Definition of the problemFrom an ethical point of view we analyse the ruling of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) of September 2019 to revise the guidelines about the coverage of noninvasive prenatal tests (NIPT) by mandatory health insurance, in order to include them under specified conditions. The decision contains four essential elements: a definition of the aim of NIPT testing (to avoid invasive testing), a criterion of access (test must be “necessary” for the pregnant woman to tackle (...) her individual situation), statements about the process of decision-making (after counselling by a physician and case by case) and a normative contextualization (termination of pregnancy under § 218 a German penal law) which is to be found in its explanations. There are tensions in the proposed model that oscillate about two axes: (1) The suffering that results from a possible birth of a child with trisomy or from not knowing about the genetic condition of the fetus can ultimately only be evaluated subjectively, from the perspective of the pregnant woman. (2) The meaning of an individual decision in the case-by-case model remains unclear because when judging about individual cases general points of view also need to be considered. However, we argue that the model of the G‑BA could be a sociopolitically and ultimately also ethically defensible pragmatic solution, exactly because of its paradoxes and its inherent flexibility. (shrink)

Although birth marks the entrance of a human being into the world and establishes the very possibility of experience the philosophical implications of this event have been largely ignored in the history of thought. This is particularly troubling in phenomenology in general and in the work of Martin Heidegger in particular. While Heidegger raises the issue of birth he drops it very quickly on the path to defining Dasein''s existence as constituted from the standpoint of death, as being-towards-death. In this (...) paper I argue, contra Heidegger, that intentional existence can only be understood from the standpoint of birth. I begin by showing that intentionality inheres in a double difference that is fundamentally dependent on birth insofar as birth is an original differentiating from prenatal existence. I conclude with the argument that only a philosophy that regards Dasein from the standpoint of birth, as being-from-birth, can give an adequate account of humans as beings who live with others and who can initiate sense constitution and action. (shrink)

The routinization of prenatal diagnosis is the source of bioethical and policy debates regarding choice, autonomy, access, and protection. To understand these debates in the context of cultural diversity and moral pluralism, we compare Israel and Germany, focusing on two recent repro-genetic “hot spots” of such policy-making at the beginning of life: pre-implantation genetic diagnosis and non-invasive prenatal genetic testing, two cutting-edge repro-genetic technologies that are regulated and viewed very differently in Germany and Israel, reflecting different medicolegal policies as well (...) as public and bioethical considerations. First, we compare policy-making in the context of PGD for HLA typing, used to create sibling donors, approved in Israel under specific conditions while prohibited in Germany. Second, we compare policy-making in the context of NIPT, which came under fire in Germany, while in Israel there has been little public debate about it. Both countries justify their contrasting policies as reflecting a concern for the well-being and care of the embryo/child, thus highlighting different concepts of embryo/child protection, autonomy, family relations, and the impact of religion and history on the promotion/protection of life. We use the juxtaposition of PGD and NIPT to highlight some inconsistencies in policies concerning the protection of extra- and intra-corporeal embryos. We conclude by drawing on the comparison to show how national variations exist alongside co-evolution. (shrink)

The concept of the ‘well-being of the child’ (like the ‘child’s welfare’ and ‘best interests of the child’) has remained underdetermined in legal and ethical texts on the needs and rights of children. As a hypothetical construct that draws attention to the child’s long-term welfare, the well-being of the child is a broader concept than autonomy and happiness. This paper clarifies some conceptual issues of the well-being of the child from a philosophical point of view. The main question is how (...) well-being could in practice acquire a concrete meaning and content for a particular issue or situation. A phenomenological-hermeneutic research perspective will be outlined that allows the child’s well-being to be elucidated and specified as an anthropological and ethical idea. It is based on a contextual understanding of generative relationships, a combination of the theory and practice of making sense, here described as ‘generative insight’, which could provide ethical guidance for decision making in families, legal practice, medicine or biomedical research. (shrink)

The contributors to this international volume take up questions about a phenomenology of time that begins with and attunes to gender issues. Themes such as feminist conceptions of time, change and becoming, the body and identity, memory and modes of experience, and the relevance of time as a moral and political question, shape Time in Feminist Phenomenology and allow readers to explore connections between feminist philosophy, phenomenology, and time. With its insistence on the importance of gender experience to the experience (...) of time, this volume is a welcome opening to new and critical thinking about being, knowledge, aesthetics, and ethics. (shrink)

