Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the (...) procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures. (shrink)

In a well-known passage from 'The Red Lily', Anatole France retorts ironically: “The law, in its majestic equality, forbids rich and poor alike to sleep under bridges, to beg in the streets, and to steal loaves of bread”. The passage highlights the different burdens experienced by different people when deciding to act or not act in certain ways. This paper critically analyzes this problem; specifically, how we ought to allocate personal responsibility for actions performed by agents who each experience different (...) social, economic, political, and internal and external influences. First, the paper outlines some prevailing conceptions of personal responsibility in the literature. Second, it offers a critique of these views, arguing that they each suffer from a variety of conceptual and practical flaws. Third, a basic framework I call the continuum- threshold account of responsibility is proposed. The account distinguishes between responsibility and blameworthiness, addresses many of our objections against other prevailing conceptions of responsibility, and takes into account background structural conditions while retaining the scope for responsibility and moral agency. (shrink)

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

BackgroundThe rise of Big Data-driven health research challenges the assumed contribution of medical research to the public good, raising questions about whether the status of such research as a common good should be taken for granted, and how public trust can be preserved. Scandals arising out of sharing data during medical research have pointed out that going beyond the requirements of law may be necessary for sustaining trust in data-intensive health research. We propose building upon the use of a social (...) licence for achieving such ethical governance.Main textWe performed a narrative review of the social licence as presented in the biomedical literature. We used a systematic search and selection process, followed by a critical conceptual analysis. The systematic search resulted in nine publications. Our conceptual analysis aims to clarify how societal permission can be granted to health research projects which rely upon the reuse and/or linkage of health data. These activities may be morally demanding. For these types of activities, a moral legitimation, beyond the limits of law, may need to be sought in order to preserve trust. Our analysis indicates that a social licence encourages us to recognise a broad range of stakeholder interests and perspectives in data-intensive health research. This is especially true for patients contributing data. Incorporating such a practice paves the way towards an ethical governance, based upon trust. Public engagement that involves patients from the start is called for to strengthen this social licence.ConclusionsThere are several merits to using the concept of social licence as a guideline for ethical governance. Firstly, it fits the novel scale of data-related risks; secondly, it focuses attention on trustworthiness; and finally, it offers co-creation as a way forward. Greater trust can be achieved in the governance of data-intensive health research by highlighting strategic dialogue with both patients contributing the data, and the public in general. This should ultimately contribute to a more ethical practice of governance. (shrink)

This study investigates what professional caregivers working in nursing homes consider to be a good life for residents suffering from dementia. Ten caregivers were interviewed; special attention was paid to the way in which they deal with conflicting values. Transcripts of the interviews were analysed qualitatively according to the method of grounded theory. The results were compared with those from a similar, earlier study on ideals found in mission statements of nursing homes. The concepts that were mentioned by most interviewed (...) participants as important for a good life were ‘peace and quiet’, ‘going along with subjective experience’ and ‘no enforcement: the way the resident wants it’. A considerable overlap was found between the interviews and the mission statements; however, when compared with the mission statements, the interviews put less emphasis on individuality and on giving meaning, and more on offering residents pleasant activities. When faced with conflicting values, caregivers tend to make pragmatic and more or less intuitive decisions. Although this has its merits, it may be desirable to stimulate conscious reflection regarding conflict between different values. (shrink)

Über das Wesen des Gelehrten, und seine Erscheinungen im Gebiete der Freiheit (1805) von Johann Gottlieb Fichte -- Vorrede -- Erste Vorlesgun: Plan des Ganzen -- Zweite Vorlesung: Nähere Bestimmung des Begriffs der göttlichen Idee -- Dritte Vorlesung: Vom angehenden Gelehrten überhaupt; insbesondere vom Talente und Fleisse -- Vierte Vorlesung: Von der Rechtschaffenheit im Studiren -- Fünfte Vorlesung: Wie die Rechtschaffenheit des Studirenden sich äussere -- Sechste Vorlesung: Ueber die akademische Freiheit -- Siebente Vorlesung: Vom vollendeten Gelehrten im Allgemeinen (...) -- Achte Vorlesung: Vom Regenten -- Neunte Vorlesung: Vom mündlichen Gelehrte=Lehrer -- Zehnte Vorlesung: Vom Schriftsteller -- Menschliche Bildung und göttliche Idee. Über Struktur und Gedankengang von Fichtes Erlanger Vorlesungen Über das Wesen des Gelehrten / Annette Sell -- Über das Wesen des Gelehrten im Kontext der Wissenschaftslehre / C. Jeffery Kinlaw -- Fichte on Bestimmung and Wesen des Gelehrten / Angelica Nuzzo -- Fichte's Über das Wesen des Gelehrten, or the educated man as the salt of the Earth / Tom Rockmore -- Werkzeuge? Zur Herrschaft der Gelehrten im Kontext des Fichteschen Spätwerks / Franziskus von Heereman -- J.G. Fichtes Über das Wesen des Gelehrten und die Bestimmung des magister bei Thomas von Aquin / Wilhelm Metz -- Wie sich der Philosoph bei Descartes und Fichte zu sich selbst verhält / Elisabeth Kessler -- The ghosts of Kantian philosophy in Fichte's Über das Wesen des Gelehrten / Richard Velkley -- Reinhold über die Bildung eines neuen Menschen / Ernst-Otto Onnasch -- Die innerliche Verknüpfung von "objektiver Wissenschaft" und "subjektiver Bildung". Wilhelm von Humboldts Universitätsidee - mit einem Ausblick auf sein Kritik an Fichtes Überlegungen zum Gelehrten und zur Universität / Holger Zaborowski -- Die Todesangst als die Vermittlung zur absoluten Idee / Paul Cobben -- Fichte and Schelling / Michael Vater -- Fichtes Über das Wesen des Gelehrten und Heidegger / Alfred Denker. (shrink)

