The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance (...) cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die. (shrink)

Mnoge biološke funkcije dopuštaju stupnjevanje. Na primjer, lučenje određenog hormona u organizmu može biti na višoj ili nižoj razini, u usporedbi s istim organizmom drugom prilikom ili u usporedbi s drugim organizmima. Koje razine funkcioniranja predstavljaju slučajeve disfunkcije; gdje da povučemo crtu? To je kvantitativni problem za teorije disfunkcije i bolesti. Cilj mi je braniti verziju bioloških teorija disfunkcije kako bih se uhvatio u koštac s ovim problemom. Međutim, također ću dopustiti da evaluativna razmatranja uđu u teoriju bolesti. Moj argument (...) se temelji na razlikovanju između biološke i kliničke perspektive. Prema mom mišljenju, bolest je ograničena na slučajeve koji spadaju u granice bioloških disfunkcija. Odgovor na kvantitativni problem ne zahtijeva proizvoljne odluke ili društveno vrijednosne sudove. Stoga se zalažem za nearbitrarnu metodu koja se temelji na činjenicama kako bi se riješio kvantitativni problem. Ipak, nisu sve biološke disfunkcije instance bolesti. Dodavanje kliničke perspektive omogućuje nam da spriječimo potencijalnu preveliku uključenost biološke perspektive, zato što postavlja dodatna ograničenja za određivanje granica bolesti. (shrink)

In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational (...) alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I conclude that Rawlsian Justice as Fairness is bad for the environment. (shrink)

Mit dem Ausdruck ‚sympathy‘ bezeichnet Mill die menschliche Fähigkeit, zu fühlen, was andere fühlen; oder allgemeiner, Zugang zum subjektiven Erleben Anderer zu erlangen. Sowohl Einfühlung als auch Mitfühlen sind in dieser Idee integriert. Für Mill ist ‚sympathy‘ eine wesentliche Voraussetzung der menschlichen Moralität. Allerdings gilt es, ‚sympathy‘ zur Fähigkeit auszubilden, genuin moralische Empfindungen zu zeigen. Erst dann sind stabile Moraldispositionen zu erwarten und damit letztlich die Realisierbarkeit des utilitaristischen Moralprinzips ermöglicht.

Individualität stellt für Mill eine Quelle und gleichzeitig ein Ziel individuellen und gesellschaftlichen Fortschritts dar. Individualität ist ein Element des Wohlergehens, wie die Überschrift des dritten Kapitels seiner Freiheitsschrift festhält. Individualität ist somit ein vorrangiges Ziel der Erziehung, Bildung und guten Regierung. Zudem kann Individualität, ausgedrückt in verschiedensten Lebensexperimenten, die Entwicklung einer Gesellschaft voranbringen. Es sollte insofern nicht überraschen, dass Individualität ein zentrales Konzept des Mill’schen. Denkens darstellt. Schließlich war sein Denken insgesamt auf die Verbesserung der Menschheit und der Lebensverhältnisse (...) gerichtet. (shrink)

Wilhelm von HumboldtHumboldt, Wilhelm von war ein berühmter preußischer Gelehrter und Bildungsreformer. Sein posthum veröffentlichtes Werk Ideen zu einem Entwurf, die Grenzen der Wirksamkeit des Staates zu beschränken wird in Mills Schrift On Liberty und in seiner Autobiography mehrfach zustimmend erwähnt und zitiert. Selbst das Epigraph, welches Mill als Motto seiner Freiheitsschrift voranstellt, stammt von Humboldt: „The grand, leading principle, towards which every argument unfolded in these pages directly converges, is the absolute and essential importance of human development in its (...) richest diversity“ (CW XVIII, 215). (shrink)

Decision-making capacity or mental competence is one of the most intensively discussed concepts in contemporary bioethics and medical ethics. In this paper I argue that anorexia nervosa, an eating disorder primarily afflicting adolescent girls and young women, seriously challenges what I label the traditional account of decision-making capacity. In light of these results, it may in addition be necessary to rethink a certain popular type of paternalistic argumentation that grounds the justification of compulsory treatment, for example of anorexic persons who (...) refuse treatment, on a lack of decision-making capacity. (shrink)

Der Begriff der Behinderung ist komplex. Er kann in einer medizinischen Perspektive als Schädigung, also als eine dauerhafte Störung der Funktionsfähigkeit des Organismus, verstanden werden; oder er kann als Einschränkung der Handlungsfähigkeit einer Person interpretiert werden, wobei in der rechtlichen Verankerung meist speziell auf die Minderung der Erwerbsfähigkeit und die eingeschränkte Teilhabe am gesellschaftlichen Leben abgehoben wird.