To explore how cultural beliefs are reflected in different popular views of pre-implantation genetic diagnosis for human leukocyte antigen match (popularly known as “savior siblings”), we compare the reception and interpretations, in Germany and Israel, of the novel/film My Sister’s Keeper. Qualitative analysis of reviews, commentaries and posts is used to classify and compare normative assessments of PGD for HLA and how they reproduce, negotiate or oppose the national policy and its underlying cultural and ethical premises. Four major themes emanated (...) from the comparison: loss of self-determination and autonomy; loss of dignity through instrumentalization; eugenics and euthanasia; and saving life. In both countries, most commentaries represented a dominant position, with a few negotiated positions. We also highlight the decoding of a relatively less explored bioethical aspect of My Sister’s Keeper’s narrative, namely the meaning of euthanasia. We conclude by discussing how the findings relate to attempts of providing cultural explanations for the regulation of HLA-PGD. (shrink)

Die allogene Transplantation von Blutstammzellen aus dem Körper von Kindern, die der Spende nicht selbst zustimmen können, in den Körper eines kranken Geschwisterkindes wirft schwierige ethische Fragen auf. Wie kann ein risikobehafteter, fremdnütziger medizinischer Eingriff ethisch gerechtfertigt werden? In dieser Arbeit werden Argumente kritisch untersucht, nach denen das Spenderkind eine Pflicht habe, bei der Transplantation mitzumachen. Die Idee der Pflicht ist nachvollziehbar aus der Perspektive der Eltern, die zwar in einem Fürsorgekonflikt sind (ein Kind zu Gunsten der Rettung des anderen (...) verletzen zu müssen), aber selbst eine Pflicht haben, für das Leben des kranken Kindes zu kämpfen. Eine Analyse des Pflichtbegriffs zeigt jedoch, dass die Erfüllung einer Pflicht daran gebunden ist, entscheidungskompetent zu sein. Drei Wege werden untersucht, eine solche Pflicht dennochzuzuschreiben: i) die Eltern übertragenihre Pflicht auf das Kind; ii) die Interessen des Spenderkindes implizieren eine Pflicht; iii) Geschwisterkinder haben aufgrund ihrer vertrauten Familienbeziehungen Pflichten untereinander, die auch die Pflicht zu spenden beinhalten. Alle drei Zuschreibungsstrategien werden als unhaltbar kritisiert. Das Ergebnis lautet, dass die Pflicht, einem Geschwisterkind Körpergewebe zu spenden, einem nicht-einwilligungsfähigen Kind nicht zugeschrieben werden kann. Andere philosophische Ansätze zur Stammzellspende von Kindern an Familienangehörige müssten entwickelt und geprüft werden. (shrink)

Responsibility is central to Emmanuel Levinas as well as Hannah Arendt. A reading of their understanding of the concept and role of responsibility for politics and ethics and in regard to its social-ontological status of primacy, its reference to historical, worldly, and human conditions, brings out the similarities and differences of their work. Regarding their historical context, they could have engaged in a dialogue; but they never did. Their personal temperament and thematic approach to key issues concerning the concept of (...) responsibility—such as subjectivity, primordiality, or relationality—can be used to build pillars for a bridge between the two thinkers’ respective approaches. This essay tries to read each author in light of the other one. (shrink)

Kaum eine zweite moderne Wissenschaft weckt im gleichen Ausmass Hoffnungen und Angste wie die Biotechnologie. Neben der Hoffnung, durch die Entschlusselung des menschlichen genetischen Codes, die Moglichkeit der Veranderung des Erbgutes und Reduplikation von Stammzellen entscheidende Fortschritte in der Diagnostik und Therapie von Krankheiten zu machen, steht die Angst vor einem Missbrauch dieses neuen Wissens. Einer Moralphilosophie, die sich nicht auf die Exegese historischer Texte reduzieren lassen will, bietet sich hier ein wichtiges neues Aufgabenfeld: Sie ist gefordert, vorausschauend die ethischen (...) Grenzen und Notwendigkeiten menschlichen Handelns neu zu beurteilen und zu begrunden. Dieser Sammelband will Diskussionen anregen und vertiefen, indem er unterschiedliche Positionen, konkurrierende philosophische, theologische und naturwissenschaftliche Begrundungs- und Argumentationsmodelle aufzeigt und kritisch aufeinander bezieht.". (shrink)