continent. 1.4 (2011): 242—252. Introduction The following two works were produced by visual artist Jonas Staal and writer Vincent W.J. van Gerven Oei during a visit as artists in residence at The Bag Factory, Johannesburg, South Africa during the summer of 2010. Both works were produced in situ and comprised in both cases a public intervention conceived by Staal and a textual work conceived by Van Gerven Oei. It was their aim, in both cases, to produce complementary works that could (...) be read “through each other,” in which the movement of artistic construction would be imitated by textual deconstruction and vice versa. Both works deal with the way in which capital, apartheid, and monumentality are interwoven in South-African society. The Missing Link addresses a monument for democracy, erected on the premises of a private corporation running both an amusement park and the Apartheid Museum franchise. The textual intervention accompanying this public intervention investigates the limits of the inclusiveness of the anti-discrimination section in the South-African constitution, itself a monumental work of democracy. The Monument for the Distribution of Wealth deals with the history and eventual dissolution of a monumental square, commemorating the Soweto Uprising, in one of the poorest townships of Johannesburg. The history accompanying this public dismemberment of memory is equally fragmented, which is expressed by the many voices recounting uncertain and perhaps even irrelevant “facts” about the genius loci, the way in which the memorial space has actually entered into the memory of the inhabitants surrounding it. Next to their individual practices, Staal and Van Gerven Oei have worked together on a number of projects ever since 2007, including several art residencies. Their work involves an investigation of the different interfaces between art, politics, and public space in media ranging from theater and public interventions, to video installations and (co-authored) textual works. The Missing Link Missing Link (1) Missing Link (2) Missing Link (3) Intervention on the monument entitled The Seven Pillars of the Constitution , part of the Apartheid Museum in Johannesburg, South Africa. The Seven Pillars represent the constitutional values propagated in South Africa since the abolition of the apartheid regime. The monument and museum were built by the Gold Reef Resorts corporation, which is also responsible for the theme park and casino next to it. By placing the word “capitalism” on the wall surrounding the museum, the capitalist system and the constant social divisions that it implies are interpreted as sophistic continuations of apartheid politics. Through the capitalist system, apartheid is still operational within South African society. Whereas during the apartheid regime, the separation clearly ran along race divisions, in the current, “democratic” system, the same actual separation is sustained without it being an explicit element of the foundations of the country, i.e. the constitution. This intervention foregrounds the constant role of capitalism is both periods. At the same time the intervention acknowledges that contemporary Western artisthood is a mirror of the privileges that are offered by the capitalist system, and the type of artist that it produces. The intervention initiates a critical discourse concerning the capitalist system situated within the disaster of capitalism itself, in other words: through the desire to break with the presumption that art would be able to operate outside the capitalist system and to confirm that art—and the artist himself—is in fact modeled on this system. The public intervention by Staal was supplemented by a textual intervention by Van Gerven Oei: a proposition to alter the seventeenth amendment of the South African constitution. Even though the anti-discrimination legislation in South-Africa is one of the most stringent and inclusive in the world, one factor—wealth—remains outside its scope, thus continuing the schisms along racial lines produced during the apartheid regime: §9.3. The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language, birth, and wealth. Monument for the Distribution of Wealth Intervention concerning the June 16 Memorial Acre in Central Western Jabavu, one of the poorest townships of Johannesburg. The monument comprises a park on which different are placed recalling an important protest the black population against the former apartheid regime. In 1976, from a school adjacent to the park, they started a massive protest against the introduction of Afrikaans in the school curriculum. The police reacted violently, and shot several hundreds of students. The construction of the June 16 Memorial Acre was started in 2005, and from the start was the paragon of corruption. Coordinated by local politicians, some family members of the protest leader from 1976 gained control of the realization of the monument, outside the regulation through external institutions. The available budget of 41 million rand (at that time well over 5 million euro) was largely embezzled. In the meantime, the monument has become fully dilapidated and defaced. The park has become overgrown with weeds and covered in a layer of dirt, and the local population is slowly plundering the square to use the material for the construction and decoration of their own houses. The Monument for the Distribution of Wealth develops the dynamics already existent around the June 16 Memorial Acre. Without obtaining official permission in advance, several local inhabitants were hired to break down the monument, sort the materials, and offer it to the neighborhood. Thus, the redistribution of wealth after the fall of the apartheid regime is finally taking place, albeit from the mere remains of the capital that was once invested in the community. The words “monument” and “for free” are spray-painted on the stacks of material, both in English and Zulu, as these are locally the most common languages. Van Gerven Oei supplemented Staal’s public intervention with an account of the history of the monument based on a series of interviews. The account clarifies how the different interests within the protest 1976 are reflected in the exceeding decay of the park, and how in the end those interests were represented by the June 16 Memorial Acre. Monument for the Distribution of Wealth 1: Removing stones Monument for the Distribution of Wealth 3: Pulling down statues Monument for the Distribution of Wealth 4: Offering the material Monument for the Distribution of Wealth 5: Offering the material Monument for the Distribution of Wealth 6 The next day A Fragmentary History of the Monument for the Distribution of Wealth, Formerly Known as the June 16 Memorial Acre in Central Western Jabavu, Soweto Vincent W.J. van Gerven Oei The following text, based on interviews and online research aims to provide parts of a history of the park in front of Morris Isaacson High School in Central Western Jabavu, Soweto. The idea for the transformation of the park into a memorial site has its source in the events of June 16, 1976: the start of the the student uprising in Soweto. The development of the park was started in the early 