The predicate “natural” is often used in a normative fashion, especially in Bioethics. But that something is natural does not alone suffice to explain its value. In this essay, I want to fulfil mainly two tasks: Firstly, to differentiate between several usages of the concept of naturalness and scrutinize whether they may serve a function in ethics; secondly, to argue for the (eudaimonistic, not moral) value of naturalness in certain respects. The value of the natural lies firstly in its significance (...) for human wellbeing: specific natural functions form necessary elements and conditions of the ability to lead a good life. Secondly, the very feature of the natural, its being purposeless, which implies that we cannot read our aims out of nature, serves as the basis of its eudaimonistic value. (shrink)

In this paper, I will focus on the role that findings of the empirical sciences might play in justifying normative claims in political philosophy. In the first section, I will describe how political theory has become a discipline divorced from empirical sciences, against a strong current in post-war political philosophy. I then argue that Rawls’s idea of reflective equilibrium, rightly interpreted, leads to a perspective on the matter of justification that takes seriously empirical findings regarding currently held normative beliefs of (...) people. I will finally outline some functions that empirical studies might have in political philosophy. (shrink)

TugendethikenTugend, Tugendethik sind normative Theorien des richtigen und guten Handelns, die den zentralen Gesichtspunkt der ethischen Bewertung in der handelnden Person, genauer in ihrer charakterlichen und motivationalen Verfassung sehen. Eine Tugend ist eine charakterlich gefestigte Haltung von Menschen, die sie das Richtige und Gute aus eigener Überzeugung erkennen und erstreben lässt. Als Tugenden gelten dabei nicht nur die im engen Sinne moralischen Tugenden wie Gerechtigkeit oder Aufrichtigkeit,WahrhaftigkeitAufrichtigkeitAufrichtigkeit, sondern sie umfassen beispielsweise auch selbstbezogene und intellektuelle Vortrefflichkeiten wie Besonnenheit oder WeisheitWeisheit, die (...) beide lange Zeit zu den Kardinaltugenden gehörten. (shrink)

Alternative approaches in the discussion of distributive justice differ in their answers to the question „equality of what“? In this essay I intend to ask instead,why equality?" The article rejects several arguments in favour of distributive equality, mainly on the grounds that they confuse two different kinds of justice, namely,formal’ justice (equal respect) and distributive justice. The ideal of distributive equality is based on comparisons but equal respect does not necessarily involve relational considerations. Subsequently I will consider equality of opportunity (...) which appears on first sight to be the most promising account. However, I will point out that this approach is not convincing as an attempt to give everyone the chance to live a good life. Finally I will submit that only a theory of absolute needs is adequate. (shrink)

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. -/- The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the (...) lack of empathy, as some philosophers have proposed—but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. -/- As this volume demonstrates, philosophers will be better equipped to determine what they mean by “the moral point of view” when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy. (shrink)

What is the basis of our capacity to act morally? This is a question that has been discussed for millennia, with philosophical debate typically distinguishing two sources of morality: reason and sentiment. This collection aims to shed light on whether the human capacity to feel for others really is central for morality and, if so, in what way. To tackle these questions, the authors discuss how fellow feeling is to be understood: its structure, content and empirical conditions. Also discussed are (...) the exact roles that relevant psychological features - specifically: empathy, sympathy and concern - may play within morality. The collection is unique in bringing together the key participants in the various discussions of the relation of fellow feeling to moral norms, moral concepts and moral agency. By integrating conceptually sophisticated and empirically informed perspectives, Forms of Fellow Feeling will appeal to readers from philosophy, psychology, sociology and cultural studies. (shrink)

It is held that absolute poverty causes approximately one third of all human deaths, some 18 million annually, and blights billions of lives with hunger and disease. This book develops universalizable norms aimed at tackling absolute poverty and the complex and multilayered problems associated with it.

