the example of potentially conducting dengue virus CHI studies in endemic settings. We argue that dengue virus CHI studies in endemic settings would fall on the higher end of the spectrum of social value, mostly because of their potential to redirect all fields of future dengue research. Drawing on this discussion, we derive several general recommendations for how reviewers should judge the social value of CHI studies. (shrink)

The reference to man as animal rationale has traditionally been used to highlight rationality as marking a qualitative gap between human beings and animals. This assumption has been questioned in a similar way by the approaches of Alasdair MacIntyre and John Dewey, who agree that before we can make adequate sense of man’s rationality, we have to draw attention to animality as the common trait of human and nonhuman living beings. However, while MacIntyre takes human dependence to show ‘why human (...) beings need the virtues,’ Dewey considers it as a starting point to argue for the necessity of what he calls ‘natural piety.’ In my paper I shall elaborate some implications of this difference, guided by the question whether Dewey’s answer contributes to a re-invention of religious categories into the naturalistic view on rationality and morality. (shrink)

The present study aimed to examine the relations between physical self-concept, intrinsic and extrinsic motivation as well as physical performance of 1,082 children aged 7–8 years. The central objective of this study was to contrast a mediation model assuming physical self-concept as a mediator of the relations between both types of motivation and physical performance to a mediation model assuming both types of motivation as mediators of the relations between physical self-concept and physical performance. Physical self-concept and both types of (...) motivation were measured by using self-reported questionnaires, while physical performance was measured with 10 motor skill tests. All tests were carried out during regular school hours (8–12 A.M.) by qualified test personnel. Beyond correlation analyses, structural equation modeling (SEM) was performed to find evidence for the predictive relations between the variables under study. Results showed that physical self-concept was significantly positively related to both types of motivation and physical performance (allp< 0.001). In contrast, results of SEM revealed that only physical self-concept (p< 0.001) and intrinsic motivation (p< 0.05) were significantly positively linked to physical performance. Furthermore, physical self-concept proved to significantly mediate the relations of both types of motivation to physical performance (p< 0.001), while only intrinsic motivation, but not extrinsic motivation, proved to significantly mediate the relation between physical self-concept and physical performance (p< 0.05). These results suggest that school-based or extracurricular interventions targeted at improving younger children's physical performance only by means of an increased level of physical activity or by external factors without supporting children's physical self-concept and intrinsic motivation may have less or no effects on their physical performance. (shrink)