1980s, and the actual transformation into a memorial site, the June 16 Memorial Acre, was initiated in 2005. Over the last few years, several monumental additions have been made to the park: A marble monument with three pillars was revealed on June 16, 2006. A sculpture of a book and several billboards on June 16, 2008. A sculpture of student leader Tsietsi Mashinini on June 16, 2010. The park was transformed into the Monument for the Distribution of Wealth on August 3, 2010. According to the entry “Youth Struggle” on the website South African History Online, the Bantu Education Act was introduced in 1953 . In 1954 , Dr Verwoerd, Minister of Native Affairs, stated: “What is the use of teaching the Bantu child mathematics when it cannot use it in practice? That is quite absurd.” According to the entry “Soweto uprising” on Wikipedia, the Afrikaans Medium Decree was issued in 1974 , forcing all black schools to use Afrikaans and English in a 50-50 mix as languages of instruction. The Regional Director of Bantu Education (Northern Transvaal Region), J.G. Erasmus, told Circuit Inspectors and Principals of Schools that from January 1, 1975 , Afrikaans had to be used for mathematics, arithmetic, and social studies from standard five (7th grade). English would be the medium for general science and practical subjects. Indigenous languages would be used for religion instruction, music, and physical culture. According the entry “Soweto uprising” on Wikipedia, on April 30, 1976 , students from the Orlando West Junior School in Soweto went on strike, refusing to go to school. Their example was followed by other schools in Soweto. A student from Morris Isaacson High School, Toboho “Tsietsi” Mashinini, proposed a meeting on June 13, 1976 to discuss further action. According to Weizmann Hamilton’s article “The Soweto Uprising 1976,” which appeared in the September 1986 edition of Inqaba Ya Basebenzi (Fortress of the Revolution), on June 13, 1976 , the South African Students’ Movement called a meeting at the Donaldson Community Center in Orlando. 300-400 Students representing 55 schools decided to hold a mass demonstration on June 16. According to Brian Mokhele, member of the Joint Community Safety Forum, Dr Edelstein was the first victim of the Soweto uprising and killed the day before the march on June 15, 1976 . Edelstein was an administrator at the pass office in Jabavu and gave golf courses to the local community. Edelstein was put in a garbage bin and pierced by pickaxes. The garbage bin was left at the very spot of the murder for many years. A few years ago, a child was beheaded at the same spot, and the basketball court next to it has been abandoned since. According to Marcus Neustetter, founder of the Trinity Session, this story is untrue. According the entry “Soweto uprising” on Wikipedia, on June 16 , Tsietsi Mashinini led students from Morris Isaacson High School to join up with others who walked from Naledi High School. A crowd of between 3,000 and 10,000 eventually ended up near Orlando High School. According to Raymond Marlowe, a local photographer, Tsietsi Mashinini was heading the march. According to the entry “Hector Pieterson” on Wikipedia, Dr Edelstein died on June 16, 1976 , stoned to death by mob and left with a sign around his neck proclaiming “Beware Afrikaaners.” The first child to die that day was called Hastings Ndlovu. According to Pat Motsiri, Orlando West is claiming struggle heritage through the Hector Pieterson Museum, while Hector Pieterson was from Jabavu. According to Pat Motsiri, his generation effectively struggled between 1980 and 1991, forcing the release of Nelson Mandela and negotiations with the apartheid regime while the 1976-generation was safely in exile. Nevertheless, this has not been recognized in any monument. After the abolition of apartheid, the generation from 1976 returned from exile, occupied important government and ANC positions, creating an abundance of 1976 memorials and refusing to acknowledge that this was only possible because of the younger generation’s struggle. He calls this a generational conflict. According to Archibald Dlamini, the park officer responsible for the Memorial Acre, he started working for the municipality in 1978. In 1981/82 , Isaac Makhele from Pimville, who used to work in the cemetery business, was the first developer of the park. It used to be just a normal park until City Parks decided to develop the Memorial Acre in 2006. In 2007 the work was stopped by the community. According to Brian Mokhele, he left the country in 1989 after he participated in the riots of 1986. But when he returned in 1999 he found that nothing had changed. He says that they were promised to be protected by the Constitution, but that reality is different. The police uses fear to suppress them so that they don’t come out to talk openly. He has been arrested twice, both times harassed and tortured by the police, but in the end always released without indictment. He says that this is their way to threaten communities to back off from politics. According to Moses, who is sitting outside rolling a joint, Brian knows everything. He tells Brian to tell me everything he knows. According to Brian Mokhele, Tsietsi Mashinini was possibly murdered in 1990 during his exile in New York. Two weeks before he was supposed to return to South Africa, his papers in order, he was found dead under mysterious circumstances. His coffin was sealed when he was buried. According to Pat Motsiri, he came up with the idea for the Memorial Acre in 2003 . He submitted the documents for the proposal to the council, which sidelined him as soon as the budget came out in 2005 . According to Brian Mokhele, there was on estimation R 41,000,000 spent to redesign the park and turn it into the Memorial Acre. The millions were divided by Amos Masondo, the mayor of Soweto, the local councilor Bongani D. Zondi, and the director of the city of Johannesburg, Pat Lephunya. They were dividing the money between several contractors: Tsietsi Mashinini’s brothers were involved in the development of the park, they got the tender to do the green areas, the landscaping. Construction was done by other companies, some did the paving, the toilets, etc. EMBA, a private company appointed by the municipality was in control of the money flow, but the money was quickly gone. According to Raymond Marlowe, the contractor bought a BMW with the money. According to Archibald Dlamini, the Mashinini brothers got the tender, so the space would look more like the other places around in Soweto. It was agreed that after they were done, they would return the property to the municipality. They did whatever they could do. According to Mafaisa, a member of the Jabavu business community, he was one of the contractors for the landscaping and the pavement under Mpho Mashinini, one of the brothers. He says that I should contact Mavi for information on Mpho. According to Poi Stuurman, a local youth worker, Mafaisa is one of the guys who ran away with the money. According to Mavi, Mpho Mashinini was never a contractor. The contracts were organized by Sbu Butelezi, the former head of the Gauteng Department for Public Works. The June 16 Foundation and