Bioethicists tend to focus on the individual as the relevant moral subject. Yet, in highly complex and socially differentiated healthcare systems a number of social groups, each committed to a common cause, are involved in medical decisions and sometimes even try to influence bioethical discourses according to their own agenda. We argue that the significance of these collective actors is unjustifiably neglected in bioethics. The growing influence of collective actors in the fields of biopolitics and bioethics leads us to pursue (...) the question as to how collective moral claims can be characterized and justified. We pay particular attention to elaborating the circumstances under which collective actors can claim ‘collective agency.’ Specifically, we develop four normative-practical criteria for collective agency in order to determine the conditions that must be given to reasonably speak of ‘collective autonomy’. For this purpose, we analyze patient organizations and families, which represent two quite different kinds of groups and can both be conceived as collective actors of high relevance for bioethical practice. Finally, we discuss some practical implications and explain why the existence of a shared practice of trust is of immediate normative relevance in this respect. (shrink)

Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit––the “surrogacy triad” consisting of the surrogate mother, the child, and the intending parents––whose constituents are bound (...) together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice. (shrink)

BackgroundThe bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other.MethodsBased on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices’ relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and (...) reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice.ResultsFirst, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy. (shrink)

ZusammenfassungIn der ethischen Debatte um die Forschung mit Biobanken wird selten zwischen verschiedenen Biomaterialien differenziert. Vor diesem Hintergrund widmet sich die vorliegende qualitative Interviewstudie erstmals den praktischen Herausforderungen, die sich bei der Sammlung von postmortal gewonnenem menschlichem Gehirngewebe zu Forschungszwecken aus Sicht von in diese Praxis involvierten Experten in Deutschland stellen. Im Zentrum der ethischen Analyse stehen Herausforderungen der Spenderrekrutierung, der Kommunikation über eine Gehirnspende sowie der informierten Zustimmung. Unsere Ergebnisse relativieren zum einen die Annahme eines sogenannten Spendermangels, insofern insbesondere (...) Kliniker eine Gatekeeper-Rolle bei der Spendergewinnung innehaben. Deren Einstellungen sollten daher als ein die Praxis unmittelbar beeinflussender Faktor stärker berücksichtigt werden; zudem sollten im Wissen um bestehende moralische Vorbehalte Ansätze zur Verbesserung der professionellen Kommunikation entwickelt werden. Bezüglich der Regelung der Einwilligung in postmortale Forschungsspenden wurde in unserem Sample das Bemühen deutlich, den ethischen Vorrang der Organspende nicht zu gefährden und die Postmortalspende vor Assoziationen mit der Organspende zu bewahren. Zur Sicherung des Vertrauens in die Forschung sowie der Autonomie von Spendern befürworteten die Experten nicht nur die Anwendung einer Zustimmungsregelung, sondern auch ein den Familienangehörigen explizit eingeräumtes Recht, einer Gehirnspende selbst dann zu widersprechen, wenn der Verstorbene seine Zustimmung erteilt hat. Die Erfahrung zeigt, dass eine offene Kommunikation über das Erfordernis eines familiären Konsenses zu einer hohen Akzeptanz des Spenderwillens in der Praxis führt. Daher könnte ein solcher, auf den Dialog von Spender und Angehörigen zu Lebzeiten bauender Ansatz auch instruktiv für die Realisierung von Spenden im Kontext der Organspende sein. (shrink)

Human reproduction in the age of reprogenetics raises fundamental ethical and political questions. Critics of so-called liberal eugenics like Jürgen Habermas have sparked an ethical debate on whether selective genetic manipulation might undermine the natural basis of the moral self-conception and autonomy of future generations. Contrary to this perception, the authors of this article argue for a dialectic understanding of the moral challenges arising from human natality: Freedom and dependency, sociality and human embodiment, autonomy and relatedness likewise determine our human (...) existence as moral beings. As an answer to these challenges, the authors develop a dialectic understanding of parenthood in the age of reprogenetics, thereby transcending present debates of modern reproductive medicine. (shrink)

The human body and its parts are widely perceived as matters beyond commercial usage. This belief is codified in several national and European documents. This so-called ‘no-property rule’ is held to be the default position across the countries of the European Union. However, a closer look at the most pertinent national and European documents, and also current practices in the field, reveals a gradual model of commercialisation of human tissue. In particular, we will argue that the ban on commercialisation of (...) body material is not as strict as it may appear at first sight, leaving room for the commercial practice of tissue procurement and transfer. We argue for more transparent information for patients and tissue donors, an intensified ethical debate on commercialisation practices, and a critical review of current normative principles. (shrink)

