BackgroundHealthcare is permeated by phenomena of vulnerability and their ethical significance. Nonetheless, application of this concept in healthcare ethics today is largely confined to clinical research. Approaches that further elaborate the concept in order to make it suitable for healthcare as a whole thus deserve renewed attention.MethodsConceptual analysis.ResultsTaking up the task to make the concept of vulnerability suitable for healthcare ethics as a whole involves two challenges. Firstly, starting from the concept as it used in research ethics, a more detailed (...) characterization and systematization of the different realms of human abilities and the various ways in which these realms contain vulnerability is to be established. Secondly, at the same time, the sought-after concept of vulnerability should avoid picturing the relation between healthcare recipient and provider as a relation between a dependent individual in need and another individual capable of providing all the help necessary. An adequate concept of vulnerability should enable one to understand when and in which respects care providers may be vulnerable as well. Philosophical accounts of vulnerability can help to meet both of these challenges.ConclusionsPhilosophical accounts of vulnerability can help to make the concept of vulnerability suitable for healthcare ethics as a whole. They come with a price, though. While the ethical role of vulnerability in medical ethics usually is to signify states of affairs that are to be diminished or overcome, philosophical accounts introduce forms of vulnerability that are regarded as valuable. Further analyzing and systematizing forms and degrees of vulnerability thus comprises the task to distinguish between amounts and types of vulnerability that can count as valuable, and amounts and types of vulnerability that are to be alleviated. (shrink)

Healthcare is permeated by phenomena of vulnerability and their ethical significance. Nonetheless, application of this concept in healthcare ethics today is largely confined to clinical research. Approaches that further elaborate the concept in order to make it suitable for healthcare as a whole thus deserve renewed attention. Conceptual analysis. Taking up the task to make the concept of vulnerability suitable for healthcare ethics as a whole involves two challenges. Firstly, starting from the concept as it used in research ethics, a (...) more detailed characterization and systematization of the different realms of human abilities and the various ways in which these realms contain vulnerability is to be established. Secondly, at the same time, the sought-after concept of vulnerability should avoid picturing the relation between healthcare recipient and provider as a relation between a dependent individual in need and another individual capable of providing all the help necessary. An adequate concept of vulnerability should enable one to understand when and in which respects care providers may be vulnerable as well. Philosophical accounts of vulnerability can help to meet both of these challenges. Philosophical accounts of vulnerability can help to make the concept of vulnerability suitable for healthcare ethics as a whole. They come with a price, though. While the ethical role of vulnerability in medical ethics usually is to signify states of affairs that are to be diminished or overcome, philosophical accounts introduce forms of vulnerability that are regarded as valuable. Further analyzing and systematizing forms and degrees of vulnerability thus comprises the task to distinguish between amounts and types of vulnerability that can count as valuable, and amounts and types of vulnerability that are to be alleviated. (shrink)

While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake. Even though Tiered Consent, Dynamic Consent and Meta Consent are designed to the demands of the self-determination perspective as well as the perspective of research as (...) a public good, they are still also criticized from both perspectives. In addition, criticisms based on concerns of justice, participation and democratic deliberation, and relational concerns have been levelled at each of the models. As all of these perspectives have valid points to make, the task at hand lies in balancing these ethical perspectives. What constitutes an adequate balancing depends on contextual factors. These factors include digital infrastructure and digital literacy, data safety regulation, good scientific and clinical practice, transparent debates on ethically relevant features of research, social inequalities, anti-discrimination laws and practices, trust in health care institutions and recognition of patient preferences, and consensus on unethical research. We argue that the role of context in determining acceptable models of consent puts the ethical importance of models of consent into perspective. Since altering contextual factors can help to live up to the ethical concerns at stake in debates about models of consent, opting for such a shift of focus comes without ethical loss. (shrink)

The elderly are often considered a vulnerable group in public and academic bioethical debates and regulations. In this paper, we examine and challenge this assumption and its ethical implications. We begin by systematically delineating the different concepts of vulnerability commonly used in bioethics, before then examining whether these concepts can be applied to old age. We argue that old age should not, in and of itself, be used as a marker of vulnerability, since ageing is a process that can develop (...) in a variety of different ways and is not always associated with particular experiences of vulnerability. We, therefore, turn to more fundamental phenomenological considerations in order to reconstruct from a first person perspective the intricate interconnections between the experiences of ageing and vulnerability. According to this account, ageing and old age are phenomena in which the basic anthropological vulnerability of human beings can manifest itself in an increased likelihood of harm and exploitation. Thus, we plead for a combined model of vulnerability that helps to avoid problems related to the current concepts of vulnerability. We conclude first that old age as such is not a sufficient criterion for being categorized as vulnerable in applied ethics, and second that reflections on ageing can help to develop a better understanding of the central role of vulnerability in human existence and in applied ethics. (shrink)