the Mashinini brothers will be the beneficiaries of the park when it is finished. According to Brian Mokhele, City Parks did not accept the Memorial Acre because it was not finished. The rest of the year, the unfinished park is not maintained, as should have happened. This was done deliberately so that in the end they can just clean the whole thing up and have a reason to redo the whole park. According to Brian Mokhele, the Mashinini brothers now work for the government. People that manipulate for money purposes always come from the government’s side. Because the park was left unfinished, the people from the neighborhood are taking away the stones to decorate their own homes with. According to Archibald Dlamini, because City Parks doesn’t accept responsibility of the park, he officially has nothing the guard, except for his cottage, which is municipal property. The thieves come at night and destroy the park, but he cannot do anything because he is sleeping. According to the website of the Thanda Foundation on June 16, 2006 a bronze statue of Hector Pieterson, the first child to die in the 1976 protests, made by Kobus Hattingh and Jacob Maponyane was unveiled in the Maponya Mall in Soweto. The statue is sculpted after the famous image shot by Sam Nzima of Mbuyisa Makhubo carrying the dead body of the boy. The sculpture was sponsored by the Thanda Foundation, founded by the Swedish entrepreneur Dan Olofsson and South-African entrepreneur Matthews Phosa. According to the official website of the City of Johannesburg, the Memorial Acre and Artwork were unveiled in 2006. According to a blog post on sowetouprisings.com, the Memorial Acre was still under development on July 24, 2006. According to Archibald Dlamini, City Parks only cleans up the park once a year just before the June 16 celebrations. Everybody is waiting for the Mashinini brothers to finish their job. The last time he talked with them was in 2007 . According to a sign on the school grounds of the Morris Isaacson High School, the June 16 Trail will be finished in 2008 . According to a blog post on sowetouprisings.com, the Memorial Acre contains another monument erected in Tsietsi’s honor. The monument was created as part of the Sunday Times Heritage Public Art program. Its physical form resembles a giant book which symbolizes the crisis in education experienced in 1976. On the face of the book is the map of the route taken by the students from Morris Isaacson High School in Central Western Jabavu to Phefeni Junior Secondary in Orlando West (currently the site of the Hector Pieterson Museum), while the back cover of the ‘book’ is inscribed with a tribute to Tsietsi Mashinini. The monument was revealed on June 16, 2008 . According to Marcus Neustetter, the billboards on the Memorial Acre were part of a school project realized in 2008. Following several workshops, the students from different high schools along the June 16 Trail were invited to work with artists on the billboards, while the neighborhood community was invited to watch the process during the festivities on June 15 and 16, 2008 . The billboards were supposed to be removed because of construction works on the Memorial Acre, which never ended up happening. According to Brian Mokhele, the former toilet facilities were converted into a house for the park officer. This park officer has been working for city parks for more than 12-15 years, but does nothing here, because the park, including the new toilet buildings, is not finished. The government is now moving around looking for people to take this job because they stopped it. They confronted everybody who was going in and chased them away. According to John, in 2009 , some girls, around 16 or 17 years old, were raped by four men who had been drinking in a local shebeen. When the bar quit they said that they would go home by car, but instead raped the girls on the Memorial Acre nearby. This happened in the unfinished toilets, because the doors couldn’t be closed. According to Brian Mokhele, there used to be some fences around the park because of the construction work that was eventually stopped, but these were also stolen. According to Archibald Dlamini, people from the neighborhood started about two and a half years ago, and the last piece was stolen near the end of 2009 . Sometimes he would catch someone with a roll of fence, and then use it for his own cottage. According to the official website of the City of Johannesburg, a statue of Tsietsi Mashinini by Johannes Pokhela was revealed on June 16, 2010 , “Youth Day.” According to Shirley Makutoane, deputy principal of Isaac Morrison High School, the statue of Tsietsi Mashinini, funded by the June 16 Foundation, has temporarily been placed within the school perimeter. The statue will be moved to the Memorial Acre when it will be finished, in 2011 . According to Brian Mokhele, beside the June 16 Foundation, there is also a June 16 Memorial Acre Foundation. Both foundations are quarreling about the money involved in the Memorial Acre project. Nobody knows who’s involved in them. According to Marcus Neustetter, the June 16 Foundation consists of people that were part of 1976 protest movement, local government officials, representatives of the Hector Pieterson Museum, and the council. According to students from the Isaac Morrison High School, the statue of Tsietsi Mashinini is on the school ground because on the Memorial Acre it would be vandalized by youths from White City, an adjacent neighborhood. Accorcing to Brian Mokhele, the statue of Tsietsi should eventually be mounted on the Memorial Acre. It is wrong that the statue is in the school at the moment, because it is not a public school. He wants the statues to depict the massiveness of the force that was coming into Soweto after the protests. According to Brian Mokhele, City Parks, City of Jo’burg, City Lights, and SAPS are making some sort of plan to take the plan back. They want to remove the trees from the Memorial Acre, and redesign the Memorial Acre into a relaxing park, without political content. They want to depoliticize the square. In doing so,they will have their own employment and not use local workforces. According to Brian Mokhele, the community wants to remove the monuments, amphitheater, and sculptures from the Memorial Acre because they do not resemble anything. The sculptures should be depicting the truth of what happened, because the Memorial Acre is a political heritage site. He wants to involve the people that actually participated in the struggle to make the monument so that everyone can enjoy it and get a better understanding of the struggle heritage. Therefore, he proposes collective ideology in which everyone has a say. This would prevent future vandalization of the monument. According to Pat Motsiri, the sculptures must depict the event around June 16, 1976. Like the story of Dr Edelstein, who was pierced by pickaxes, forced into a garbage bin and burned alive. According to Jonas Staal, the Memorial Acre should be destroyed, its elements stacked on pallets, thus forming the Monument for the Distribution of Wealth . According to Mafaisa, his men can do the work quickly. He has about twenty men working under him. (shrink)