The laughter of the Thracian handmaid. About the ›unworldliness‹ of philosophy. Interpreting Plato’s story of the Thracian handmaid, this essay focuses on questions concerning the supposition of an opposition between common sense and philosophical thinking. Taking the laughter of the maid seriously the author discusses the role of laughter for Plato’s approach. By reevaluating the function of laughter she argues for its strength in revealing ideological thinking or an undisclosed hypothesis, and in enabling philosophical thinking. Thus, the author argues that (...) the alliance of laughter and thinking unsettles the state of being enclosed in ideology, everydayness or thoughtlessness, and both distances and unsettles human beings. And hence, it may free us to pose again the question as to how we are thinking what. (shrink)

Obwohl Elternschaft in der Geschichte der Philosophie kein zentrales Thema darstellt, spielt sie doch in einigen Debatten und Beiträgen eine wichtige Rolle. Dabei variiert die Schwerpunktsetzung zwischen dem äußeren Verhältnis der Elternschaft zu Staat und Gesellschaft und der Analyse innerfamiliärer Beziehungen. Im Folgenden geben wir zunächst einen kurzen historischen Überblick, um sodann auf Einzelprobleme und fragen einer philosophischen Analyse des Themas Elternschaft einzugehen. Hierzu gehören neben einer Rekonstruktion der grundlegenden konzeptionellen Struktur von Elternschaft, die Themenbereiche Rechte und Pflichten, Verantwortung sowie (...) Liebe und Sorge. (shrink)

Prenatal diagnosis, especially noninvasive prenatal testing, has changed the experience of pregnancy, prenatal care and responsibilities in Israel and Germany in different ways. These differences reflect the countries' historical legacies, medico-legal policies, normative and cultural identities. Building on this observation, the contributors of this book present conversations between leading scholars from Israel and Germany based on an empirical bioethical perspective, analyses about the reshaping of 'life' by biomedicine, and philosophical reflections on socio-cultural claims and epistemic horizons of responsibilities. Practices and (...) discussions of reproductive medicine transform the concepts of responsibility and irresponsibility. (shrink)

Die allogene Transplantation von Blutstammzellen aus dem Körper von Kindern, die der Spende nicht selbst zustimmen können, in den Körper eines kranken Geschwisterkindes wirft schwierige ethische Fragen auf. Wie kann ein risikobehafteter, fremdnütziger medizinischer Eingriff ethisch gerechtfertigt werden? In dieser Arbeit werden Argumente kritisch untersucht, nach denen das Spenderkind eine Pflicht habe, bei der Transplantation mitzumachen. Die Idee der Pflicht ist nachvollziehbar aus der Perspektive der Eltern, die zwar in einem Fürsorgekonflikt sind (ein Kind zu Gunsten der Rettung des anderen (...) verletzen zu müssen), aber selbst eine Pflicht haben, für das Leben des kranken Kindes zu kämpfen. Eine Analyse des Pflichtbegriffs zeigt jedoch, dass die Erfüllung einer Pflicht daran gebunden ist, entscheidungskompetent zu sein. Drei Wege werden untersucht, eine solche Pflicht dennochzuzuschreiben: i) die Eltern übertragenihre Pflicht auf das Kind; ii) die Interessen des Spenderkindes implizieren eine Pflicht; iii) Geschwisterkinder haben aufgrund ihrer vertrauten Familienbeziehungen Pflichten untereinander, die auch die Pflicht zu spenden beinhalten. Alle drei Zuschreibungsstrategien werden als unhaltbar kritisiert. Das Ergebnis lautet, dass die Pflicht, einem Geschwisterkind Körpergewebe zu spenden, einem nicht-einwilligungsfähigen Kind nicht zugeschrieben werden kann. Andere philosophische Ansätze zur Stammzellspende von Kindern an Familienangehörige müssten entwickelt und geprüft werden. (shrink)

Interpreting Plato's story of the Thracian handmaid, this essay focuses on questions concerning the supposition of an opposition between common sense and philosophical thinking. Taking the laughter of the maid seriously the author discusses the role of laughter for Plato's approach. By reevaluating the function of laughter she argues for its strength in revealing ideological thinking or an undisclosed hypothesis, and in enabling philosophical thinking. Thus, the author argues that the alliance of laughter and thinking unsettles the state of being (...) enclosed in ideology, everydayness or thoughtlessness, and both distances and unsettles human beings. And hence, it may free us to pose again the question as to how we are thinking what. (shrink)