In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall stipulate a definition of (...) care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ‘relational autonomy’ can be applied fruitfully in the practice of psychiatric care. (shrink)

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of ‘globalised’ in the bioethics literature: a focus on global issues; an attempt to develop a universal ethical theory that can transcend (...) cultural differences; an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place. (shrink)

It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker’s expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts (...) or to find work. We show that their narratives of identity, relationship and value differ from the narratives that others use to understand and identify them. Since identities, relationships and values give rise to normative expectations, in both cases there is a conflict between what the women expect of their caregivers and vice-versa. The narratives also show that two similar persons with multiple sclerosis may need very different care. This implies that nurses caring for such persons should listen carefully to their stories and reflect on their own perceptions of self. (shrink)

In the Netherlands there is a growing debate over the possibility of introducting ‘compassionate interference’ as a form of good psychiatric care. Instead of respecting the autonomy of the patient by adopting an attitude of non‐interference, professional carers should take a more active and commited role. There was a great deal of hostile reaction to this suggestion, the most commonly voiced criticism being that it smacked of ‘modern paternalism’. Still, the current conception of care leaves us with a paradox. On (...) the one hand patients are regarded as individuals who have a strong interest in ( and a right to) freedom and non‐interference; on the other hand many of them have a desperate need for flourishing, viable relationships. In fact, part of their problem is that they cannot relate very well with other people. This creates a dichotomy, because respecting patients' autonomy often means that they cannot be given the help they so desperately need. In this respect current care practices do not answer the caring needs of these patients.The criticism on care practices is to be considerd as important. It invites us to reexamine and reevaluate the current conception of caring relationships and its main values. In line with this reexamination an alternative perspective on care is introduced in this paper, a perspective in which `compassionate interference' is not so much a threat to autonomy, but a means of attaining autonomy. For this we need a different definition of autonomy than that commonly used in current care practice. (shrink)

Clinical ethicists tend to see themselves as moral experts to be called in when clinicians encounter a particularly difficult moral problem. Drawing on a naturalized moral epistemology, we argue that clinicians already have the moral knowledge they need—the norms and values that guide clinical practice are built right into the various health care professions. To reflect on their practice, clinicians need to (a) be aware of their own professional norms and values; (b) be able to express them to their colleagues, (...) their patients, and the patients' families; and (c) work together with these other actors to provide ethically responsible care. The ethicist's job is to use her own training in three kinds of philosophical reflection as the basis for teaching clinicians how to think about what they do. (shrink)

There are no moral cookbooks—no algorithms for whipping up moral confections to suit every occasion. But more modest and flexible tools might still be useful for practical ethics. One team describes how professionals can be taught to use a framework for understanding moral problems.

Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)

Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...) healthcare organisations throughout the Netherlands were included. After completion of the programme, participants feel sufficiently confident and equipped to facilitate an MCD session. Feeling competent does not mean that participants have no doubts or questions left. Rather, they are aware of their limitations and see the need for continuous learning. According to the respondents, the actual exercise of facilitating MCD during and in between the training sessions contributed most to the development of competences necessary for being an MCD facilitator. Respondents without prior experience of participating in MCD sessions felt less competent after the training than those who had participated in MCD sessions before. Self-attributed competence varied between participants with different professional backgrounds. (shrink)

Several criticisms of the Groningen Protocol rest on misunderstandings about how it works or which babies it concerns. Some other objections—about quality‐of‐life judgments and parents' role in making decisions about their children—cannot be easily cleared away, but at least in the context of Dutch culture and medicine, the protocol is acceptable.

Since Carol Gilligan's In a Different Voice (1982) the ethics of care has developed as a movement of allied thinkers, in different continents, who have a shared concern and who reflect on similar topics. This shared concern is that care can only be revalued and take its societal place if existing asymmetrical power relations are unveiled, and if the dignity of care givers and care receivers is better guaranteed, socially, politically and personally. In this first volume of a new series (...) leading care ethicists from Europe and the United States focus on the moral significance of two concepts in the debate that ask for further reflection. In discussion with the work of Axel Honneth on recognition and the work of Emmanuel Housset on compassion a contribution is made to a reconsideration of recognition and compassion from an ethics of care perspective. This volume contains contributions by Andries Baart, Estelle Ferrarese, Chris Gastmans, Mieke Grypdonck, Emmanuel Housset, Carlo Leget, Hilde Lindemann, Axel Liegeois, Christa Schnabl, Joan C. Tronto, Annelies van Heijst, Linus Vanlaere, Frans Vosman and Margaret Urban Walker. (shrink)

