BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...) arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

Bernadette M Tobin; Richard Peters's Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 1, 30 May 2006, Pages 15–27, https://doi.

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

Bernadette M Tobin; Richard Peters's Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 1, 30 May 2006, Pages 15–27, https://doi.

It is in its Consequentialist mood that Australian philosophizing most clearly displays the 'no-nonsense' quality that we are tempted to think of as a national virtue: I hope this volume goes some way to showing the dangers of our being tempted by such flattering but ultimately shallow (and indeed morally coarse) national myths.

Two years ago, a group of philosophers and bioethicists published what they called a 'Consensus Statement on Conscientious Objection in Healthcare'. The statement, called the Brocher Statement because the group met at a foundation of that name in Geneva, sets out ten points that should 'inform, at the level of legislations and institutional policies, the way that conscientious objections in healthcare is regulated'. The statement proposes a very low threshold for compelling the performance of a practice in violation of conscience, (...) whether of an individual or of an institution, in healthcare. In so doing, it reflects the position advanced ten years earlier by the influential Australian philosopher, Julian Savulescu. Himself one of the group who proposed this 'Consensus Statement', Savulescu had claimed that '[a] doctor's conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient's good and the patient's informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors'. Such a policy would, I submit, fail to accommodate the legitimate scope for conscientious decision-making, which is at the heart of medical professionalism. (shrink)

The success of assisted reproductive technologies (ARTs) worldwide has led to an accumulation of frozen embryos that are surplus to the reproductive needs of those for whom they were created. In these situations, couples must decide whether to discard them or donate them for scientific research or for use by other infertile couples. While legislation and regulation may limit the decisions that couples make, their decisions are often shaped by their religious beliefs. Unfortunately, health professionals, scientists and policy-makers are often (...) unaware of the way in which faith traditions view ART and decisions concerning the ‘fate’ of surplus embryos. In this paper scholars representing six major religious traditions provide a commentary on a hypothetical case concerning the donation or destruction of excess ART embryos. These commentaries provide a rich account of religious perspectives on the status of the human embryo and an insight into the relevance of faith to health and policy decisions, particularly in reproductive medicine, ART and embryo research. (shrink)

„On 23rd February 2022, when the editors had worked out topical issues of dispute relating to politics, ethics, technology and religion for a Hans Jonas Centre conference on responsibility for the future and discourse ethics, it was suddenly foreseeable that Russia would invade the core area of Ukraine the next night. We immediately informed our Ukrainian colleagues that we would allow them asylum, if desired, and invite them to the conference in Bad Kissingen as keynote speakers. In no time at (...) all, the new programme for the confer-ence was ready: After commemorating Hans Jonas' honorary doctorate in Berlin under the motto ‘Fatalism would be a mortal sin’ exactly 30 years ago, we now focus on ‘Discourse despite war’. After that, we discuss digitalisation as well as theology, philosophy and commitment". With contributions by Prof. Dr. Claus Altmayer; Harald Asel, M.A.; Dorothee Bär, MdB; Dr. Thomas Bausch; Prof. Dr. Dietrich Böhler; Prof. Dr. Michael Bongardt; Wolfgang Freese; Bernadette Herrmann, M.A.; Sebastian Höpfl; Bischof em. Prof. Dr. Dr. h.c. mult. Wolfgang Huber; Dr. Grigori Katsakoulis; Pfarrer Wolfgang Klein; Wolfgang Korb; Dr. Lena Kornyeyeva; Prof. Dr. Dr. h.c. Klaus Leisinger; Prof. Dr. Dr. h.c. Hans Lenk; Prof. Dr. Ulf Liedke; Prof. Dr. Alfons Matheis; Dr. Olaf Meyer; Dr. Jürgen Naeher-Zeiffer; Stephanie von Dallwitz; Dr. Marianne Rabe; Dr. Manuela Rottmann, MdB; PD Dr. Dr. Thomas Rusche; Prof. Dr. Johann Michael Schmidt; Dr. Eva-Maria Schwickert; Maritta Strasser, M.A.; OB Dr. Dirk Vogel and Prof. Dr. Anatoliy Yermolenko. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

