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)

In lieu of an abstract, here is a brief excerpt of the content:Form and Discontent*Rosmarie Waldrop (bio)1. Composition as ExplanationIn the beginning there is Gertrude Stein, who says in “Composition as Explanation”: “Everything is the same except composition and as the composition is different and always going to be different everything is not the same” [520].I could also say, in the beginning is Aristotle: “the fable is simply this, the combination of the incidents” [1460].2. A Look AroundThe forms that (...) have been striking me as “wild” have tended to be Steinian in this sense of stressing the horizontal, the axis of composition. I’m most struck by 3 tendencies: one is literally spatial composition, e.g. Susan Howe’s work; another, an emphasis on discontinuity, leaps on the level of syntax, of logic, of grammar. Breaks that do not immediately fold back into a smooth unity and may occur in mid-sentence:I was on my way from Carthage, it was night. It is not wax I am scorching was dead about her with knots.—Norma Cole, MarsI hide behind a category by misbehaving.—Carla Harryman, Under the BridgeLoop conceived in a line, the spine with its regions, reasons. On another, sweaters hang by the wrist to dry. The list is sweet. You lie. The eye is met by the season.—Ron Silliman, ParadiseYou took my temperature which I had meant to save for a more difficult day.—Rosmarie Waldrop, The Reproduction of ProfilesWent out so I’d take the car and a whole system of banking and money is based on a hierarchy.—Leslie Scalapino, Considering How Exaggerated the Music IsROAST POTATOESRoast Potatoes for.—Gertrude Stein, “Tender Buttons”Or, a subtler example, Mei-mei Berssenbrugge’s almost unnoticeable shifts from one grammatical structure into another: [End Page 54]Never mind if he calls, the places you get through inwardness take time, and to drift down to the shore of the island, you know by the sand moving, even the coarse sand here It’s hard to say if you can even stand up, there....[13]The third tendency is mathematical. There is a lot of counting. Not stresses, not even syllables—I’m not considering that most unimaginative bunch, the new formalists—but words per line, sentences per paragraph. You all know about Ron Silliman’s love for the Fibonacci number series, or Lyn Hejinian’s My Life, which began with 37 sections of 37 sentences each. When she published a second edition at age 45, she added 8 sentences to each section plus 8 new sections.Jacques Roubaud: “No ideas but in numbers” [291].Then, in a somewhat more remote way, a number of people use ideas of permutation. For example, Jackson Mac Low’s 4 Trains, of which I will quote the first two stanzas:Train rule atom intricate nitrogen. Rule unusual leotard entropy. Atom train ostrich might. Intricate nitrogen train rule intricate casual atom train entropy. Nitrogen intricate train rule ostrich genealogy entropy nitrogen.Rule unusual leotard entropy. Unusual nitrogen unusual social unusual atom leotard. Leotard entropy ostrich train atom rule dies. Entropy nitrogen train rule ostrich pope yearly.[7]As Zukofsky puts it: “[Thus] poetry may be defined as an order of words that as movement and tone (rhythm and pitch) approaches in varying degrees the wordless art of music as a kind of mathematical limit” [27].All these examples draw attention to arrangement, composition. They all listen to language. I once wrote:I don’t even have thoughts, I say, I have methods that make language think, take over and me by the hand. Into sense or offense, syntax stretched across rules, relations of force, fluid the dip of the plumb line, the pull of eyes.... No beginnings. All unrepentant middle.[A Form / of Taking / It All 74]And none of these forms are “organic form.” None relies primarily on metaphor, though from the Romantics on poetry has been more or less identified with it.3. Frameworka. HistoricalLet me step back for a moment to the beginnings of the concept of organic form, what it reacted against.When Goethe started to make a splash writing free verse, around 1770, the dominant aesthetic... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Four Prose PoemsRosmarie Waldrop (bio)Conversation 9 On Varieties of OblivionAfter bitter resistance the river disappears into the night, he says. Washes the daily war out into tides of wounded dream. I know no word to dive from, the dark so dense, so almost without dimension, swallowing the sounds back into eclipse while making love to my body. Fish smell travels the regions of sleep, westward like the dawn. Then (...) I wake, too early to bring anything back, unsure of what I want, terrified I’ll fail to seize it by a hair.We need a grand decor for oblivion, she says. But the sea takes all with equal tenderness. As the past does. Already it suffuses the present with more inclusive tonalities. Not constraining it in melodic sequence, but setting a rooster next to the silence that molds my words. Or injured flesh. Impersonal. Only an animal could be so.An avatar of the holy ghost, he chuckles. Or the angel of the annunciation beating his wings against a door slammed shut. Behind it, love already plays the organ. With or without him. He is invisible because we have rejected his message.On old photos, she says, I see a stranger standing in my skin. As if an apple could fall too far from the tree. Yet she is called my past and functions as near-certainty. The way some beliefs are exempt from doubt, are as it were the hinges on which my doubts and questions turn. So that I seem the same to you while I’ve already moved through the next door. From left to right. [End Page 63]Conversation 10 On SeparationMy separation from the landscape started even earlier, she says. In my mother’s mirror, which staged dialectic and confused my instincts. There are few trains in the thick smoke, the run-down station, more waste of grain, more images lost. I carry a mirror in my cortex, but cannot inhabit my womb. Or the silence that is the matter between parts of speech.A pebble in an eddy, he says, reveals the course of the current. Sometimes it’s a small difference that makes our closeness arch, for a moment, into a solid vault, a space thick with birdsong and green sun. Then it again slips through my fingers. I search for a word, and nothing exists but the gap beckoning me to some strange horizon without event.Only out of body could we be out of the panic of time, she says. Momentarily bracket it maybe, in illness, degrees of withdrawal. But hours reproduce, days go by consumed by heat, the flimmer above the lake. I can’t distinguish gravity from other distortions of space, or sign from symbol. My sense of time begins six billion years ago, when the fish stretched their fins onto dry land though the sea groaned in their belly, or forty, with breasts and monthly bleeding. The now always already darkening, the way a sentence anticipates the period it will stiffen in.The galaxies avoid collapsing onto each other by virtue of their recessional motion, he says. Father and son walk away from the bed in opposite directions. But sweat clings to our names, the secretions of closeness. As if we were submerged in one and the same sleep. If I withdraw into more impermeable regions, your shadow grows. All respiratory passages lead to you. As if you were the certainty the game of doubting presupposes. The niggling voice of death. [End Page 64]Conversation 11 On DepthIt would take more than a pebble, she says, to sound your undertones. Something slips away as you speak, tense with life, like a startled beast in the woods. Is it a lizard, snake, or unused thought that runs alongside your words, while the rustling vines close over the trace of flight?Isn’t this a case, he says, of deep breathing pulled into spasms of interpretation the way children are pulled into the future by the very gravity of their innocence. And with a speed unlimited by the young space. The joints between future and present swell and sweep apart whole galaxies, but even the... (shrink)