Die öffentliche Wahrnehmung der Forschung mit extrakorporalen Embryonen bildet den Kern des vorliegenden Beitrags. Hierzu wurden über 400 Personen schriftlich befragt. Die Art der Embryonengewinnung (künstliche Erzeugung vs. überzählige Embryonen) wird als bedeutsam für die Bewertung der Forschung angesehen. Mehrheitlich besteht der Wunsch nach rechtlich klaren Grenzen. Die größte Ambivalenz zeigt sich hinsichtlich der Frage nach einer gesetzlichen Erlaubnis der Embryonenforschung. Umgekehrt hat die Bevölkerung eine eindeutigere Meinung zum Verbot von Embryonenforschung und zur Einführung strikter rechtlicher Regelungen. Die Wahl der (...) Mittelkategorie bei der Untersuchung der Einstellung ist durch das Ausmaß der Ambivalenz mitbestimmt. Es konnte nachgewiesen werden, dass Laien das Dilemma der Embryonenforschung ähnlich bewerten wie Experten. Der Wunsch nach einer Freigabe der Forschung mit Embryonen besteht bei einer Teilgruppe, jedoch ist dieser Wunsch von einem hohen Ausmaß an Ambivalenz begleitet. (shrink)

Patientenmobilität und grenzüberschreitende Gesundheitsversorgung sind alltägliche Phänomene in der Europäischen Union (EU). Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien über ethische Aspekte grenzübergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzübergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwähnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Möglichkeit der Patientenmobilität und die damit vor (...) allem verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings können wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil können sogar negative Konsequenzen für einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Überlegungen kritisch zu sehen ist. (shrink)

Renowned neurologist and author Dr Oliver Sacks is a visiting professor at the University of Warwick as part of the Institute of Advanced Study. Dr Sacks was born in London. He earned his medical degree at the University of Oxford (Queen’s College) and the Middlesex Hospital (now UCL), followed by residencies and fellowships at Mt. Zion Hospital in San Francisco and at University of California Los Angeles (UCLA). As well as authoring best-selling books such as Awakenings and The Man Who (...) Mistook His Wife for a Hat, he is clinical professor of neurology at NYU Langone Medical Center in New York. Warwick is part of a consortium led by New York University which is building an applied science research institute, the Center for Urban Science and Progress (CUSP). Dr Sacks recently completed a five-year residency at Columbia University in New York, where he was professor of neurology and psychiatry. He also held the title of Columbia University Artist, in recognition of his contributions to the arts as well as to medicine. He is a fellow of the Royal College of Physicians and the Association of British Neurologists, the American Academy of Arts and Sciences, and the American Academy of Arts and Letters, and has been a fellow of the New York Institute for the Humanities at NYU for more than 25 years. In 2008, he was appointed CBE. (shrink)

Katharina D. Giesel befasst sich mit den Fragen, was in den verschiedensten Sozialwissenschaften unter Leitbildern verstanden wird, wie diese Kategorie konzeptionell in Forschungs- und Handlungskonzepte eingebunden wird und inwiefern ...

Many legal, social, and medical theorists and practitioners, as well as lay people, seem to be concerned with the harmfulness of discriminative practices. However, the philosophical literature on the moral wrongness of discrimination, with a few exceptions, does not focus on harm. In this paper, I examine, and improve, a recent account of wrongful discrimination, which divides into a definition of group discrimination, and a characterisation of its moral wrong-making feature in terms of harm. The resulting account analyses the wrongness (...) of discrimination in terms of intrapersonal comparisons of the discriminatee’s actual, and relevantly counterfactual, well-being levels. I show that the account faces problems from counterfactuals, which can be traced back specifically to the orthodox - comparative, counterfactual, welfarist - concept of harm. I argue that non-counterfactual and non-comparative harm concepts face problems of their own, and don’t fit easily with our best understanding of discrimination; hence they are unsuitable to replace the orthodox concept here. I then propose a non-orthodox - comparative, counterfactual, hybrid - concept of harm, which relies on counterfactual comparisons of ways of being treated. I suggest how such a concept can help us handle the problems from counterfactuals, at least for my account of discrimination. I also show that there are similar proposals in other harm-related debates. An upshot of the paper is thus to corroborate the case for a non-orthodox, hybrid concept of harm, which seems better able to fulfil its functional roles in a variety of contexts. (shrink)

A realist view of numbers often rests on the following thesis: statements like ‘The number of moons of Jupiter is four’ are identity statements in which the copula is flanked by singular terms whose semantic function consists in referring to a number (henceforth: Identity). On the basis of Identity the realists argue that the assertive use of such statements commits us to numbers. Recently, some anti-realists have disputed this argument. According to them, Identity is false, and, thus, we may deny (...) that the relevant statements commit us to numbers. The present paper argues that the correct linguistic analysis of the relevant number statements supports the anti-realist view that Identity is false. However, as will further be shown, pace the anti-realist, this analysis does not establish that such statements do not commit us to numbers after all. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly (...) negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