This article by Johannes B. Lotz, S.J., never before translated into English, describes his contacts with Martin Heidegger. First it describes his arrival, along with Karl Rahner, S.J., to pursue doctoral studies in Freiburg im Breisgau and their first experiences with the famous professor. Lotz continues his narrative by mentioning times he met with Heidegger over the subsequent forty years up to the philosopher’s death. With Gustav Siewerth, Max Müller, Bernhard Welte, and Karl Rahner, Lotz belonged to a group of (...) Catholic thinkers influenced—some more, some less—by Martin Heidegger. In Lotz’s view some of Heidegger’s ideas were already found in Aquinas, and a philosophy of Being needed to go beyond existential analysis into religion, revelation, and cultural criticism. (shrink)

This article by Johannes B. Lotz, S.J., never before translated into English, describes his contacts with Martin Heidegger. First it describes his arrival, along with Karl Rahner, S.J., to pursue doctoral studies in Freiburg im Breisgau and their first experiences with the famous professor. Lotz continues his narrative by mentioning times he met with Heidegger over the subsequent forty years up to the philosopher’s death. With Gustav Siewerth, Max Müller, Bernhard Welte, and Karl Rahner, Lotz belonged to a group of (...) Catholic thinkers influenced—some more, some less—by Martin Heidegger. In Lotz’s view some of Heidegger’s ideas were already found in Aquinas, and a philosophy of Being needed to go beyond existential analysis into religion, revelation, and cultural criticism. (shrink)