Even though sign-systems are a crucial part of society, critical realism, as developed by Roy Bhaskar, does not yet have an adequate theory of signs and semiosis. The few suggestions that Bhaskar offers can be advanced through the semiotics of C.S. Peirce. In doing so, however, it becomes necessary to reconsider Bhaskar's ontological domains of the real, the actual, and the subjective, and expand the last domain into one of semiosis. This new understanding of ontological domains, incorporating Peirceian semiotics, provides (...) the basis for rethinking the ontology of society: the customary dyad structures/agents becomes the triad structures/agents/discourses, each of which possesses material, sociological, and meaningful aspects. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

The 21st century is steeped in claims to interconnection, technological innovation, and new affective intensities amid challenges to the primacy and centrality of 'the human'. Flashpoint epistemology attends to the lived difficulties that arise in teaching, policymaking, curriculum and research among continuous practices of differentiation, and for which there is no pre-existing template for judgment, resolution or action. Flashpoint Epistemology Volume 1 examines contemporary collisions and reworkings of cultural-political issues in education through arts and humanities-based approaches. How and whether lines (...) are (re)drawn in educational practice - and via who-what - between justice, morality, religion, ethics, subjectivities, intersectionality, the sublime and the senses are a particular focus. The volume offers innovative relational approaches and new narrativization strategies, examining the aporia experienced when operating in educational domains of inevitable, recurring, difficult, fortuitous and/or unforeseen flashpoints. The chapters will engage researchers seeking new approaches to education's complexities, nested discourses, and ever-moving horizons of enactment. It will also benefit post/graduate students and teachers whose work intersects with sociological, philosophical and cultural studies and who are curious about claims to interconnection, the ethical quandaries embedded in practice, and the affordances and limits of technological innovation. (shrink)

Zusammenfassung In diesem Aufsatz wird erstens der Frage nach den gesellschaftlichen Umgangsweisen von europäischen Gesellschaften der Neuzeit mit religiös gerahmter, weiblicher Nahrungsabstinenz nachgegangen. Zweitens werden Überlegungen dahingehend angestellt, welche Bedingungen und Faktoren für die Persistenz dieser relativ marginalisierten Praxis im untersuchten Zeitraum ausgemacht werden können. Dabei wird in der Argumentation für einen wissensgeschichtlichen Ansatz plädiert. Mit diesem Instrumentarium können u. a. auch hybride Erklärungsweisen der historischen Akteure rekonstruiert werden, die nicht einfach den Kategorien „natürlich“ bzw. „übernatürlich“ zugeordnet werden können. Der (...) Gegenstand der Fallstudie sind nahrungsabstinente Katholikinnen Westeuropas im Zeitraum von 1780 bis 1980. Nahrungsabstinenz hat dabei auf der objektsprachlichen Ebene sowohl die Bedeutung von Nicht-essen können oder wollen bis hin zur völligen Abwesenheit des Bedürfnisses nach „irdischer“ Nahrung. (shrink)

An innovative approach to rethinking sciences of mind at the turn of the twenty-first century via the texts of philosopher and psychologist William James.

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

Most work on reflexivity has focused on individuals exercising their reflexivity through discourse. However, agents have three major aspects (intentionality, causal efficacy and embodiment) and they are fundamentally social. This article examines the possibility of collective reflexivity conducted not just by saying, but also by doing—that is, through their embodiment. By expanding the concept of ‘performatives’ to encompass not just speech acts but also acts that speak (i.e. embodied activities as socially meaningful) and applying the work of Charles S. Peirce (...) in order to develop an ontology of embodied reflexivity, it becomes possible to determine several criteria defining embodied collective reflexivity. Assessing possibilities such as legislative debate, political demonstrations, religious ritual and dramatic performance reveals that a certain set of practices does in fact meet those criteria and discloses additional aspects of what constitutes embodied collective reflexivity. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