In today’s highly dynamic societies, moral norms and values are subject to change. Moral change is partly driven by technological developments. For instance, the introduction of robots in elderly care practices requires caregivers to share moral responsibility with a robot (see van Wynsberghe 2013 ). Since we do not know what elements of morality will change and how they will change (see van der Burg 2003 ), moral education should aim at fostering what has been called “moral resilience” (Swierstra 2013 (...) ). We seek to fill two gaps in the existing literature: (i) research on moral education has not paid enough attention to the development of moral resilience; (ii) the very limited literature on moral resilience does not conceptualise moral resilience in relation to new technological developments. We argue that philosophical accounts of moral education need to do justice to the importance of moral resilience, and that a specific form of moral resilience should be conceptualised as “technomoral resilience” to underline the added value of cultivating moral resilience in relation to technomoral change. We illustrate the role of technomoral resilience in practice by looking at the context of elderly care. To make the first step towards an account of how technomoral resilience can be fostered in moral education, we propose that moral education shall focus on a triangle of capacities: (1) moral imagination, (2) a capacity for critical reflection, and (3) a capacity for maintaining one’s moral agency in the face of disturbances. (shrink)

It has recently been pointed out that the cloudiness of the concept of authenticity as well as inflated ideologies of the ‘true self’ provide good reasons to criticize theories and ideals of authenticity. Nevertheless, there are also good reasons to defend an ethical ideal of authenticity, not least because of its critical and oppositional force, which is directed against experiences of self-abandonment and self-alienation. I will argue for an elaborated ethical ideal of authenticity: the ambitious ideal of a continuous self-reflective (...) process of ‘self-authentication’. For this purpose, the ideal of being authentic in expressing and unfolding one’s individual personality and characteristics will be combined with the ideal of being ‘an authentic person’ - whereby ‘a person’ is to be understood in a Kantian sense as an autonomous person who is reasonable and morally responsible. (shrink)

As the pre-eminent Enlightenment philosopher, Kant famously calls on all humans to make up their own minds, independently from the constraints imposed on them by others. Kant's focus, however, is on universal human reason, and he tells us little about what makes us individual persons. In this book, Katharina T. Kraus explores Kant's distinctive account of psychological personhood by unfolding how, according to Kant, we come to know ourselves as such persons. Drawing on Kant's Critical works and on his (...) Lectures and Reflections, Kraus develops the first textually comprehensive and systematically coherent account of our capacity for what Kant calls 'inner experience'. The novel view of self-knowledge and self-formation in Kant that she offers addresses present-day issues in philosophy of mind and will be relevant for contemporary philosophical debates. It will be of interest to scholars of the history of philosophy, as well as of philosophy of mind and psychology. (shrink)

Katharina Dück widmet sich in diesem Buch dem umfangreichen Doktrinenschatz des Begriffs „Materia prima“ im Spannungsfeld von Theorie und wiederholbarer Praxis in deutschsprachigen alchemisch-naturkundlichen Sachschriften des 16. Jahrhunderts. Sie trägt damit neue Aspekte zur Debatte des Materialismus in der Frühen Neuzeit bei. Untersucht werden Texte sogenannter Meisterdenker als auch Zeugnisse derer, die bisher wenig berücksichtigt wurden. Dem Corpus Paracelsicum und der Strömung des Paracelsismus wird besondere Beachtung gezollt. Drei rasterartig umrissene Grundmuster, denen die „Materia prima“-Vorstellungen zugeordnet sind, werden ausführlich (...) vorgestellt und dabei Kontinuitäten sowie Transformationen von vorhandenen Materie-Konzepten festgestellt.​. (shrink)

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

When facing a choice between saving one person and saving many, some people have argued that fairness requires us to decide without aggregating numbers; rather we should decide by coin toss or some form of lottery, or alternatively we should straightforwardly save the greater number but justify this in a non-aggregating contractualist way. This paper expands the debate beyond well-known number cases to previously under-considered probability cases, in which not (only) the numbers of people, but (also) the probabilities of success (...) for saving people vary. It is shown that, in these latter cases, both the coin toss and the lottery lead to what is called an awkward conclusion, which makes probabilities count in a problematic way. Attempts to avoid this conclusion are shown to lead into difficulties as well. Finally, it is shown that while the greater number method cannot be justified on contractualist grounds for probability cases, it may be replaced by another decision method which is so justified. This decision method is extensionally equivalent to maximising expected value and seems to be the least problematic way of dealing with probability cases in a non-aggregating manner. (shrink)

