Ich will meine Gedanken folgendermaßen zusammenfassen: Ein spontanes und früh erlerntes Glaubenserlebnis ringt immer mit einer wissenschaftlichen Analyse. Zwar wird die Religionspsychologie negativ aufgefaßt, aber sie hilft uns auch einzusehen, wie solch eine Einstellung entstehen kann. Die intensive Glaubenserfahrung enthält immer eine Totalitätsorientierung, die den eigentlichen Grund in transzendentalen Größen sucht. Eine aufgezwängte Umorientierung bringt immer einen gewissen Schmerz mit sich. Eine religionspsychologische Analyse der Glaubensmotive führt jedoch auch zu einem Verständnis für das wichtige Zusammenspiel, das die Symbol-motive der Tradition (...) haben, und müßte auch mit den persönlich erlebten Situationen seit der Kindheit rechnen. Dadurch, daß man Zusammenspielsmöglichkeiten zwischen den historisch gegebenen Modellen und den individuellen Situationen findet, geschieht ein Wechsel, der wichtige Modelle des menschlichen Lebens vertieft und ins Bewußtsein bringt. Dies ist doch kein selbstverständlicher oder automatischer Prozeß, sondern falsche Verbindungen und negative Bindungen sind auch möglich. Hier muß eine religionsspychologische Ethik entwickelt werden. Große Aufträge erwarten uns in der Zukunft. Das oben Erwähnte kann man auch so ausdrücken: Der Glaube an Gottes Wirken ist nicht streitig mit dem Handhaben wissenschaftlicher Modelle. Ebensowenig wie das Brot und der Wein des Abendmahls was anderes als Brot und Wein zu sein brauche, ebensowenig brauchen das Gesundbeten, das Zungenreden, die Prophezeiung, die Stigmatisierung, ja des Lebens heilige Momente etwas anderes zu sein als die Ergebnisse menschlich gegebener Prozesse, um Gottes Gegenwart zu erleben. Durch die innere symbolische Interaktion wird menschliche Dürftigkeit in eine Heiligkeit mit Ewigkeitswert verwandelt - und umgekehrt: Die jahrhundertelange Mythologie findet ihre menschliche Inkarnation. (shrink)

Some things that we take to be the case in a fictional work are never made explicit by the work itself. For instance, we assume that Sherlock Holmes does not have a third nostril, that he wears underpants and that he has never solved a case with a purple gnome, even though neither of these things is ever mentioned in the narration. This article argues that examples like these can be accounted for through the same content-enriching reasoning that we employ (...) when confronted with non-fictional discourse, with the important difference that fictional discourse essentially involves pretence. Fictional discourse works in much the same way as non-fictional discourse, and what is conveyed without being stated can accordingly be explained through familiar pragmatic mechanisms. It is argued that this account carries some distinct advantages over competing views. (shrink)

What is objectionable about “blacking up” or other comparable acts of imagining involving unethical attitudes? Can such imaginings be wrong, even if there are no harmful consequences and imaginers are not meant to apply these attitudes beyond the fiction? In this article, we argue that blackface—and imagining in general—can be ethically flawed in virtue of being oppressive, in virtue of either its content or what imaginers do with it, where both depend on how the imagined attitudes interact with the imagining’s (...) context. We explain and demonstrate this using speech act theory alongside a detailed case study of blackface. (shrink)

Using emotional film clips is one of the most popular and effective methods of emotion elicitation. The main goal of the present study was to develop and test the effectiveness of a new and comprehensive set of emotional film excerpts. Fifty film experts were asked to remember specific film scenes that elicited fear, anger, sadness, disgust, amusement, tenderness, as well as emotionally neutral scenes. For each emotion, the 10 most frequently mentioned scenes were selected and cut into film clips. Next, (...) 364 participants viewed the film clips in individual laboratory sessions and rated each film on multiple dimensions. Results showed that the film clips were effective with regard to several criteria such as emotional discreteness, arousal, positive and negative affect. Finally, ranking scores were computed for 24 classification criteria: Subjective arousal, positive and negative affect (derived from the PANAS; Watson & Tellegen, 1988), a positive and a negative affect scores derived from the Differential Emotions Scale (DES; Izard et al., 1974), six emotional discreteness scores (for anger, disgust, sadness, fear, amusement and tenderness), and 15 “mixed feelings” scores assessing the effectiveness of each film excerpt to produce blends of specific emotions. In addition, a number of emotionally neutral film clips were also validated. The database and editing instructions to construct the film clips have been made freely available in a website. (shrink)