This paper contributes to the growing line of thought in bioethics that respect for autonomy should not be equated to the facilitation of individualistic self determination through standard requirements of informed consent in all healthcare contexts. The paper describes how in the context of donation for living related liver transplantation (LRLT) meaningful, responsible decision making is often embedded within family processes and its negotiation. We suggest that good donor risk communication in families promote “conscientious autonomy” and “reflective trust”. From this, (...) the paper offers the suggestion that transplant teams and other relevant professionals have to broaden their role and responsibility for risk communication beyond proper disclosure by addressing the impact of varied psychosocial conditions on risk interpretation and assessment for potential donors and family stakeholders. In conclusion, we suggest further research questions on how professional responsibility and role-taking in risk communication should be morally understood. (shrink)

ABSTRACT This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person’s well‐being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical (...) perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family‐member is put under pressure and changes during her loved one’s illness that leads to difficulties and misunderstandings concerning the issue of responsibility. These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they, at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are. (shrink)

In this article, I bring together the archive of institutional activism of Niara Sudarkasa in the U.S. and the posthumous impact of activist and public administrator Marielle Franco. The 1970s historical sources show Sudarkasa’s institutional solidarity with students and faculty in the creation of one of the first Africana Studies departments in the U.S. Reading them, I articulate an ethos for the curation ‘715 Haven Street: Art Looks Back,’ a public digital art gallery comprised of art and history found in (...) the DAAS Papers (Department of Afroamerican and African Studies) housed in the Bentley Library’s digital and physical archives. The analysis of the primary sources is guided by an engagement with the ‘Marielle Effect,’ generating a historical parameter for Abolitionist solidarity between American, Brazilian, Latin American, African American, Diasporic, and ally scholarly communities. The discussion of these parameters is embedded in my discussion of the concept of pacification, a phenomenon of colonial and post-colonial policing that survives through the perpetuation of an extra-judicial policing impetus articulated along race, identity, legality, and sexual legitimacy of subjects. (shrink)

Various types of continuity for preference relations on a metric space are examined constructively. In particular, necessary and sufficient conditions are given for an order-dense, strongly extensional preference relation on a complete metric space to be continuous. It is also shown, in the spirit of constructive reverse mathematics, that the continuity of sequentially continuous, order-dense preference relations on complete, separable metric spaces is connected to Ishihara's principleBD-ℕ, and therefore is not provable within Bishop-style constructive mathematics alone.

There are several recent and noteworthy studies on the testimonies and fragments of Melissos of Samos: Laks-Most, Brémond. Furthermore, one can learn a great deal about Melissos from the lectures and discussions undertaken in the framework of “Eleatica 2012”. When taken together, these studies enable us to fully appreciate Melissos’ original work in terms of its sources, its audacious arguments and its later criticisms. Melissos is here presented as a spokesman of the Eleatic school in an order that aims to (...) do justice to the ancient testimonies that relate and refute his arguments as well as to the verbatim fragments. For the sake of clarity, however, various secondary testimonies have been omitted. (shrink)

Several criticisms of the Groningen Protocol rest on misunderstandings about how it works or which babies it concerns. Some other objections—about quality‐of‐life judgments and parents' role in making decisions about their children—cannot be easily cleared away, but at least in the context of Dutch culture and medicine, the protocol is acceptable.

Cis‐regulatory elements govern gene expression programs to determine cell identity during development. Recently, the possibility that multiple enhancers are orchestrated in clusters of enhancers has been suggested. How these elements are arranged in the 3D space to control the activation of a specific promoter remains unclear. Our recent work revealed that the TGFβ pathway drives the assembly of enhancer clusters and precise gene activation during neurogenesis. We discovered that the TGFβ pathway coactivator JMJD3 was essential in maintaining these structures in (...) the 3D space. To do that, JMJD3 required an intrinsically disordered region involved in forming phase‐separated biomolecular condensates found in the enhancer clusters. Our data support the existence of a relationship between 3D‐conformation of the chromatin, biomolecular condensates, and TGFβ‐driven response during mammalian neurogenesis. In this review, we discuss how signaling (TGFβ), epigenetics (JMJD3), and biochemical properties (biomolecular condensates nucleation) are coordinated to modulate the genome structure to guarantee proper neural development. Moreover, we comment on the potential underlying mechanisms and implications of the enhancer‐mediated regulation. Finally, we point out the knowledge gaps that still need to be addressed. (shrink)

Borrett, Kelly and Kwan [ Phenomenology, dynamical neural networks and brain function, Philosophical Psychology, 13, 000-000] claim that unbiased, self-evident, direct description is possible, and may supply the data that brain theories account for. Merleau-Ponty's [ Phenomenology of perception, London: Routledge] description of Schneider's apraxia is offered as a case in point. According to the authors, Schneider's apraxia justifies brain components of predicative and pre-predicative experience. The description derives from a bias, however, that parallels modularity's morphological reduction. The presence of (...) biasing presuppositions contradicts the goal of direct description. Moreover, the authors' brain account is not necessary to explain Schneider's apraxia, and morphological reduction is not sufficient to explain emergent phenomena of motor control. (shrink)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