The world is undeniably full of injustice. Many feel that much political philosophy is practically impotent and engaged instead in overly abstract theorising insufficiently sensitive to the realities of the world. One response to this concern is David Miller’s influential model of evidence-based political philosophy, which claims to be sensitive to empirical evidence from the social sciences, takes seriously people’s opinions, and defends the role of facts in grounding normative principles. Using various examples from the field of global justice, one (...) of Miller’s key areas of work, I show that Miller’s method is unconvincing on two levels. His theoretical argument for fact-dependence is flawed, and his practical argument for an opinion-sensitive political theory is either guilty of status quo bias or, in an attempt to escape it, becomes self-defeating. While the paper is primarily critical, I endeavour also to draw out the implications of my critiques for the role of the ‘real world’ in theorising. (shrink)

Luck egalitarianism has come under a lot of criticism for its apparent harshness towards negligent victims of voluntary actions (the harshness objection) and its inability to respond to morally-acceptable voluntary acts that lead to disadvantage (the discrimination objection). This paper surveys a series of responses in the luck egalitarian literature, showing that for the most part each one is unable to respond, on its own, to the crux of the objections. These responses often face a dilemma: Either they must bite (...) the bullet on the objections to retain their luck egalitarian commitments, or they must propose a reply to the objection that diverges from their core luck egalitarian principles. In this paper, I advance a preliminary framework for grounding luck egalitarian theories of justice based upon a two-level model and what I shall call the Fact of Inherent Normativity. Two-level luck egalitarianism makes fundamental rights and basic needs de facto insensitive to responsibility at the first level, while retaining the scope for responsibility for the distribution of second-level goods. The account remains distinctly luck egalitarian, while leaving scope for the consideration of rights, respect, and a host of other morally relevant considerations within the luck egalitarian framework. Luck egalitarianism, properly understood as a two-level theory, can successfully respond to objections against its harshness and propensity to discriminate. (shrink)

This paper aims to square our considered judgements about the moral significance of healthcare with various empirical and conceptual challenges about its role in a theory of justice. I do so by defending the moral significance of healthcare by reference to a central but neglected dimension – healthcare’s expressive function. Over and above its influence on health outcomes and other metrics of justice (such as opportunity or welfare), and despite its relatively limited impact on population health outcomes, healthcare expresses respect (...) for individuals in a distinctive and morally salient way. Grounding the moral significance of healthcare in this way not only highlights an important distinguishing feature of healthcare, but it also makes our support for healthcare immune from several powerful objections against its significance. This conclusion has important implications for theorists of (health) justice and for political philosophers more widely, highlighting the appropriate role of healthcare within public policy and normative theorising about theories of justice. (shrink)

The rise of fake news, climate change denial, and the anti-vaccination movement all pose important challenges to contemporary views about freedom of expression. This paper attempts to delineate the limits of freedom of expression, specifically with regard to truth, lies, and harm. My strategy is to offer a critical reading of John Stuart Mill’s On Liberty to demonstrate its enduring relevance to contemporary issues in the freedom of expression. My critical reading of Mill provides guidance on when state interference is (...) justified, the role of education, the nature of harm in the age of mass media and globalisation, and the relevance of truth and lies in the freedom of expression. Ultimately, I demonstrate that the Millian account I present can deal adequately with contemporary issues in the freedom of expression in line with the current social context, relevant empirical facts, and our considered judgements. (shrink)

Theological education, spiritual formation and leadership are all contested issues in the Church, especially within the African context. Although these topics are thoroughly discussed, the relation and the interdependence are not always clear. This article discusses these topics in relation to each other and in relation to the One who calls servant leaders to guide his church for her service in the world. The importance of the local church as missional church is emphasised in the article. Thus, what the faith (...) community believes and teaches about God determines our ecclesiology, theological education and leadership. What does God have to do with theological education, spiritual formation and leadership development in Africa? The answer is everything! The article used a literary study to research the relationship between the different topics and the church and concluded that dependence exists between them. CONTRIBUTION: Much is written on theological education in Africa. However, students come into theological education with an already established spirituality formed by other agents. The article contributes to the discussion about the relation between formal theological, spiritual formation and leadership. It emphasises the relation between the theological institution and the local church. (shrink)

In the strategic document of the African Union approved in 2013 and spanning over 50 years, known as Agenda 2063, we find a blueprint for transforming Africa into a global powerhouse of the future. Many of the themes mentioned in Agenda 2063 are also mentioned in the New Testament, such as slavery, unity, poverty, women, children, discrimination and diversity. It is therefore clear that Christianity has something to contribute to Agenda 2063. Another word used throughout the Agenda 2063 document is (...) ‘transformation’. Concepts such as ‘transformative leadership’ and ‘radical transformation at all levels and in all spheres’ are mentioned. This contribution draws on the Agenda 2063 document to engage the missiological themes of unity, reconciliation and justice through the lens of the Belhar Confession. Deeply aware of the pain and disruption colonial Christianity has caused in many instances in Africa, the author contends that the Good News, particularly the New Testament themes of unity, reconciliation and justice, present a potentially transformative approach towards developing Africa. The research question that this article attends to is: how can the churches in Africa contribute to the aspirations of Agenda 2063 from the themes of unity, justice and reconciliation as declared in the Belhar Confession? By interrogating these key concepts of Agenda 2063 through the Confession of Belhar, the author concludes that the Belhar Confession can be regarded as a key African document, which could be explored further to facilitate unity, reconciliation and justice on the continent.Contribution: This article indicates the important relationship between church and state and the need for a partnership for the benefit of both. The need for a transforming state and a transforming church to participate in a transformed Africa is argued. The article promotes multi-, inter- and transdisciplinary aspects of studies as part of a mission praxis and application. (shrink)

