ZusammenfassungEs ist ein Standard-Verfahren der Medizinethik, auf die Möglichkeit des Missbrauchs solcher Instrumente hinzuweisen, die im lege-artis-Gebrauch legitim sein können. Ein etabliertes Instrument der medizinischen Praxis sind paternalistische Handlungen, die bei geringer Reichweite individueller Entscheidungskompetenz, etwa bei Minderjährigen, verantwortliches Handeln absichern sollen. In der bisherigen Debatte wird Paternalismus als Problem eines ungerechtfertigten oder übermäßigen Gebrauchs diskutiert. Bislang erscheint in der medizinethischen Paternalismus-Debatte das Problem des scheinbaren Paternalismus zu wenig reflektiert. Auch die Thematik der sexualisierten Gewalt gegen Minderjährige im medizinischen Setting (...) ist bisher wenig beachtet worden. Für diese spezifische Form der Gewalt gibt es verschiedene Ermöglichungsbedingungen. Eine wichtige liegt in der Akzeptanz paternalistischer Handlungen im medizinischen Kontext. Denn ein scheinbarer Paternalismus im Zusammenhang mit sexualisierter Gewalt gegen Minderjährige profitiert von der Praxis des passageren Übergehens des aktuellen Willens eines Kindes. Der prominente Fall Larry Nassars, der als Teamarzt der US-Kunstturnerinnen in hunderten Fällen junge Patientinnen sexualisierter Gewalt ausgesetzt hat, macht auf die Möglichkeit sexualisierter Gewalt durch medizinisches Personal aufmerksam. Geht es in der Paternalismus-Debatte um die Frage, in welchen Zusammenhängen Paternalismus problematisch oder unproblematisch ist, so trägt diese Studie den Problemaspekt der Täuschung im Zusammenhang mit sexualisierter Gewalt bei. Sie leistet damit einerseits einen Beitrag zur Thematisierung sexualisierter Gewalt im klinischen Kontext, und sie trägt zum anderen zur medizinethischen Diskussion des Paternalismus bei, die nicht von der Möglichkeit des Schein-Paternalismus absehen sollte. Unter Schein-Paternalismus oder fingiertem Paternalismus wird hier eine Haltung und Praxis verstanden, die in der Gestalt eines Paternalismus eigene Interessen des Agierenden zum Schaden der in Abhängigkeit befindlichen Person verfolgt und Fürsorgepflichten ignoriert. Denn die kindliche Gewöhnung an die Unterordnung des eigenen Willens und Körpers im asymmetrischen klinischen Kontext kann dazu genutzt werden, fingierten Paternalismus zu etablieren. Die Rede vom Schein-Paternalismus soll dabei aber nicht darüber hinwegtäuschen, dass die Grenzziehung zwischen Paternalismus und Nicht-Paternalismus in der Praxis ebenso komplex ist wie diejenige zwischen körperlich-asexueller und körperlich-sexueller Gewalt. Ein präzises und transparentes lege-artis-Modell des Paternalismus soll hier als Basis für die Prävention sexualisierter Gewalt im klinischen Kontext diskutiert werden. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur zur sexualisierten Gewalt im klinischen Kontext und zum Paternalismus. Es folgt dann eine Zusammenfügung der so gewonnenen Erkenntnisse, sodass am Ende eine komplexere Aussage AB über das Verhältnis von sexualisierter Gewalt und Schein-Paternalismus steht. (shrink)

THE LEFT AND RIGHTS: A CONCEPTUAL ANALYSIS OF SOCIALIST RIGHTS by Tom Campbell Boston: Routledge and Kegan Paul, 1983. 296 pp., $12.95 Campbell's attempt to construct a socialist version of rights and the rule of law fails because it does not draw on individualism. Campbell's positive rights are ineffective barrien to both the schemes of Utopian visionaries who command political authority and more mundane sources of the abuse of power. He leaves unanswered the question of who will determine the extent (...) of the ?needs?; that would constitute socialist rights, in the absence of unlimited resources to fulfill them. And his rejection of individualism ¡eaves him no means of adjudicating among conflicting positive claim?rights. (shrink)