In modern moral philosophy, virtue ethics has developed into one of the major approaches to ethical inquiry. As it seems, however, it is faced with a kind of perplexity similar to the one that Elisabeth Anscombe has described in Modern moral philosophy with regard to ethics in general. For if we assume that Anscombe is right in claiming that virtue ethics ought to be grounded in a sound philosophy of psychology, modern virtue ethics seems to be baseless since it lacks (...) or even avoids reflections on the human soul. To overcome this difficulty, the paper explores the conceptual connections between virtue and soul in Aristotle's ethics. It claims that the human soul is the principle of virtue since reflections on the soul help us to define the nature of virtue, to understand the different kinds of virtues, and to answer the question why human beings need the virtues at all. (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)

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)

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support (...) on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N= 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r= 0.51 and 0.56, respectively,p< 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r= −0.43,p< 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r= −0.30,p< 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis. (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)

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)

This essay reconsiders More's letter to Brixius. It uncovers early modern understandings of self-fashioning/ethos and epistolary conventions of the period, and with these contexts, it rereads More's self-presentation or ethos-development in the letter. The essay argues that More's ethos in the letter highlights an authentic facet of himself and, thereby, gives us a glimpse of the historical More who, in the Brixius moment, is angry, but not excessively or habitually, as has sometimes been claimed.

ZusammenfassungDie rechtliche Regelung der Fortpflanzungsmedizin ist dringend reformbedürftig. Das Embryonenschutzgesetz von 1990 erfasst die neuesten technischen Entwicklungen nicht, ist in manchen Bereichen unstimmig und lückenhaft, setzt die betroffenen Frauen, Paare und Kinder unnötigen gesundheitlichen Risiken aus, erschwert paradoxerweise die Durchsetzung von Kinderrechten und erzeugt Gerechtigkeitsprobleme und Rechtsunsicherheit für die betroffenen Paare und die behandelnden Ärztinnen und Ärzte.Das Embryonenschutzgesetz enthält zudem nur strafrechtliche Verbote. Diese erlauben keine angemessene Reaktion auf die medizinische Entwicklung und den gesellschaftlichen Wandel und werden der Komplexität der (...) Materie nicht gerecht.Diese Probleme müssen gelöst werden. Der Bundesgesetzgeber verfügt seit mehr als 20 Jahren über die Kompetenz zur Regelung der Fortpflanzungsmedizin. Er sollte in der kommenden Legislaturperiode ein umfassendes Fortpflanzungsmedizingesetz schaffen. (shrink)

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ABSTRACT Leaders have been thought to play a vital role in influencing employees’ unethical behavior. However, what happens to leaders and followers in the aftermath of unethical conduct has received little attention in the literature. Drawing from the correspondent inference theory, we examine the conditions under which leaders attribute their followers’ unethical behavior to poor moral character and eventually assign them low performance ratings. Through a two-wave research design and data from 290 matched employee–leader dyads, we found that a leader (...) is more likely to infer that a follower who has engaged in unethical behavior is of poor moral character when the leader has a higher moral identity, and the leader will impose lower performance ratings on this follower when the leader prefers lower moral decoupling. (shrink)

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)