Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or is it a (...) matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest (...) standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children. (shrink)

This work clarifies the role of the best interest standard (BIS) as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, (...) not taking the family into account and not suitable as limiting principle. This work responds to these criticisms, showing that they do not stand up to scrutiny. They either do not apply to the BIS, only apply to misuses of the BIS or criticise a BIS that is not seriously defended in the literature. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of (...) defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are: (1) The obligation to protect patients against COVID-19 spread; (2) The obligation to maintain professional competence and remain available for patients; (3) Clinicians’ role and place in society in relation to COVID-19; (4) The obligation to encourage societal vaccination uptake. These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a (...) duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional’s ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians. (shrink)

The interests of a patient are not only related to objective ideas about health, but are also determined by the patient’s own view of the good. To act in the best interests of a patient requires co...

Carson and Flood (2017) present an interesting argument regarding a duty to vaccinate as a social obligation. Their argument is based on Catholic social teaching, and particularly on the moral prec...

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

While the best interest standard (BIS) enjoys wide endorsement as the ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In (...) response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS. Among other things I argue: (1) The BIS provides more robust protections for the moral claims of children. (2) The CPA model and the HP do not resolve the indeterminacy and vagueness present in complex medical situations, and the BIS is better suited to deal with this vagueness and indeterminacy. (3) The BIS is a general principle of medical ethics with special application in pediatrics; it fits seamlessly into the system of medical ethics and fulfills many functions within pediatrics. The HP and the CPA model do not fit so readily within medical ethics, and are not equipped to take over the functions of the BIS. (shrink)

This article presents arguments that reframe the discussion on vaccination ethics. The correct starting point for discussions on vaccination ethics is not what society owes parents, but rather what society owes children. Drawing on the justice theory of Powers and Faden, two conclusions are defended by presenting and defending a set of arguments. First, a just society is obligated to protect its children against serious vaccine‐preventable diseases such as measles through adequate levels of vaccination. Second, this obligation of the just (...) society rests on identifiable individuals and institutions: parents, healthcare professionals, government, and vaccine producers have important obligations in this regard. This removes vaccination out of the realm of individual or parental discretion, and situates it in the realm of societal obligation. Children are owed vaccination, society is obligated to provide it. If parents cannot or will not provide it, society ought to respond. (shrink)

This article presents an argument related to justice obligations during a pandemic and explores implications of the argument. A just society responds to a serious threat to the well-being of its people such as a viral pandemic to mitigate the impact of the pandemic on the well-being of its members. This creates identifiable societal obligations which are discharged by the institutions and individuals within society that are situated to do so. There are therefore identifiable obligations resting on various societal institutions, (...) such as government, churches, schools, and corporate institutions, as well as obligations resting on individuals. Should an institution or individual fail to act in ways consistent with these social obligations, they perpetrate an injustice on society and its members. (shrink)

Malm and Navin (2020) argue that it is wrong to withhold varicella vaccine from children to let wild virus circulate purely to prevent zoster in older adults. They demonstrate how this practice acc...

Several congregations in the workspace of the Netherdutch Reformed Church of Africa are losing viability and sustainability. This can be attributed to various factors, the most prominent being isolation. Isolation is defined here as the inability of some congregations to move away from maintenance and an inward focus towards making necessary adjustments on the way to a dimension of missional focus. While commitment and enthusiasm are present in the work of all congregations, some find it difficult to adapt their established (...) ideas and in some cases obsolete customs and traditions. Other congregations have made the necessary adjustments by defining themselves as missional. In congregations where constructive change occurs, the focus moves to undertake congregational ministries. The congregation not only gains insight into their own situation but also becomes aware of God’s calling for that specific congregation within a specific context. The focus shifts from their own situation and needs to the needs and challenges of the context surrounding the specific congregation. A consequence of this change in focus is that the whole ministry of the congregation adjusts accordingly. These congregations discover their own unique spirituality and begin to ask: For whom do we exist? The article is based on a PhD thesis, where Osmer’s four questions of practical theology were brought into the conversation with the modelling process of neuro-linguistic programming, in an attempt to sojourn with congregations towards a contextual missional focus. This research was undertaken to expand Osmer’s four questions of practical theology by using the modelling process of neuro-linguistic programming so that congregations may succeed in making the necessary adjustments. (shrink)