Is it a stronger interference with people's freedom to withdraw options they currently have than to withhold similar options they do not have? Drawing on recent theorizing about sociopolitical freedom, this article identifies considerations that often make this the case for public policy. However, when applied to tobacco control, these considerations are shown to give us at best only very weak freedom-based reason to prioritize the status quo. This supports a popular argument for so-called “endgame” tobacco control measures: If we (...) believe that cigarettes would and should be withheld from entering markets in hypothetical scenarios in which they do not yet exist, then we also have reason to seek their abolition in situations, such as ours, in which cigarettes do exist—if necessary by banning their sale. The same considerations are then used to disarm objections that have recently been raised to using nudges in public policy. (shrink)

Claims to rights and negotiation about their shape are pervasive in our public and private culture. Rights consciousness is surely desirable and is part and parcel of the transition toward a more democratic world. In this essay I consider the proper placement of moral rights in moral theory. In a famous essay, "Taking Rights Seriously," Ronald Dworkin argues that if it is accepted that individuals have moral rights against their government, that implies serious constraints on the conduct of government and (...) the freedom of a political majority to enforce its wishes through law. I endorse the thesis that individuals have such moral rights and support taking rights seriously in Dworkin's sense. My focus is elsewhere. In this essay I shall argue that moral rights do not and should not figure in our fundamental moral principles; rights enter at the level of subordinate principles. In a very broad way, to take this stand is to side with utilitarians and consequentialists, who see rights as instruments for achieving other values, not moral goals in their own right. (shrink)

This paper aims to explore and examine the implied commitment to the premises of recognition in Rawls’s account of redistributive justice. It attempts to find out whether or not recognition relations that produce humiliation and cultural injustice can be followed to their logical conclusion in his theory of redistribution. This paper makes two claims. Firstly, although Rawls does not disregard the harms of misrecognition as demonstrated in his notion of self-respect being the most important primary good, he cannot liberally accommodate (...) the idea of humiliation as a case of injustice without compromising the basic premises of his theory. Secondly, while resource distribution produces indirect side effects that can impact upon cultural injustice, addressing recognition issues through the prism of redistribution can inadvertently result in further misrecognition. The paper concludes that in the final analysis Rawls wrongly takes redistribution as the overarching principle of justice to which recognition is but a subservient principle. (shrink)

Bovine tuberculosis is an important and controversial animal health policy issue in England, which impacts humans, cattle and badgers. The government policy of badger culling has led to widespread opposition, in part due to the conclusions of a large field trial recommending against culling, and in part because badgers are a cherished wildlife species. Animal rights theorists argue that sentient nonhumans should be accorded fundamental rights against killing and suffering. In bovine TB policy, however, pro-culling actors claim that badgers must (...) be culled to avoid the slaughter of cattle. The first part of the paper compares AR theories of Regan, Francione, Cochrane, Garner and Donaldson and Kymlicka in the context of wildlife species. The second part of the paper applies these AR theories to bovine TB and badger control. AR theories are applied to badger control policy options of do nothing, badger culling, and badger vaccination. We conclude that AR theories are strongly opposed to badger culling. In general, culling is prohibited due to a badger’s right to life and its rights against suffering. The AR theories support a do-nothing, i.e. non-culling, non-vaccination approach to badger control. In the case of the AR theories of Regan and Francione, this is based on abolitionist positions with respect to farming. For Cochrane, Garner, and Donaldson and Kymlicka, the do-nothing policy option is preferred because badger vaccination causes a degree of suffering which generally is not for the individual’s benefit. (shrink)

In the long-running debate on the interest of the dead, Joan C. Callahan argues against such interests and although Søren Holm for practical reasons is prepared to consider posthumous interests, he does not see any moral basis to support such interests. He argues that the whole question is irresolvable, yet finds privacy interests where Tutankhamen is concerned. Callahan argues that there can be reasons to hold on to the fiction that there are posthumous interests, namely if it is comforting for (...) the living and instrumental for society. Thus, despite arguing against the position that the dead have any interests or for any moral basis for such interests, these “interests” are still taken into consideration in the end. This shows the unsatisfactory basis of their positions and indicates the tenacity of the moral intuition that the dead can have moral claims on the living. One example of a posthumous interest is the interest in one’s good name. Here we argue that it is an interest of moral significance. This implies that if individuals restrict use of their sample when they are still alive, those restrictions apply after their death. Further, it implies that one should be concerned with the reputation of historic persons. Research that defeats these interests calls for justification. We have suggested two lines of thinking along which such a discussion could go: investigating the truth-value of the good name and the relevance of bringing it into possible disrepute. (shrink)