The extent to which machine metaphors are used in synthetic biology is striking. These metaphors contain a specific perspective on organisms as well as on scientific and technological progress. Expressions such as “genetically engineered machine”, “genetic circuit”, and “platform organism”, taken from the realms of electronic engineering, car manufacturing, and information technology, highlight specific aspects of the functioning of living beings while at the same time hiding others, such as evolutionary change and interdependencies in ecosystems. Since these latter aspects are (...) relevant for, for example, risk evaluation of uncontained uses of synthetic organisms, it is ethically imperative to resist the thrust of machine metaphors in this respect. In addition, from the perspective of the machine metaphor viewing an entity as a moral agent or patient becomes dubious. If one were to regard living beings, including humans, as machines, it becomes difficult to justify ascriptions of moral status. Finally, the machine metaphor reinforces beliefs in the potential of synthetic biology to play a decisive role in solving societal problems, and downplays the role of alternative technological, and social and political measures. (shrink)

Synthetic biology is a new biotechnology that is developing at an impressive pace and attracting a considerable amount of attention from outside the scientific community as well. In this article, two main philosophically and ethically relevant characteristics of this field of research will be laid bare, namely its reliance on mechanistic metaphors to denominate simple forms of life and its appeal to the semantic field of creativity. It is argued that given these characteristics synthetic biology can be understood as a (...) prime example of a kind of human interference with reality that German philosopher Hannah Arendt called “fabrication.” This kind of self-world-relation contrasts to “action,” a relation that introduces, among other things, the idea of an inherent value of the object acted upon. Taking up this latter perspective, one scientific and two ethical challenges to synthetic biology’s take on the realm of life are identified. (shrink)

Synthetic biology can be understood as expanding the abilities and aspirations of genetic engineering. Nonetheless, whereas genetic engineering has been subject to criticism due to its endangering biodiversity, synthetic biology may actually appear to prove advantageous for biodiversity. After all, one might claim, synthesizing novel forms of life increases the numbers of species present in nature and thus ought to be ethically recommended. Two perspectives on how to spell out the conception of intrinsic value of biodiversity are examined in order (...) to assess this line of thought. At the cost of introducing two separate capacities of human knowledge acquisition, the ‘admiration stance’ turns out to reject outright the assumption of a synthetic species' intrinsic value and of an imperative to create novel species. The ‘kinship stance’ by contrast does ascribe value to both synthetic and natural species and organisms. Nonetheless, while from this perspective creating novel species may become an ethical demand under certain conditions, it favours changing organisms by getting in contact with them rather than synthesizing them. It is concluded that neither the admiration nor the kinship stance warrants a supposed general moral obligation to create novel species to increase biodiversity. (shrink)

Das Forschungsfeld der Synthetischen Biologie lässt sich als eine Fortentwicklung der Gentechnik verstehen, bei der in besonderer Weise ingenieurwissenschaftliche Methoden und Paradigmen zum Tragen kommen. Die Synthetische Biologie profitiert dabei von den Fortschritten der Gensequenzierungs- und DNA-Synthesetechnologien und von neuen Verfahren des Genome Editing. DNA-Sequenzen bis hin zu ganzen Genomen einzelliger Organismen können rekombiniert und vollständig synthetisiert werden und die entsprechenden intra- und interzellulären Prozesse können zielgerichtet verändert werden. Mit dieser im Vergleich zur klassischen Gentechnik erhöhten Eingriffstiefe verbindet sich in (...) der Synthetischen Biologie das ingenieurwissenschaftlich geprägte Ideal, DNA-Sequenzen modularisiert und standardisiert zu beschreiben, so dass sie als BioBricks je nach intendiertem Anwendungszweck des zu verändernden Organismus frei miteinander kombiniert – ›zusammengesteckt‹ – werden können. (shrink)

Synthetic biology is an emerging technology that aims to design and engineer DNA and molecular structures of single cell organisms. Existing organisms can be altered, novel organisms can be created. In doing so, synthetic biology makes use of specific technoscientific understandings of living beings. This volume sets out to explore and assess synthetic biology and its notions of life from philosophical, ethical, social, and legal perspectives. Contents Concepts, Metaphors, Worldviews.- Public Good and Private Ownership.Social and Legal Ramifications.- Opportunities, Risks, Governance. (...) Target Groups Scholars of sociology, philosophy, theory of science, history of science, biology, engineering Politicians and policymakers The Editor Dr. Joachim Boldt is Deputy Director at the Institut für Ethik und Geschichte der Medizin in Freiburg, Germany. (shrink)