This book offers a novel theory of childhood well-being as a social good. It re-examines our fundamental assumptions about parenting, parental authority, and a liberal society's role in the raising of children. The author defends the idea that the good of a child is inexorably linked to the good of society. He identifies and critiques the problematic assumption that parenting is an extension of individual liberty and shows how we run into problems in medical decision-making for children because of this (...) assumption. He develops an objective conception of what is good for a child in liberal society, drawing on the assumptions of liberty, and from here constructs a set of things that society and its members owe children. There are ways in which society should support and intervene in parental decisions to guarantee a child's well-being. Ultimately, raising children is a social activity that requires input from society. The author then applies this theory of childhood well-being to develop a framework for medical decision-making for children. He also uses practical examples, such as vaccinations, parental leave, and healthcare access, to demonstrate the implications of his theory for public policy. The Limits of Parental Authority: Childhood Wellbeing as a Social Good will be of interest to research and advanced students working in bioethics, political philosophy, and public health policy. (shrink)

Questions related to end-of-life decision making are common in clinical ethics and may be exceedingly difficult. Chief among these are the provision of cardiopulmonary resuscitation (CPR) and do-not-resuscitate orders (DNRs). To better address such questions, clarity is needed on the values of medical ethics that underlie CPR and the relevant moral framework for making treatment decisions. An informed consent model is insufficient to provide justification for CPR. Instead, ethical justification for CPR rests on the rule of rescue and on substituted (...) interest judgments. Patients’ known wishes and values are relevant, particularly in protecting them from unwanted CPR. Clinicians should rescue patients with the means at their disposal, as a prima facie moral imperative, unless there are compelling reasons to refrain. We present a moral framework for making decisions regarding CPR and DNR. (shrink)

This book assists health care providers to understand the specific interplay of the roles and relationships currently forming the debates in pediatric clinical ethics. It builds on the fact that, unlike adult medical ethics, pediatric ethics begins within an acutely and powerfully experienced dynamic of patient-family-state-physician relationship. The book provides a unique perspective as it interacts with established approaches as well as recent developments in pediatric ethics theory, and then explores these developments further through cases. The book first focuses on (...) setting the stage by introducing a theoretical framework and elaborating how pediatric ethics differ from non-pediatric ethics. It approaches different theoretical frameworks in a critical manner drawing on their strengths and weaknesses. It helps the reader in developing an ability to engage in ethical reasoning and moral deliberation in order to focus on the wellbeing of the child as the main participant in the ethical deliberation, as well as to be able to identify the child’s moral claims. The second section of the book focuses on the practical application of these theoretical frameworks and discusses specific areas pertaining to decision-making. These are: the critically ill child, new and enduring ethical controversies, and social justice at large, the latter of which includes looking at the child’s place in society, access to healthcare, social determinants of health, and vaccinations. With the dynamic changes and challenges pediatric care faces across the globe, as well as the changing face of new technologies, no professional working in the field of pediatrics can afford not to take due note of this resource. (shrink)

Children do not belong to their parents. They are not property, although throughout much of history they were considered chattel. In the 21st century, it is generally agreed that children are indiv...

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

It is natural to assume that every value bearer must be good, bad, or neutral. This paper argues that this assumption is false if value incomparability is possible. More precisely, if value incommensurability is possible, then there is a fourth category of absolute value, in addition to the good, the bad, and the neutral.

This article’s guiding thesis is that the theory of radical democratic citizenship is built on a tension between a radical, conflictual element and a democratic element. As radical democrats, these philosophers point to the intimate relation between conflict and both emancipation and democracy. But as radical democrats, they also propose different methods that prevent conflict from breaking up the polis—the common ground that makes democratic conflict possible. I look at two radical democrats’ way of dealing with this tension: Chantal Mouffe (...) and Étienne Balibar. My claim is that the former ends up overemphasising the danger of division in her later democratic works and is therefore unable to account for more intense forms of democratic resistance (such as riots). In the work of Balibar, however, we find a way of dealing with this tension. (shrink)

_ Source: _Volume 24, Issue 2, pp 279 - 299 This article provides the first overview of research on the kabbalistic sources of Benedictus de Spinoza. While this topic has not been a major focus in Spinoza research, this article argues that it has both biographical and philosophical relevance for the investigation of Spinoza and the context in which he first conceived of his hallmark ideas. Revisiting the extant historical sources, this article refines the present understanding of the connection between (...) Spinoza and the seventeenth-century kabbalistic circle of Amsterdam and the kabbalistic literature of that time. (shrink)