Theological education, spiritual formation and leadership are all contested issues in the Church, especially within the African context. Although these topics are thoroughly discussed, the relation and the interdependence are not always clear. This article discusses these topics in relation to each other and in relation to the One who calls servant leaders to guide his church for her service in the world. The importance of the local church as missional church is emphasised in the article. Thus, what the faith (...) community believes and teaches about God determines our ecclesiology, theological education and leadership. What does God have to do with theological education, spiritual formation and leadership development in Africa? The answer is everything! The article used a literary study to research the relationship between the different topics and the church and concluded that dependence exists between them. CONTRIBUTION: Much is written on theological education in Africa. However, students come into theological education with an already established spirituality formed by other agents. The article contributes to the discussion about the relation between formal theological, spiritual formation and leadership. It emphasises the relation between the theological institution and the local church. (shrink)

A transforming spirituality is needed to attend to the ‘third-millennial needs’ of Africa to address issues such as relationships, globalisation, ecology and social issues. It is argued that reformed theology, African spiritualities and a spirituality of creation need to be enriched by each other to bring about transformation in Africa. To discover a transforming spirituality of creation, participants need to listen to the different spiritualities and beliefs, without attempting to create a meta-narrative. Participants need to acknowledge the differences and even (...) tensions, and embrace these. As such, this article attends to the research question, how can a dialogue between reformed theology and spirituality of creation help to establish a transforming spirituality based on common values for the diverse African continent in ‘our third-millennial world’?Contribution: From a multidisplinary theological perspective, the article deals with ‘historical thought’ regarding spirituality and creation. This includes both the textual history from Christianity and oral history from Africa. A missional hermeneutics is used to bring different traditions and beliefs together. (shrink)

The Remmelink Committee published its report on medical decisions at the end of life in the Netherlands in September 1991. As a result, the Dutch debate about physician aid‐in‐dying has been broadened to include life‐terminating acts that have not been explicitly requested by the patient.

This article focuses on the current trends and initiatives in human capacity building in Africa. It takes as it starting point that human capacity development is essential for Africa to become an information and know-ledge society and therefore an equal partner in the global sharing of knowledge. Four knowledge areas are identified and discussed. These are education, research and development, brain drain and information and documentation drain. The paper concludes that there is a clear understanding in Africa that its future (...) lies with education and that most African leaders have a strong political will to invest in human capacity building on the continent. It is also clear that much has been done, particularly primary education. Africa will most defi-nitely benefit from this in the long run. Problem areas remain however. These are in the needed growth of research and development and how to address the brain and information drain phenomena. (shrink)

This research investigated the impact measures (such as lockdowns) used to combat the spread of the coronavirus disease of 2019 (COVID-19) have on the church’s mission. When people face travel and assembly restrictions, the church as a community of witnesses testifying and participating in Christ’s work risks is being neutralised, and its presence weakened. What then does mission as ‘being with’ look like in these situations? Is faithful presence something one can turn on and off at will depending on the (...) situation? If faithful presence was no more, what then was the impact of such absence on the church’s mission? These questions underscore the relevance of this research which sought to ascertain the impact the COVID-19 pandemic lockdown had on the church’s mission. The crucial area this research sought to explore are the lessons from the COVID-19 lockdown that will help the church prepare for future pandemics which scientists say are inevitable. The research made use of a qualitative interview method to discover the meaning of ‘being with’ in the context of the COVID-19 lockdown. The results revealed six attributes of a missional church. Based on these attributes, the research recommends a seven-step process to prepare the church for possible future pandemics.Contribution: This research has provided the church with an opportunity to shift from being ‘inward-looking’ to a church that is community focused, a church that prepares, trains and equips its adherents for the work of ministry in their own communities such that the work of ministry continues with or without gatherings. (shrink)

In the strategic document of the African Union approved in 2013 and spanning over 50 years, known as Agenda 2063, we find a blueprint for transforming Africa into a global powerhouse of the future. Many of the themes mentioned in Agenda 2063 are also mentioned in the New Testament, such as slavery, unity, poverty, women, children, discrimination and diversity. It is therefore clear that Christianity has something to contribute to Agenda 2063. Another word used throughout the Agenda 2063 document is (...) 'transformation'. Concepts such as 'transformative leadership' and 'radical transformation at all levels and in all spheres' are mentioned. This contribution draws on the Agenda 2063 document to engage the missiological themes of unity, reconciliation and justice through the lens of the Belhar Confession. Deeply aware of the pain and disruption colonial Christianity has caused in many instances in Africa, the author contends that the Good News, particularly the New Testament themes of unity, reconciliation and justice, present a potentially transformative approach towards developing Africa. The research question that this article attends to is: how can the churches in Africa contribute to the aspirations of Agenda 2063 from the themes of unity, justice and reconciliation as declared in the Belhar Confession? By interrogating these key concepts of Agenda 2063 through the Confession of Belhar, the author concludes that the Belhar Confession can be regarded as a key African document, which could be explored further to facilitate unity, reconciliation and justice on the continent. CONTRIBUTION: This article indicates the important relationship between church and state and the need for a partnership for the benefit of both. The need for a transforming state and a transforming church to participate in a transformed Africa is argued. The article promotes multi-, inter- and transdisciplinary aspects of studies as part of a mission praxis and application. (shrink)