Medical Officers serving with their national contingents in peacekeeping operations are faced with difficult ethical decisions in regard to their obligations to the local civilian population. Such populations may be under-resourced in regard to medical care, and vulnerable to abuse and exploitation. Though the medical officer may support the local medical services, he/she should never undermine these resources. Adopting a human rights approach and observing the requirements of ethical medicine, aids the doctor in prioritising his/her duties. At times there may (...) be conflict with one’s own military superiors. It is wise to discuss potential difficulties prior to setting out on the mission. Human rights abuses cannot be ignored. The medical officer has a duty to do his/her best to report their observations so as to prevent abuse or to bring it to an end. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 347-350 [Access article in PDF] Book Review The Sin of Knowledge: Ancient Themes and Modern Variations, The Sin of Knowledge: Ancient Themes and Modern Variations, by Theodore Ziolkowski; xvi & 222 pp. Princeton: Princeton University Press, $29.95. After thirty-five years of teaching and administrating at Princeton University, dozens of books, and innumerable articles, the eminent Germanist Theodore Ziolkowski has turned his attention to a (...) theme appropriate for someone so immersed in the intellectual life: the sorrow and grief that accompany human knowledge. Although Ziolkowski has made great contributions in standard studies of genre (notably the elegy and the twentieth-century novel) and authors (Mann, Hesse, and Broch), he became especially well known for his theorization and implementation of thematic studies, ranging from the sublime--fictionalizations of the life of Jesus--to the humorous--talking animals in literature. The figures whom Ziolkowski has selected for analysis of the sin of knowledge are Adam, Prometheus, and Faust, each of whom he views through both an ancient and a modern lens.All three of these mythic heroes violate "divine prohibitions against the new knowledge" (p. 69). Less heroically, all of these myths treat women misogynistically. Generally, Ziolkowski sees each of these stories as having emerged in a time of crisis, when new opportunities presented humanity with knowledge both alluring and disruptive. Because these are highly elastic myths, able to provide meaning in a variety of contexts, they have all mutated in modern times. Adam's Fall comes to represent the human transition from innocence to consciousness, Prometheus becomes a symbol for socialism's promise, and Faust turns into a representative of the American way of life.Looking at the ancient legend of Adam, Ziolkowski notes that sexuality and wisdom are linked in many of the oldest texts in humanity's recorded history. The emphasis on knowledge, however, is especially strong in the Hebrew myth. While many Near Eastern traditions have stories with similarities to the Biblical account of Adam and Eve, only Hebrew mythology has the Tree of Knowledge. For Ziolkowski, the fact that this story was probably set down during the reign of King Solomon explains this emphasis on knowledge. Because the Age of Solomon was a time of unparalleled wealth and power for the Hebrews, [End Page 347] Ziolkowski argues that the tale of Adam and Eve is the kind of myth "produced by cultures that have reached a certain level of sophistication... and look back with a degree of nostalgia at an imagined simpler, happier existence" (p. 23). According to Ziolkowski, knowledge becomes a sin for the Hebrews as they come to terms with the limitations of everything that their knowledge has brought them even at the height of their power and glory.In the modern era, Ziolkowski continues, the story of Adam has become secularized, representing the transition of humanity from a state of innocence to one of consciousness. He finds references to the Fall in Voltaire's Candide, Kleist's The Broken Pitcher, E. T. A. Hoffmann's The Golden Pot, Melville's Billy Budd, and Hesse's Demian. The overall trend of these representations of the rise of consciousness has been increasingly negative, culminating in sentiments like those expressed by the East German author Günter Kunter, who argues that "our whole present misery and all the problems of industrial civilization" can be linked to "the moment when man used the first firestone as a tool, the Fall" (p. 107). As Ziolkowski concludes: "Two centuries of secularization have brought the modern Adam to a depressing end" (p. 108).Citing Nietzsche, who compared Prometheus to Adam (and Pandora to Eve), Ziolkowski looks first at Hesiod's depiction of Prometheus as a trickster and then to Aeschylus' hero. Unlike the authors of the story of Adam and Eve, though, Aeschylus depicts Prometheus' claim to divine knowledge in a positive light: "Rather than a humankind declining from a glorious golden age to the present deplorable iron age, Aeschylus sees humanity progressing by means of knowledge--the crafts, arts, and sciences--from blindness and ignorance... (shrink)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (shrink)

From oral culture, through the advent of literacy, to the introduction of printing, to the development of electronic media, communication structures have radically altered culture in profound ways. As the first book to take a critical realist approach to culture, Theatre, Communication, Critical Realism examines theatre and its history through the interaction of society’s structures, agents, and discourses. Tobin Nellhaus shows that communication structure—a culture’s use and development of speech, handwriting, printing, and electronics—explains much about why, when, and how (...) theatre has transformed. (shrink)