In den Publikationen der Synthetischen Biologie und in Darstellungen dieser neuen Biotechnologie finden sich häufig Begriffe des Herstellens, Konstruierens, Erschaffens und Kreierens. Im folgenden Beitrag wird dieses Begriffsfeld auf der Basis von technikphilosophischen und kunsttheoretischen Ansätzen systematisiert. Es wird erstens untersucht, inwiefern sich die verschiedenen Forschungsrichtungen in der Synthetischen Biologie mit diesem Begriffsinstrumentarium angemessen beschreiben lassen; zweitens wird analysiert, welche ethischen Fragestellungen mit den unterschiedlichen Begriffen des Herstellens und Erschaffens im Fall der Synthetischen Biologie verbunden sind.

Zur Verbesserung der Begutachtungspraxis muss die Prüfung von Forschungsvorhaben durch Ethikkommissionen als Abwägungsprozess verstanden werden. Die übergeordnete Aufgabe von Ethikkommissionen besteht darin, im Spannungsfeld von Therapie und Forschung möglichst hohen Schutz für Patientinnen und Patienten zu gewährleisten. Die naturwissenschaftliche Forschungsmethodik muss durch das Ziel der Therapie „gezähmt“ werden.

Gedächtnis-Enhancement oder Memory-Enhancement ist ein Teilbereich der verschiedenen Ansätze zur pharmakologischen und technischen Verbesserung menschlicher Leistungsfähigkeit. Wie Erfahrungsberichte von Menschen mit von Natur aus gesteigertem Erinnerungsvermögen zeigen, ist eine Steigerung der Gedächtnisfähigkeit prinzipiell möglich. Allerdings verweisen diese Erfahrungen auch auf einige Komplikationen und Beschwernisse infolge dieser gesteigerten Leistungsfähigkeit. Es wird argumentiert, dass erstens diejenigen philosophischen Theorien, die die Funktion des Gedächtnisses v. a. in der Speicherung von Informationen lokalisieren, einige dieser Probleme nicht antizipieren und nur unzulänglich erklären können. Zweitens wird (...) argumentiert, dass philosophische Konzepte zur Funktion von Erinnern und Vergessen, die deren Bedeutung bei der Bildung eines normativ geleiteten Selbstverständnisses in den Vordergrund stellen, diese und weitere mögliche Komplikationen deutlicher in den Blick bekommen können. Beispielhaft wird hier auf Ansätze von Ricoeur und Nietzsche eingegangen. (shrink)

An interpretation of Kierkegaard’s most provocative work, in which the Danish philosopher makes the biblical account of Abraham’s sacrifice of Isaac the epitome of faith.

Since the second half of the twentieth century, the principle of autonomy has come to be regarded as the cornerstone of medical ethics. Older principles of medical ethics, such as beneficence and non-maleficence, both of which can be subsumed under the concept of “care”, have correspondingly decreased in importance. Drawing on hermeneutic analyses of the constitutive interrelations between autonomous will-formation on the one hand, and well-being and social embeddedness on the other hand, it will be argued that a proper understanding (...) of autonomy necessarily incorporates attention to well-being and care, and vice versa. The true ethical challenge is not to determine whether autonomy or care ought to take precedence, but to understand respecting autonomy and providing care as two aspects of one and the same ethical demand to attend to and help other individuals. (shrink)

This book is open access under a CC BY 4.0 license. This book examines the concept of care and care practices in healthcare from the interdisciplinary perspectives of continental philosophy, care ethics, the social sciences, and anthropology. Areas addressed include dementia care, midwifery, diabetes care, psychiatry, and reproductive medicine. Special attention is paid to ambivalences and tensions within both the concept of care and care practices. Contributions in the first section of the book explore phenomenological and hermeneutic approaches to care (...) and reveal historical precursors to care ethics. Empirical case studies and reflections on care in institutionalised and standardised settings form the second section of the book. The concluding chapter, jointly written by many of the contributors, points at recurring challenges of understanding and practicing care that open up the field for further research and discussion. This collection will be of great value to scholars and practitioners of medicine, ethics, philosophy, social science and history. (shrink)

Care is among the most important concepts in healthcare. It is not only a descriptive concept, but it also conveys a normative orientation. Approaches to the ethics of care have shown that care can indeed be understood as an overarching normative concept that integrates different normative orientations. Nonetheless, determining what constitutes good care is usually a matter of finding reasonable compromises. In healthcare settings, a typical compromise involves finding a balance between optimal care for individuals on the one hand and (...) the institutional demands of providing care to many care receivers over long periods of time as well as the limits of what can legitimately be asked of individual care providers on the other. (shrink)