In the United Kingdom, there are moves to extend formal ethical review of research involving human subjects beyond the traditional oversight by NHS local or multi-centre research ethics committees of medical or clinical research, to also encompass all ‘non-clinical’ research involving human subjects. This paper describes and analyses the development and implementation of a model for ethical review within the university sector. At Cardiff University, a devolved or two-tiered system of ethics review has been created in which a top-level university (...) research ethics committee provides policy advice to and oversight of school-based research ethics committees that engage in formal ethics review of research conducted in their respective schools. We describe the system and reflect on the challenges and benefits of implementing such a coordinated and comprehensive university-wide system of ethics review. (shrink)

This new study provides a thorough analysis of the ethical reasoning of doctors and nurses. Based on extensive interviews, Soren Holm's work demonstrates how qualitative research methods can be used to study ethical reasoning, and that the results of such studies are important for normative ethics, that is, the analysis of how health care professionals ought to act.

The question of if, and under what conditions transsexuals should be allowed to participate in sports in their acquired sex is becoming increasingly relevant partly because the number of transsexuals is increasing partly because many countries now provide mechanisms for achieving legal recognition as belonging to the new acquired sex. This paper develops (1) an analysis of the justification for maintaining sex segregation in some sports and (2) an account of the rights of transsexuals to be recognised in their new (...) sex. On the basis of these two analyses it critically evaluates two set of rules for the participation of transsexuals in elite sports: the UK guidelines issued in pursuance of the Gender Recognition Act 2004 and the International Olympic Committee's guidelines. It is argued that these guidelines are conflicting and that a modified set of criteria is more justifiable. (shrink)

In this article we provide an in-depth description of a new model of informed consent called ‘meta consent’ and consider its practical implementation. We explore justifications for preferring meta consent over alternative models of consent as a solution to the problem of secondary use of health data for research. We finally argue that meta consent strikes an appropriate balance between enabling valuable research and protecting the individual.

This article introduces the notion of ‘routinisation’ into discussions of informed consent. It is argued that the routinisation of informed consent poses a threat to the protection of the personal autonomy of a patient through the negotiation of informed consent. On the basis of a large survey, we provide evidence of the routinisation of informed consent in various types of interaction on the internet; among these, the routinisation of consent to the exchange of health related information. We also provide evidence (...) that the extent of the routinisation of informed consent is dependent on the character of the information exchanged, and we uncover a range of causes of routinisation. Finally, the article discusses possible ways of countering the problem of routinisation of informed consent. (shrink)

In an analysis of artificially intelligent systems for medical diagnostics and treatment planning we argue that patients should be able to exercise a right to withdraw from AI diagnostics and treatment planning for reasons related to (1) the physician’s role in the patients’ formation of and acting on personal preferences and values, (2) the bias and opacity problem of AI systems, and (3) rational concerns about the future societal effects of introducing AI systems in the health care sector.

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

Increasingly, commissioners and providers of services for people with intellectual disabilities are turning to assistive technology and telecare as a potential solution to the problem of the increased demand for services, brought about by an expanding population of people with intellectual disabilities in the context of relatively static or diminishing resources. While there are numerous potential benefits of assistive technology and telecare, both for service providers and service users, there are also a number of ethical issues. The aim of this (...) paper is to raise these issues and to set them within the ethical framework proposed by Beauchamp and Childress. There is a need for a wider debate as a first step in the development of strategies to address the issues raised in the paper. (shrink)

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that (...) the methods offered for specification and balancing of principles are inadequate. (shrink)

OBJECTIVES: To study whether linguistic analysis and changes in information leaflets can improve readability and understanding. DESIGN: Randomised, controlled study. Two information leaflets concerned with trials of drugs for conditions/diseases which are commonly known were modified, and the original was tested against the revised version. SETTING: Denmark. PARTICIPANTS: 235 persons in the relevant age groups. MAIN MEASURES: Readability and understanding of contents. RESULTS: Both readability and understanding of contents was improved: readability with regard to both information leaflets and understanding with (...) regard to one of the leaflets. CONCLUSION: The results show that both readability and understanding can be improved by increased attention to the linguistic features of the information. (shrink)