MacIntyre is a major defender of the resurgence of the Aristotelian approach in ethical and political theory. He considers Aristotelianism not only a feasible, but also an intellectually superior alternative to most contemporary dominant ideologies, and to liberalism in particular. There is, however, an important and instructive modification to his view of what is admissible from Aristotle that should be accounted for. The paper traces MacIntyre’s search for a defensible restatement of the Aristotelian ethics and examines in particular his changing (...) attitude to metaphysics as the basis for ethics within his project. Different stages of the development to his proposed Aristotelian alternative are analyzed and evaluated. The paper tries to show that despite the fact that MacIntyre initially repudiated Aristotle’s metaphysical biology, nevertheless his account has always been (implicitly or explicitly) metaphysical. (shrink)

What is animal welfare? Why has it proved so difficult to find a definition that everyone can agree on? This concise and accessible guide is for anyone who is interested in animals and who has wondered how we can assess their welfare scientifically. It defines animal welfare as 'health and animals having what they want', a definition that can be easily understood by scientists and non-scientists alike, expresses in simple words what underlies many existing definitions, and shows what evidence we (...) need to collect to improve animal welfare in practice. Above all, it puts the animal's own point of view at the heart of an assessment of its welfare. But, can we really understand what animals want? A consistent theme running through the book is that not only is it possible to establish what animals want, but that this information is vital in helping us to make sense of the long and often confusing list of welfare measures that are now in use such as 'stress' and 'feel good hormones', expressive sounds and gestures, natural behaviour, cognitive bias, and stereotypies. Defining welfare as 'health and what animals want' allows us to distinguish between measures that are simply what an animal does when it is alert, aroused, or active and those measures that genuinely allow us to distinguish between situations the animals themselves see as positive or negative. Sentience (conscious feelings of pleasure, pain, and suffering) is for many people the essence of what is meant by welfare, but studying consciousness is notoriously difficult, particularly in non-human species. These difficulties are discussed in the context of our current - and as yet incomplete - knowledge of human and animal consciousness. Finally, the book highlights some key ideas in the relationship between animal welfare science and animal ethics and shows how closely the well-being of humans is linked to that of other animals. The Science of Animal Welfare is an ideal companion for undergraduate and graduate students taking courses in animal behaviour and welfare, as well as for professional researchers, practitioners and animal welfare consultants. At the same time, it is easily understandable to non-scientists and anyone without prior knowledge but with an interest in animals and the rapidly evolving science of animal welfare. (shrink)

This paper draws on the economics of ethical compliance model to examine the association between ethical reasoning, perceived risk of detection, perceived levels of penalties and Chinese auditors'' ethical behavior in an audit conflict situation. Using 53 Chinese auditors from Shenzen as subjects, and a survey questionnaire, this study found that there is a significant negative association between ethical reasoning and the likelihood of unethical behavior and that this negative association is weaker for auditors who perceive higher risks of detection.

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Gdy kartkuje się tę książkę, to od razu rzuca się w oczy mieszanie treści biblijnych z szeregiem pojęć matematycznej i fizycznej natury. Gdy zaś próbuje się ją podczytywać, wtedy z kolei natrafia się na język filozoficzny. Mamy łączenie radykalnie odmiennych porządków sensu. Z jednej strony staje filozoficzna interpretacja pierwszych dziesięciu zdań Biblii, z drugiej szczególny opis kilku obiektów matematycznych i fizycznych. Pierwszym wrażeniem jest doznanie nieprzystawalności. Co jedno może mieć wspólnego z drugim? Oryginalność zestawienia jest uzasadniona celem prezentowanych rozważań. Najogólniej, (...) chodzi tu o możliwie odpowiedzialną, metodycznie kontrolowaną, racjonalną próbę interpretacji początku Biblii za pomocą pojęć filozoficznych, a następnie o odświeżenie wybranych symboli z początku Genesis za pomocą zmetaforyzowanych pojęć matematycznych i fizycznych. (shrink)

In 1976, I met John Bell several times in CERN and we talked about a possible violation of optical theorem, purity tests, EPR paradox, Bell’s inequalities and their violation. In this review, I resume our discussions, and explain how they were related to my earlier research. I also reproduce handwritten notes, which I gave to Bell during our first meeting and a handwritten letter he sent to me in 1982. We have never met again, but I have continued to discuss (...) BI-CHSH inequalities and their violation in several papers. The research stimulated by Bell’s papers and experiments performed to check his inequalities led to several important applications of quantum entanglement in quantum information and quantum technologies. Unfortunately, it led also to extraordinary metaphysical claims and speculations which in our opinion John Bell would not endorse today. BI-CHSH inequalities are violated in physics and in cognitive science, but it neither proved the completeness of quantum mechanics nor its nonlocality. Quantum computing advantage is not due to some magical instantaneous influences between distant physical systems. Therefore one has to be _cautious in drawing-far-reaching philosophical conclusions from Bell’s inequalities_. The true resource for quantum computing is contextuality and not nonlocality. (shrink)