Theories of global justice have moved from issues relating to crimes against humanity and war crimes or, furthermore, ?negative duties? with respect to non-citizens, towards problems of distributive justice and global inequality. Thomas Nagel's Storrs Lectures from 2005, exemplifying Rawlsian internationalism, argue that liberal requirements concerning duties of distributive justice apply exclusively within a single nation-state, and do not extend to duties of this nature between rich and poor countries. Nagel even argues that the demand for global equality is not (...) a demand of justice at all. In the present article I will try to offer a normative basis for the criticism of such a view. Following Kant and more recently Philip Pettit, I locate this normative basis on political freedom conceived as non-domination. Such a conception opens up the possibility of a political cosmopolitanism, which is based not on an empirical interdependence among people at a global level, but on a normative interdependence. Subsequent cosmopolitan duties extend both to the elimination of domination everywhere in the world and to the equal enjoyment of non-dominated choice. Thus, it will be argued that modern republicanism is falsely identified with a particular, bounded community, but supports a political, not simply a moral, cosmopolitanism. This kind of cosmopolitanism conceives of sovereign states neither as useless constructions, nor as mere instruments for realizing the pre-institutional value of justice among human beings. Instead, their existence is what gives the value of justice its application. Cosmopolitanism is not after all about the abolishment of all boundaries, but about the essential capacity to draw and redraw them infinitely under conditions of global justice. (shrink)

The purpose of this article is to explore the potential contribution of Axel Honneth's critical theory of recognition to empirical and normative debates on global justice. I first present, very briefly, an overview of recent theories of global distributive justice. I argue that theorists of distributive justice do not pay enough attention to sources of self-respect and conditions for identity formation, and that they are blind toward the danger of harming people's sense of self even by well-intentioned redistributive policies. Honneth's (...) theory suffers from complementary shortcomings; it is anti-technocratic but largely oblivious to the global nature of many contemporary justice claims. Given this situation, I seek to broaden the theory's scope by outlining transnational extensions of the recognition principles of love, rights and solidarity identified by Honneth. In conclusion, I show how utilizing a broadened conceptualization of the struggle for recognition allows us to better understand the changing logic of justice-oriented foreign policies. (shrink)

Two distinct approaches to the incorporation of animal interests within democratic theory are identified. The first, anthropocentric, account suggests that animal interests ought to be considered within a democratic polity if and when enough humans desire this to be the case. Within this anthropocentric account, the relationship between democracy and the protection of animal interests remains contingent. An alternative account holds that the interests of animals ought to be taken into account because they have a democratic right that their interests (...) are considered. This alternative account is defended in this article by utilising democratic theory and, in particular, the all-affected principle. The interests of animals are affected by collective decisions and, therefore, they, or – more specifically – their representatives, have a democratic right to have some say in the making of those decisions. This approach is favourably contrasted with an alternative, citizenship, account which relies on contested, capacity-oriented, claims current within the field of animal ethics. (shrink)

Democracy is in serious difficulties. Three features of the crisis stand out. First is the dominant culture of disillusionment in democracy, which transpires as the mistrust in constitutionalist institutions and values. Second, political authority, both at domestic and international levels, is largely substituted by the rule of non-transparent and unpredictable social powers. Third, democratic states are deprived of much of their capacity to govern, but they retain a non-negligible capacity to coerce.The article is structured as follows. Section I introduces Karl (...) Polanyi’s concept of embeddedness and juxtaposes it to the theoretical defense of market disembeddedness advanced by the classical political economy. It then points to the challenge that the complexity of the contemporary society poses to the idea of embeddedness and identifies the need for further analytical clarification of the idea. Section II tries to explain why the idea of embeddedness is intuitively suspect. One reason is found in the domi... (shrink)

I was in bondage in Missouri, too. I can't say that my treatment was bad. In one respect I say it was not bad, but in another I consider it was as bad as could be. I was a slave. That covers it all. I had not the rights of a man. It cannot be too often repeated: peasants and workmen have no natural rights, not one. Only we ought instantly to add, that kings and nobles have none either.