The use of algorithms to support prediction-based decision-making is becoming commonplace in a range of domains including health, criminal justice, education, social services, lending, and hiring. An assumption governing such decisions is that there is a property Y such that individual a should be allocated resource R by decision-maker D if a is Y. When there is uncertainty about whether a is Y, algorithms may provide valuable decision support by accurately predicting whether a is Y on the basis of known (...) features of a. Based on recent work on statistical evidence in epistemology this article presents an argument against relying exclusively on algorithmic predictions to allocate resources when they provide purely statistical evidence that a is Y. The article then responds to the objection that any evidence that will increase the proportion of correct decisions should be accepted as the basis for allocations regardless of its epistemic deficiency. Finally, some important practical aspects of the conclusion are considered. (shrink)

This paper considers the relation between medical ethics (ME) and common morality (CM), professional norms, and moral philosophy. It proceeds by analyzing two recent book-length critical analyses of this relationship by Bob Baker in “The Structure of Moral Revolutions—Studies of Changes in the Morality of Abortion, Death, and the Bioethics Revolution” and Rosamond Rhodes in “The Trusted Doctor—Medical Ethics and Professionalism.” It argues that despite the strengths of these critical arguments, there is nevertheless a relationship between ME, understood as the (...) professional ethics of the healthcare professions, and both CM and moral philosophy. It also argues that ME cannot and should not be understood purely as the internally developed professional norms of the medical or healthcare professions. (shrink)

In this paper I examine the connection between accounts of biological teleology and the biocentrist claim that all living beings have a good of their own. I first present the background for biocentrists’ appeal to biological teleology. Then I raise a problem of scope for teleology-based biocentrism and, drawing in part on recent work by Basl and Sandler, I discuss Taylor and Varner’s responses to this problem. I then challenge Basl and Sandler’s own response to the scope problem for its (...) reliance on a selectionist account of organismic teleology. Finally I examine the prospects for a biocentrist response to the problem of scope based on an alternative organisational account of internal teleology. I conclude by assessing the prospects for teleology-based biocentrism. (shrink)

What does it mean for algorithmic classifications to be fair to different socially salient groups? According to classification parity criteria, what is required is equality across groups with respect to some performance measure such as error rates. Critics of classification parity object that classification parity entails that achieving fairness may require us to choose an algorithm that makes no group better off and some groups worse off than an alternative. In this article, I interpret the problem of algorithmic fairness as (...) a case concerning the ethics of the distribution of algorithmic classifications across groups (as opposed to, e.g., the fairness of data collection). I begin with a short introduction of algorithmic fairness as a problem discussed in machine learning. I then show how the criticism raised against classification parity is a form of leveling down objection, and I interpret the egalitarianism of classification parity as deontic egalitarianism. I then discuss a challenge to this interpretation and suggest a revision. Finally, I examine how my interpretation provides proponents of classification parity with a response to the leveling down criticism and how it relates to a recent suggestion to evaluate fairness for automated decision-making systems based on risk and welfare considerations from behind a veil of ignorance. (shrink)

This paper discusses the use of the Milgram obedience experiments and the Tuskegee syphilis study in the bioethical literature. The two studies are presented and a variety of uses of them identified and discussed. It is argued that the use of these studies as paradigms of problematic research relies on a reduction of their complexity. What is discussed is thus often constructions of these studies that are closer to hypothetical examples than to the real studies.

In a recent article in the Journal of Medical Ethics, Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that Manson’s considerations on the costs of a meta-consent model are incomplete and therefore misleading; his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank research is (...) actually conducted and a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice. (shrink)

In this response to Neil Manson’s latest intervention in our debate about the best consent model for biobank research we show, contra Manson that the ‘expiry problem’ that affects broad consent models because of changes over time in methods, purposes, types of data used and governance structures is a real and significant problem. We further show that our preferred implementation of meta consent as a national consent platform solves this problem and is not subject to the cost and burden objections (...) that Manson raises. (shrink)

The increased use of information technology in every day health care creates vast amounts of stored health data that can be used for research. The secondary research use of routinely collected data raises questions about appropriate consent mechanisms for such use. One option is meta consent where individuals state their own consent preferences in relation to future use of their data, e.g. whether they want the data to be accessible to researchers under conditions of specific consent, broad consent, blanket consent (...) or not at all. This study investigates whether meta consent preferences can be successfully elicited by a smartphone application in the adult Danish population. A smartphone app was developed for the elicitation of meta consent preferences. An invitation to use the app was distributed to a stratified, representative sample of the Danish adult population. The meta consent choices, the use of the app, user experience data, and demographic data were logged and analysed statistically using IBM SPSS version 20. Of 1000 potential respondents 221 used the app. One hundred eighty-eight of the respondents were female and 103 male. The age range was 19 to 79 years with an average of 51 years. Most users indicate 1) that they find the choices they are asked to make easy to understand, 2) that the application is easy to use, and 3) that this kind of choice should be offered to people. It is possible to collect meta consent preferences in the general, adult population using a smartphone app. (shrink)