In this article, I reconstruct Étienne Balibar’s work against the background of the debate on modern universal citizenship. I argue that universal citizenship is neither fundamentally emancipatory nor fundamentally oppressive but is rather both. In order to defend this position, I build on Balibar’s concept of the “citizen subject.” First, I parse this concept, showing how it allows us to think about the contradictions of modern universal citizenship. In the second section, I elucidate its temporal logic and show how it (...) undermines the telos of modern universal citizenship. In sections three to five, I show how citizenship’s universalism clarifies both its oppressive and its emancipatory thrust. The dialectic of universal citizenship, I argue, unfolds as a conflict between and within political universals. In the conclusion, I will tie up these different strands and end with some reflections on the conditions of possibility of this dialectic. (shrink)

Philosophy & Social Criticism, Volume 48, Issue 6, Page 904-933, July 2022. In this article, I reconstruct Étienne Balibar’s work against the background of the debate on modern universal citizenship. I argue that universal citizenship is neither fundamentally emancipatory nor fundamentally oppressive but is rather both. In order to defend this position, I build on Balibar’s concept of the “citizen subject.” First, I parse this concept, showing how it allows us to think about the contradictions of modern universal citizenship. In (...) the second section, I elucidate its temporal logic and show how it undermines the telos of modern universal citizenship. In sections three to five, I show how citizenship’s universalism clarifies both its oppressive and its emancipatory thrust. The dialectic of universal citizenship, I argue, unfolds as a conflict between and within political universals. In the conclusion, I will tie up these different strands and end with some reflections on the conditions of possibility of this dialectic. (shrink)

A groundbreaking, deeply personal, magnum opus on madness and philosophy from a psychotic patient turned philosopher.

The objective of this doctoral dissertation is to interpret the explanation of akrasia that the Dutch philosopher Benedictus Spinoza (1632-1677) gives in his work The Ethics. One is said to act acratically when one intentionally performs an action that one judges to be worse than another action which one believes one might perform instead. In order to interpret Spinoza’s explanation of akrasia, a large part of this dissertation investigates Spinoza’s theory of emotion. The first chapter is introductory and outlines Spinoza’s (...) categorisation of mental states and his conception of the relation between the mind and the body. The second chapter deals with Spinoza’s epistemology and the relation between cognitive mental states and states of the brain. The third chapter argues that Spinoza holds that emotions are non-cognitive mental states that are caused by cognitive mental states. The fourth chapter interprets Spinoza’s discussion of the emotions of Joy and Sadness insofar as they are mental states. The fifth chapter suggests that when Spinoza says that the power of our body is increased or decreased when we are joyful or sad, he means that when we are joyful or sad then, at the same time, our heart and perhaps the organs of our digestive system are affected in such a way that our bodily health is increased or decreased. The sixth chapter points to three problems that concern Spinoza’s definitions of the psychophysical states of pleasure, pain, cheerfulness and melancholy, and offers slightly altered definitions of these states. The seventh chapter interprets the various aspects of Spinoza’s conception of the emotion of Desire, both insofar as it is a state of the mind and insofar it is a state of the body, as well as the relation between the emotion of Desire and man’s striving for self-preservation. The eighth chapter discusses what Spinoza writes on the strength of emotions and the way in which we make value judgments in order to finally interpret why it is, according to Spinoza, that ‘we so often see the better for ourselves but follow the worse’. (shrink)

According to Longtermism, our acts’ expected influence on the expected value of the world is mainly determined by their effects in the far future. There is, given total utilitarianism, a straightforward argument for Longtermism due to the enormous number of people that might exist in the future, but this argument does not work on person-affecting views. In this paper, we will argue that these views might also lead to Longtermism if Prudential Longtermism is true. Prudential Longtermism holds for a person (...) if and only if our acts’ overall influence on that person’s expected well-being is mainly determined by the acts’ effects in the far future. We argue that (due to a small chance of anti-ageing and uploading) there could be an enormous amount of prudential value for some contemporary person in the far future and that value may be so large that it dominates their overall expectation of lifetime well-being. (shrink)

Spinoza and Education offers a comprehensive investigation into the educational implications of Spinoza’s moral theory. Taking Spinoza’s naturalism as its point of departure, it constructs a considered account of education, taking special care to investigate the educational implications of Spinoza’s psychological egoism. What emerges is a counterintuitive form of education grounded in the egoistic striving of the teacher to persevere and to flourish in existence while still catering to the ethical demands of the students and the greater community. -/- In (...) providing an educational reading of Spinoza’s moral theory, this book sets up a critical dialogue between educational theory and recent studies which highlight the centrality of ethics in Spinoza’s overall philosophy. By placing his work in a contemporary educational context, chapters explore a counterintuitive conception of education as an ethical project, aimed at overcoming the desire to seek short-term satisfaction and troubling the influential concept of the student as consumer. This book also considers how education, from a Spinozistic point of view, may be approached in terms of a kind of cognitive therapy serving to further a more scientifically adequate understanding of the world and aimed at combating prejudices and superstition. -/- Spinoza and Education demonstrates that Spinoza’s moral theory can further an educational ideal, where notions of freedom and self-preservation provide the conceptual core of a coherent philosophy of education. As such, it will appeal to researchers, academics and postgraduate students in the fields of philosophy of education, theory of education, critical thinking, philosophy, ethics, and Spinoza studies. (shrink)

In this dialogue Thomas A and Jeito intuitively discuss the difference between a miracle and a fact. They conclude that the doings of God aren’t miracles.