Recent social‐psychological research suggests that a considerable amount of, for example, racial and gendered discrimination may be connected to implicit biases: mental processes beyond our direct control or endorsement, that influence our behaviour toward members of socially salient groups. In this article I seek to improve our understanding of the phenomenon of implicit bias, including its moral status, by examining it through the lens of a theory of discrimination. In doing so, I also suggest ways to improve this theory of (...) discrimination, by creating conceptual space for implicit bias discrimination. I explore two ways of distinguishing direct and indirect discrimination and spell out the resulting four different forms of discrimination. The resulting taxonomy provides some room for implicit bias discrimination. I also deal with four challenges to my proposal for capturing implicit bias within discrimination theory: the metaphysical challenge, the moral insignificance challenge, the causal connection challenge, and the challenge from irreducibly collective bias. (shrink)

Developmental psychology currently faces a deep puzzle: most children before 4 years of age fail elicited-response false-belief tasks, but preverbal infants demonstrate spontaneous false-belief understanding. Two main strategies are available: cultural constructivism and early-belief understanding. The latter view assumes that failure at elicited-response false-belief tasks need not reflect the inability to understand false beliefs. The burden of early-belief understanding is to explain why elicited-response false-belief tasks are so challenging for most children under 4 years of age. The goal of this (...) article is to offer a pragmatic framework whose purpose is to discharge this burden. (shrink)

Hume's explanation of our tendency to confuse calm passions with reason due to lack of feeling appears to present a tension with his claim that we cannot be mistaken about our own impressions. I argue that the calm/violent distinction cannot be understood in terms of presence/absence of feeling. Rather, for Hume the presence or absence of disruption and disordering of natural and/or customary modes of thought is the key distinction between the calm and violent passions. This reading provides new explanations (...) of our confusion of calm passions with reason, and the potential for calm passions to prevail over violent. (shrink)

Purpose: To explain physical activity behavior, social-cognitive theories were most commonly used in the past. Besides conscious processes, the approach of dual processes additionally incorporates non-conscious regulatory processes into physical activity behavior theories. Habits are one of various non-conscious variables that can influence behavior and thus play an important role in terms of behavior change. The aim of this review was to examine the relationship between habit strength and physical activity behavior in longitudinal studies.Methods: According to the PRISMA guidelines, a (...) systematic search was conducted in three databases. Only peer-reviewed articles using a longitudinal study design were included. Both, habit and physical activity were measured at least once, and habit was related to physical activity behavior. Study quality was evaluated by assessment tools of the NHLBI.Results: Of 3.382 identified publications between 2016 and 2019, fifteen studies with different study designs were included. Most studies supported that positive correlations between habit and physical activity exist. Some positive direct and indirect effects of habit on physical activity were detected and only a minority of studies showed the influence of physical activity on habit strength. Studies differentiating between instigation and execution habit found positive correlations and revealed instigation habit as a stronger predictor of physical activity. The quality of studies was rated as reasonable using assessment tools of the NHLBI.Conclusion: This review revealed a bidirectional relationship between habit and physical activity. Whether habit predicts physical activity or vice versa is still unclear. The observation of habit influencing physical activity may be most appropriate in studies fostering physical activity maintenance while the influence of physical activity on habit may be reasonable in experimental studies with physical activity as intervention content to form a habit. Future investigations should differentiate between habit formation and physical activity maintenance studies depending on the research objective. Long-term study designs addressing the complexity of habitual behavior would be beneficial for establishing cue-behavior associations for the formation of habits. Furthermore, studies should differentiate between instigation and execution habit in order to investigate the influence of both variables on physical activity behavior independently. (shrink)

Lassen sich für die Kunst noch begriffliche Grenzen ziehen? Oder ist sie in einer Zeit, in der alles Kunst sein kann, letztlich an ihr Ende gelangt? In diesem Spannungsfeld bewegen sich die kunsttheoretischen Schriften des amerikanischen Philosophen Arthur C. Danto. Einerseits hat er unablässig die These verfochten, die Entwicklung der Kunst sei mit künstlerischen Strömungen wie der Pop Art an ihr Ende gelangt. Andererseits hat er um eine überzeugende Konturierung des Kunstbegriffs gerungen und eine der vielversprechendsten Kunstphilosophien des 20. Jahrhunderts (...) vorgelegt. Erstmals werden hier Dantos Schriften zur Bestimmung des Kunstbegriffs sowie zum Ende der Kunst zusammengelesen. Die Autorin nimmt die begrifflichen und zeitlichen Grenzen der Kunst in den Blick und fragt zugleich nach einer produktiven Bestimmung dieser 'Enden' innerhalb des nicht stillzustellenden Fortschreitens künstlerischer Praxis. (shrink)