When is it justified to use opaque artificial intelligence (AI) output in medical decision-making? Consideration of this question is of central importance for the responsible use of opaque machine learning (ML) models, which have been shown to produce accurate and reliable diagnoses, prognoses, and treatment suggestions in medicine. In this article, I discuss the merits of two answers to the question. According to the Explanation View, clinicians must have access to an explanation of why an output was produced. According to (...) the Validation View, it is sufficient that the AI system has been validated using established standards for safety and reliability. I defend the Explanation View against two lines of criticism, and I argue that within the framework of evidence-based medicine mere validation seems insufficient for the use of AI output. I end by characterizing the epistemic responsibility of clinicians and point out how a mere AI output cannot in itself ground a practical conclusion about what to do. (shrink)

In this paper, I discuss the aetiological account of biological interests, developed by Varner, in the context of artefactual organisms envisioned by current research in synthetic biology. In “Sections 2–5”, I present Varner's theory and criticise it for being incapable of ascribing non-derivative interests to artefactual organisms due to their lack of a history of natural selection. In “Sections 6–7”, I develop a new alternative to Varner's account, building on the organisational theory of biological teleology and function. I argue that (...) the organisational account of biological interest is superior to Varner's aetiological account because it can accommodate both artefactual and naturally evolved organisms, provides a non-arbitrary and practical way of determining biological interests, supports the claim that organisms have interests in a sense in which artefacts do not, and avoids the possibility of there being a conflict between what an organismic part is supposed to do and what is in the interest of the organism. (shrink)

Non-therapeutic circumcision violates boys’ right to bodily integrity as well as to self-determination. There is neither any verifiable medical advantage connected with the intervention nor is it painless nor without significant risks. Possible negative consequences for the psychosexual development of circumcised boys (due to substantial loss of highly erogenous tissue) have not yet been sufficiently explored, but appear to ensue in a significant number of cases. According to standard legal criteria, these considerations would normally entail that the operation be deemed (...) an ‘impermissible risk’—neither justifiable on grounds of parental rights nor of religious liberty: as with any other freedom right, these end where another person's body begins. Nevertheless, after a resounding decision by a Cologne district court that non-therapeutic circumcision constitutes bodily assault, the German legislature responded by enacting a new statute expressly designed to permit male circumcision even outside of medical settings. We first criticise the normative foundations upon which such a legal concession seems to rest, and then analyse two major flaws in the new German law which we consider emblematic of the difficulty that any legal attempt to protect medically irrelevant genital cutting is bound to face. (shrink)

Several authors have argued that contractualism faces a dilemma when it comes to justifying risks generated by socially valuable activities. At the heart of the matter is the question of whether contractualists should adopt an ex post or an ex ante perspective when assessing whether an action or policy is justifiable to each person. In this paper I argue for the modest conclusion that ex post contractualism is a live option notwithstanding recent criticisms raised by proponents of the ex ante (...) perspective. I then consider how an ex post contractualist can best respond to the problem that it seems to prohibit a range of intuitively permissible and socially valuable activities. (shrink)

The purpose of this paper is to describe the scientific background to the current ethical and legislative debates about the generation and use of human stem cells, and to give an overview of the ethical issues underlying these debates. The ethical issues discussed are 1) stem cells and the status of the embryo, 2) women as the sources of ova for stem cell production, 3) the use of ova from other species, 4) slippery slopes towards reproductive cloning, 5) the public (...) presentation of stem cell research and 6) the evaluation of scientific uncertainty and its implications for public policy. (shrink)