Education and Free Will critically assesses and makes use of Spinoza’s insights on human freedom to construe an account of education that is compatible with causal determinism without sacrificing the educational goal of increasing students’ autonomy and self-determination. Offering a thorough investigation into the philosophical position of causal determinism, Dahlbeck discusses Spinoza’s view of self-determination and presents his own suggestions for an education for autonomy from a causal determinist point of view. -/- The book begins by outlining the free will (...) problem in education, before expanding on a philosophical understanding of autonomy and how it is seen as an educational ideal. It considers Spinoza’s determinism and discusses his denial of moral responsibility. Later chapters consider the relationship between causal determinism and autonomy, the educational implications of understanding free will and how free will can be utilised as a valuable fiction in education. -/- This book will be of great interest to academics and postgraduate students in the field of education, especially those with an interest in moral education and philosophy of education. It will also be of interest to those in the fields of philosophy and psychology and specifically those focusing on the free will problem, on Spinoza studies, and on the relation between moral psychology and external influence. (shrink)

This book is a philosophical enquiry into the educational consequences of Spinoza’s political theory. Spinoza’s political theory is of particular interest for educational thought as it brings together the normative aims of his ethical theory with his realistic depiction of human psychology and the ramifications of this for successful political governance. As such, this book aims to introduce the reader to Spinoza’s original vision of civic education, as a project that ultimately aims at the ethical flourishing of individuals, while being (...) carefully tailored and adjusted to the natural limitations of human reason. -/- Readers will benefit from a succinct introduction to Spinoza’s political philosophy and from an account of civic education that is based on careful exegetical work. It draws conclusions only hinted at in Spinoza’s own writings. (shrink)

Fictionalism confronts the dual epistemological nature of education. In this book, Johan Dahlbeck argues that all education, at bottom, concerns a striving for truth initiated through fictions. This foundational aporia is then interrogated and made sense of via Hans Vaihinger’s philosophy of ‘as if’ and Spinoza’s peculiar form of exemplarism. Using a variety of fictional examples, Dahlbeck investigates the different dimensions of educational fictionalism, from teacher exemplarism to the basic educational fictions necessary for getting started in education in the (...) first place. Fictionalism will be a valuable resource for anyone interested in the philosophical foundations of education. (shrink)

This book develops a view of logic as a theory of information-driven agency and intelligent interaction between many agents - with conversation, argumentation and games as guiding examples. It provides one uniform account of dynamic logics for acts of inference, observation, questions and communication, that can handle both update of knowledge and revision of beliefs. It then extends the dynamic style of analysis to include changing preferences and goals, temporal processes, group action and strategic interaction in games. Throughout, the book (...) develops a mathematical theory unifying all these systems, and positioning them at the interface of logic, philosophy, computer science and game theory. A series of further chapters explores repercussions of the 'dynamic stance' for these areas, as well as cognitive science. (shrink)

In this dialogue Zhuangzi and Jacob discuss nothing and something and their relation with God.

In response to critiques of rights as moralistic and depoliticising, a literature on the political nature and contestability of rights has emerged. In this view, rights are not merely formal, liberal and moralistic imperatives, but can also be invoked by the excluded in a struggle against domination. This article examines the limits to this practice of rights-claiming and its implication in forms of domination. It does this by returning to Marx’s blueprint for the critique of subjective rights. This engagement with (...) Marx will, however, take a particular form. I will read Marx first through the eyes of Claude Lefort and thereafter against Lefort. The latter’s critique of Marx still constitutes the strongest case against the dismissal of subjective rights. Introducing a reading of Lefort into the argument allows us to discover what is dead and what is well alive in the Marxist theory of rights. What is dead, I will argue, is Marx’s early conception of subjective rights as ideology and illusion. However, the more mature Marx developed a theory and critique of the legal form that is able to explain why the politics of rights—despite its undeniable advances—has not been able to overcome certain forms of domination. (shrink)