This paper discusses the role of age in scientific practice from an ethical perspective. In social perception, people tend to categorise others rather automatically along three major dimensions: race, sex, and age.1 Much empirical and theoretical attention has been devoted to the study of racism and sexism, but comparatively little research in the social and behaviural sciences has been directed at understanding what some refer to as the third ‘-ism’: ageism.2 For a serious understanding of the implications of ageism in (...) science, it is necessary to discuss, first, the conflicting relationships between classical and modern concepts of time and calendar age, and thereafter the concept of ageism. (shrink)

In diesem Beitrag sollen zentrale Spielarten und Familienverwandte des Liberalismus vorgestellt sowie auf zentrale Herausforderungen eingegangen werden, die sich dem Liberalismus als politischer Theorie gegenwärtig stellen. In diesem Beitrag sollen zum einen zentrale Spielarten und Familienverwandte von Rawls’ Liberalismus vorgestellt werden. Dabei handelt es sich um den Links- und Rechtslibertarismus, den Neoliberalismus sowie den Nationalliberalismus. Zum anderen sollen mit dem gesellschaftlichen Pluralismus, dem Verhältnis zur Demokratie und der Umweltzerstörung wichtige Herausforderungen thematisiert werden, mit denen sich der politische Liberalismus heutzutage konfrontiert (...) sieht. (shrink)

John Rawls ist im 20. Jahrhundert sicherlich einer der bedeutendsten praktischen Philosophen. Seine Werke und die damit verbundene Begriffs- und Theoriebildung haben viele Traditionslinien philosophischer Klassiker der Moderne aufgegriffen, synthetisiert und neu ausgelegt. Mit seinem Nachdenken über Gerechtigkeit prägt er bis heute viele philosophische Debatten, sei es in positiver Bezugnahme oder negativer Abgrenzung.

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease, involving dialysis or conservative care. Shared decision-making is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift (...) from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD. (shrink)

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

This paper shall give a review of Elizabeth A. Buchanan : Readings in Virtual Research Ethics. Issues and Controversies. Information Science Pub. , 2003. 350 pages Broschur. 69,00 €.

The Remmelink Committee published its report on medical decisions at the end of life in the Netherlands in September 1991. As a result, the Dutch debate about physician aid‐in‐dying has been broadened to include life‐terminating acts that have not been explicitly requested by the patient.

We introduce prime products as a generalization of ultraproducts for positive logic. Prime products are shown to satisfy a version of Łoś’s Theorem restricted to positive formulas, as well as the following variant of the Keisler Isomorphism Theorem: under the generalized continuum hypothesis, two models have the same positive theory if and only if they have isomorphic prime powers of ultrapowers.

It is often argued that clinical research should not violate the Kantian principle that people must not be used merely as a means for the purposes of others. At first sight, the practice of clinical research itself, however, seems to violate precisely this principle: clinical research is often beneficial to future people rather than to participants; even if participants benefit, all things considered, they are exposed to discomforts which are absent both in regular care for their diseases and in other (...) areas of daily life. Therefore, in this paper we will consider whether people are used merely as a means by being enrolled in clinical research. On the basis of recent studies of Kantian scholars we will argue that clinical research is compatible with the Kantian principle if the conditions of possible consent and end-sharing have been met. Participants are not used merely as a means if they have sufficient reasons to consent to being enrolled in clinical research and can share the ends of the researchers who use them. Moreover, we will claim that even if people are used merely as a means by participating in clinical research, it may not always be morally wrong to use them in this way. (shrink)

BackgroundPregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing (...) the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.MethodWe use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.ResultsSolidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.ConclusionsWe conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications. (shrink)

Certain organoid subtypes are particularly sensitive. We explore whether moral intuitions about the heartbeat warrant unique moral consideration for newly advanced contracting cardiac organoids. Despite the heartbeat’s moral significance in organ procurement and abortion discussions, we argue that this significance should not translate into moral implications for cardiac organoids.

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

The innovative field of Regenerative Medicine (RM) is expected to extend the possibilities of prevention or early treatment in healthcare. Increasingly, clinical trials will be developed for people at risk of disease to investigate these RM interventions. These individuals at risk are characterised by their susceptibility for developing clinically manifest disease in future due to the existence of degenerative abnormalities. So far, there has been little debate about the ethical appropriateness of including such individuals at risk in clinical trials. We (...) discuss three main challenges of selecting this participant model for testing RM interventions: the challenge of achieving a proportional risk–benefit balance; complexities in the trial design in terms of follow-up and sample size; and the difficulty of obtaining informed consent due to the many uncertainties. We conclude that selecting the model is not ethically justifiable for first-in-man trials with RM interventions due to the high risks and uncertainties. However, the model can be ethically appropriate for testing the efficacy of RM interventions under the following conditions: interventions should be low risk; the degenerative abnormalities (and other risk factors) should be strongly related with disease within a short time frame; robust preclinical evidence of efficacy needs to be present; and the informed consent procedure should contain extra safeguards with regard to communication on uncertainties. (shrink)