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not defined as absence of disease (...) but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

Moral Theory and Theorizing in Healthcare Ethics Content Type Journal Article Category Editorial Pages 365-368 DOI 10.1007/s10677-011-9291-x Authors Mike McNamee, College of Human and Health Sciences, Swansea, SA28PP UK Thomas Schramme, Universität Hamburg, Philosophisches Seminar, Von-Melle-Park 6, 20146 Hamburg, Germany Journal Ethical Theory and Moral Practice Online ISSN 1572-8447 Print ISSN 1386-2820 Journal Volume Volume 14 Journal Issue Volume 14, Number 4.

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves (...) the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation. (shrink)

In 2012, the symposium "Christopher Boorse and the Philosophy of Medicine" was held at the University of Hamburg. The initial ideas presented at this event, which celebrated Chris's contribution to the development of what is now a vibrant area of research, especially to the theory of disease, form the core of the papers published in this issue. Similarly to what Robert Nozick once said about John Rawls's work, it can be demanded that philosophers of medicine must now either work within (...) Boorse's theory or explain why not. It is simply the main contender in the so-called naturalist camp of contributions to the theory of disease. All of the papers in this issue address his approach in some respect, and all of them are friendly toward his theory up to a point. In this brief introduction, I try to extract common threads. In doing so, I focus on three issues that have the capacity to determine future debates. The first is the methodology of developing a theory of disease, especially what conceptual analysis amounts to and what it may achieve. The second is the issue of value-ladenness of the concepts of health and disease, a topic that has been at the forefront of the philosophical debate, but which -- to my mind -- has often been misunderstood. The third issue is the problem of the unity of medical terminology. We can ask whether there is only one core medical concept, be it "disease," "pathology," "disorder," "malady," or something else. Alternatively, we might propose different concepts for different purposes. (shrink)

ABSTRACT In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of (...) duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure (...) of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard. (shrink)

The chapter starts from a specific interpretation of what it means to know the difference between right and wrong, which stems from Gilbert Ryle. To know the difference between right and wrong implies caring about morality. The author links Ryle’s ideas to the notion of being a moral person. Two different ideas found in moral philosophy are delineated, namely, the amoral person, that is, someone who rejects the demands of morality, and the morally incapacitated person, that is, someone who cannot (...) take those demands into account. Psychopaths are not amoral in the philosophers’ sense of the word, but are incapable of, or seriously deficient in, taking the moral point of view. (shrink)

This chapter introduces the main findings of the medical research on psychopathy as well as the most significant threads of the philosophical debates surrounding psychopathy. It also introduces the articles collected in this volume. The introduction focuses on issues in moral psychology and metaethics, such as moral motivation, moral responsibility, and moral understanding. It shows the difficulty in conceptualising psychopathy and in using psychopathy as a test case for philosophical theories.

In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties (...) to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

Ideal for students in the philosophy of medicine, healthcare and public health, this book offers an introduction to the philosophical debates around health justice. It presents clear conceptual definitions of health, disease and illness and the various theories of justice, developing a specific normative argument in the debate on health justice.

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, (...) the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)

Journal of Social Philosophy, EarlyView.

Does the reference to a mental realm in using the notion of mental disorder lead to a dilemma that consists in either implying a Cartesian account of the mind-body relation or in the need to give up a notion of mental disorder in its own right? Many psychiatrists seem to believe that denying substance dualism requires a purely neurophysiological stance for explaining mental disorder. However, this conviction is based on a limited awareness of the philosophical debate on the mind-body problem. (...) This article discusses the reasonableness of the concept of mental disorder in relation to reductionist and eliminativist strategies in the philosophy of mind. It is concluded that we need a psychological level of explanation that cannot be reduced to neurophysiological findings in order to make sense of mental disorder. (shrink)

Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention of disease. I point out epistemic and moral problems with these types of nudges, which lead to my conclusion that health-enhancing nudges fail. They fail because we cannot know which choices enhance individual health—properly understood in a holistic way—and because health-enhancing nudges (...) are often themselves bad for our health. They can be bad for our health because they assume inferior agency in their targets and accordingly regularly lead to appropriate resentment and anger—strong emotions which go along with an increased risk of health impairments. Briefly, health-enhancing nudges fail because they are based on persistent ignorance and on a presumptuous attitude. (shrink)

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion (...) of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims. (shrink)