This paper is focused on the analysis of two documents (the Council of Europe's Bioethics Convention and the Additional Cloning Protocol) inasmuch as they refer to the relationship between human dignity and human genetic engineering. After presenting the stipulations of the abovementioned documents, I will review various proposed meanings of human dignity and will try to identify which of these seem to be at the core of their underlying assumptions. Is the concept of dignity proposed in the two documents coherent? (...) Is it morally legitimate? Is it, as some might assume, of Kantian origin? Does it have any philosophical roots? (shrink)

The growing interest in lifestyle campaigns as a means to promote public health has increased steadily during the past several decades. Governments, national health organizations, NGOs, and wealthy donors are collaborating with media professionals and academic scholars to address the pressing health issues of the 21st century. To counter the potential negative influences of hundreds of lifestyle advertising messages that media consumers are exposed to on a daily basis, health communication professionals are designing more sophisticated campaigns that blend beneficial health (...) information with various forms of entertainment media. This article discusses important ethical considerations raised by health professionals and media scholars and considers lifestyle campaigns within the context of competing ethical approaches to social change. A heuristic model is presented that facilitates a communitarian ethical approach to lifestyle campaigns, examining four important groups of stakeholders. Specific recommendations for future lifestyle campaigns based on this model are proposed. (shrink)

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim (...) is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism. (shrink)

There is no lack of criticisms frequently levelled against the international pharmaceutical industry (Big Pharma): excessive profits, dubious or even dishonest practices, exploiting the sick and selective use of research data. Neither is there a shortage of examples used to support such opinions. A recent book by Brody (Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry, 2008) provides a précis of the main areas of criticism, adopting a twofold strategy: (1) An assumption that the special nature and human need (...) for pharmaceutical medicines requires that such products should not be treated like other commodities and (2) A multilevel descriptive approach that facilitates an ethical analysis of relationships and practices. At the same time, Brody is fully aware of the nature of the fundamental dilemma: the apparent addiction to (and denial of) the widespread availability of gifts and financial support for conferences etc., but recognises that ‘Remove the industry and its products, and a considerable portion of scientific medicine’s power to help the patient vanishes’ (Brody 2008, p. 5). The paper explores some of the relevant issues, and argues that despite the identified shortcomings and a need for rigorous and perhaps enhanced regulation, and realistic price control, the commercially competitive pharmaceutical industry remains the best option for developing safer and more effective medicinal treatments. At the same time, adoption of a broader ethical basis for the industry’s activities, such as a triple bottom line policy, would register an important move in the right direction and go some way toward answering critics. (shrink)

The Will Theory of Rights has commonly been criticized for excluding from the class of rights bearers all subjects who are incapable of agency. The Interest Theory of Rights faces the challenge of avoiding undue proliferation of the class of rights bearers. I advance a novel argument for a specific demarcation of the class of rights bearers. I then argue that this demarcation implies that the function of the moral rights of subjects incapable of exercising agency is to protect them (...) from being treated with illegitimate disregard in a certain sense. I advance reasons for holding that this theory is neither a Will Theory nor an Interest Theory, or a combination of these theories. The proposed account is significant also if it is interpreted as a version of the Interest Theory. It brings significant benefits in the form of cohesiveness, simplicity, and intuitive appeal. (shrink)

The relationship between libertarianism and state is a contested one. Despite pressing full and strict ownership of one’s person and any justly acquired goods, many libertarians have suggested ways in which a state, albeit limited, can be regarded as just. Peter Vallentyne has proposed that all plausible versions of libertarianism are compatible with what he calls ‘private-law states’. His proposal is underpinned by a particular conception of rights, which brings Interest Theory of rights and Will Theory of rights together. If (...) convincing, Vallentyne’s theory of rights enables libertarians to accommodate a limited but nevertheless coercive state that can act without the full consent of the affected citizen. In this paper, it is argued that Vallentyne’s hybrid theory of rights is implausible from a libertarian perspective as well as fails to align itself with common and deeply held moral intuitions. Hence the conflict between mainstream libertarianism and the state is not solved by Vallentyne’s proposal. (shrink)

Human social life is structured by social norms creating both obligations and entitlements. Recent research has found that young children enforce simple obligations against norm violators by protesting. It is not known, however, whether they understand entitlements in the sense that they will actively object to a second party attempting to interfere in something that a third party is entitled to do — what we call counter-protest. In two studies, we found that 3-year-old children understand when a person is entitled (...) to do something, and so they actively defend this person’s entitlement against unjustified interference from second parties. In some cases, they even enforce second-order entitlements, for example, in the case of ownership where an owner is entitled to entitle others to use the owner’s property. (shrink)