In her paper ‘Why Not Common Morality?’, Rosamond Rhodes argues that medical ethics cannot and should not be derived from common morality and that medical ethics should instead be conceptualised as professional ethics and the content left to the medical profession to develop and decide.1 I have considerable sympathy with the first claim and have myself argued along somewhat similar lines.2 I am, however, very sceptical about elements of the second claim and will briefly explain why. The first part of (...) Rhodes’s constructive argument is to show that practising medicine is not only a role, it is something more. Medicine is a profession and as such its members have to internalise and personally endorse a specific ethics. Rhodes is careful to state that more work is needed to complete the justification for this claim, but the arguments she does provide are strangely ahistorical. First, it is not that long ago that what we now conceive of as one profession was actually two very strictly separated professions, that is, university educated physicians and apprenticed surgeons. Can we really be certain that medicine is now one, unified profession1? Second the way butchers, bakers and candlestick makers are traduced is also oddly ahistorical. It is only fairly recently in many countries that anyone can butcher meat, bake bread or make candlesticks and legally sell the product to the public. Historically these trades have in Europe not been mere roles, but …. (shrink)

The archive of the Nobel Assembly for Physiology or Medicine in Solna, Sweden, is a remarkable repository that contains reports and dossiers of the Nobel Prize nominations of senior and junior physicians from around the world. Although this archive has begun to be used more by scholars, it has been insufficiently examined by historians of surgery. No other German surgeon was nominated as often as Ferdinand Sauerbruch for the Nobel Prize for Physiology or Medicine in the first half of the (...) 20th century. This contribution reconstructs why and by whom Sauerbruch was nominated, and discusses the Nobel committee evaluations of his work. Political factors did not play an obvious role in the Nobel committee discussions, in spite of the fact that Adolf Hitler in 1937 had prohibited all German citizens to accept the Nobel Prize. The main reasons why Sauerbruch ultimately was not considered prize-worthy were that Sauerbruch’s achievements were marked by scientific priority disputes, and that his work was not seen as original enough. (shrink)

Background There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. Methods To address this question, we study the web-linking patterns of bioethics institutions, (...) the citation patterns of bioethics papers and the buying patterns of bioethics books. Results All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. Conclusion These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects. (shrink)

In their intriguing and closely argued paper Nielsen Busch and Mjaaland argue that the “Dead Donor Rule” (DDR) has been consistently misinterpreted and that it should properly be understood as a ru...

Background Denmark has implemented a comprehensive, nationwide pharmaceutical information system, and this system has been evaluated by the Danish Council of Ethics. The system can be seen as an exemplar of a comprehensive health information system for clinical use. Analysis The paper analyses 1) how informed consent can be implemented in the system and how different implementations create different impacts on autonomy and control of information, and 2) arguments directed towards justifying not seeking informed consent in this context. Results and (...) Conclusion Based on the analysis a heuristic is provided which enables a ranking and estimation of the impact on autonomy and control of information of different options for consent to entry of data into the system and use of data from the system. The danger of routinisation of consent is identified. The Danish pharmaceutical information system raises issues in relation to autonomy and control of information, issues that will also occur in relation to other similar comprehensive health information systems. Some of these issues are well understood and their impact can be judged using the heuristic which is provided. More research is, however needed in relation to routinisation of consent. (shrink)

One of the ways in which public health officials control outbreaks of epidemic disease is by attempting to control the situations in which the infectious agent can spread. This may include isolation of infected persons, quarantine of persons who may be infected and detention of persons who are present in or have entered premises where infected persons are being treated. Most who have analysed such measures think that the restrictions in liberty they entail and the detriments in welfare they impose (...) can be justified and this paper proceeds from the assumption that detention measures are justifiable in some circumstances. Such measures are often implemented without any compensation being given to the persons who are detained. This raises the question: What do we owe to those whose liberty is justifiably restricted (e.g. through isolation, quarantine or detention) as a public health measure during a public health emergency? More specifically, do we owe them compensation for any losses they experience? The paper falls in four main sections. The first section provides examples of the current regulatory state of affairs from the US, Canada and WHO. The second section lays out the liberal, welfarist and pragmatic arguments for providing compensation. The third section discusses the arguments against compensation and the fourth and final section provides the conclusion. It is argued that the arguments for providing compensation clearly outweigh the counterarguments and that the default public policy therefore should be that compensation is provided. (shrink)

Non-compliance is a label often used about patients who do not follow therapeutic advice. This paper analyses the notion of compliance, and tries to show that this notion is inextricably bound to a paternalistic conception of the doctor-patient relationship. It is proposed that we should perhaps not talk so much about the non-compliant patient, but instead shift the focus towards the non-compliant doctor.

Volume 19, Issue 5, May 2019, Page 60-61.