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The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)

IntroductionBurnout is a growing problem among young researchers, affecting individuals, organizations and society. Our study aims to identify burnout profiles and highlight the corresponding job demands and resources, resulting in recommendations to reduce burnout risk in the academic context.MethodsThis cross-sectional study collected data from young researchers at five Flemish universities through an online survey measuring burnout risk, work engagement, sleeping behavior, and the most prominent job demands and resources. We conducted Latent Profile Analysis to identify burnout profiles in young researchers (...) and subsequently compared these groups on job demands and resources patterns.ResultsFive burnout profiles were identified: High Burnout Risk, Cynical, Overextended, Low Burnout Risk, and No Burnout Risk. Each burnout profile was associated with a different pattern of job demands and resources. For instance, high levels of meaningfulness decreased the odds to being classified in the Cynical profile.ConclusionOur findings show that the Cynical profile corresponds to a relatively high number of young researchers, which may imply that they are particularly vulnerable to the cynicism dimension of burnout. Additionally, work-life interference and perceived publication pressure seemed the most significant predictors of burnout risk, while meaningfulness, social support from supervisor and learning opportunities played an important protective role. (shrink)

Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)

Feminist scholars have identified pervasive gender discrimination in science as an institution, as well as gender bias in the very content of many scientific theories. An ameliorative project at heart, feminist philosophy of science has inquired into the social and epistemological roots and consequences of these problems and into their potential solutions. Most feminist philosophers agree on a need for diversity in scientific communities to counter the detrimental effects of gender bias. Diversity could thus serve as a unifying concept for (...) a potential consensus of the field. Yet there are substantial differences in the kinds and roles of diversity envisaged. This element argues that we need diversity, both in terms of social locations and of values, to overcome former biases and blind spots. Diversity as such, however, is insufficient. To reap its epistemic benefits, diversity also needs to be institutionalised in a way that counters various forms of epistemic injustice. (shrink)

Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a ‘de-moralized’ discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models of addiction may seem (...) to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction. (shrink)

This article gives an overview of the influence of the work of Michel Foucault on the philosophy of Agamben. Discussed are Foucault’s influence on the Homo Sacer cycle, on (the development) of Agamben’s notion of power (and on his closely related notion of freedom and art of life), as well as on Agamben’s philosophy of language and methodology. While most commentaries focus on Agamben’s interpretation of Foucault’s concept of biopower, his work also contains many interesting references to Foucault on freedom (...) and possibilities—and I think that it is here that Foucault’s influence on Agamben is most deeply felt. This article focuses on the shifts Agamben takes while looking for the Entwicklungsfähigkeit in the work of Foucault. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

Zusammenfassung In der Langzeitbetreuung von Menschen mit Demenz finden kommunikative Handlungen, die das Potenzial haben, Menschen mit Demenz zu täuschen, auf der Seite des Personals eine unterschiedliche Akzeptanz. Bushaltestellen, an denen kein Bus fährt, falsche Zugabteile, in denen ein Film die vorbeiziehende Landschaft simuliert, das Verstecken von Medikamenten in Nahrungsmitteln sind Interventionen, die Menschen in die Irre führen können, ohne ihnen tatsächlich falsche Informationen zu geben. Derartige kommunikative Praktiken wie Täuschungen, aber auch Lügen, definiert als absichtlich mitgeteilte irreführende Nachrichten, werfen (...) die Frage auf, wie sie ethisch begründet werden können. Anhand einer fiktiven Fallschilderung, in dem eine Pflegeheimbewohnerin mit Hilfe eines vorgetäuschten Telefonanrufs daran gehindert wird, das Heim zu verlassen, zeige ich, dass die Täuschung, als eine von drei möglichen Handlungsoptionen, aus der Fürsorgeperspektive positiv bewertet werden kann, da die Bewohnerin ohne Zwang am Verlassen des Heimes gehindert wird. Das Prinzip der Autonomie aber wird verletzt, da die Bewohnerin nicht frei zwischen der Täuschung und der Realität wählen kann. Hinsichtlich der Verpflichtung gegenüber Dritten ist die Täuschung problematisch, da orientierte Bewohner und Bewohnerinnen die Szene beobachten und befürchten könnten, sie würden ebenfalls getäuscht. Die Synthese der verschiedenen Argumente zeigt, dass ein Spaziergang in Verbindung mit einem validierenden Gespräch als weitere Handlungsoption die Prinzipien der Fürsorge und Autonomie in Einklang bringt, aber aufgrund des Zeitaufwands das Risiko einer ungerechten Verteilung der Pflegeressourcen birgt. (shrink)

While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences (...) of the proposed moral obligation to actively reinterpret variant classifications that carry a higher risk of being false positives. Such reclassification is likely to result in ‘downgrades’: previously pathogenic variants (pathogenic/likely pathogenic, P/LP) reclassified to benign (likely benign/benign, LB/B) or uncertain variants (variant of uncertain significance, VUS). Any laboratory policy to actively reinterpret (specific sets of) classifications will confront the clinician with the question whether the person tested should be recontacted on a reinterpretation of previously reported results. As others have pointed out, recontacting in general comes with challenges, since patients may not want to be recontacted or have forgotten about their genetic test.2 3 Recontacting in case of a downgrade, however, is particularly impactful. Previous studies on the psychosocial impact of reclassification on patients …. (shrink)

At present, the debate on global justice, a debate which is at the core of global ethics, is largely being conducted by European and American scholars from different disciplines without taking into account views and concepts from other regions of the world, particularly, from the Global South. The lack of a truly intercultural, interreligious, and international exchange of ideas provokes doubts whether the concepts of global justice introduced so far are able to transcend regional and cultural horizons. The article introduces (...) concepts of justice from African scholars, whose voices have remained marginal until now, like the Kenyan philosopher Henry Odera Oruka, the Ethiopian philosopher Teodros Kiros, and the debate on ubuntu, one of the most controversial concepts in southern Africa today. These concepts focus on issues that are seldom considered in the debate on global justice, such as the importance of bodily needs as a prerequisite for human beings to act as moral beings and the importance of human rel.. (shrink)

This supplement serves a double purpose. It presents, on the one hand, a selection of papers devoted to the title question “How much philosophy in the philosophy of science?”. On the other hand, it signalizes the newly established cooperation between the German Society for the Philosophy of Science and the Journal for General Philosophy of Science .The GWP was founded in Hannover in 2011 and had its inaugural conference in March 2013 [for a report on the “GWP.2013” by H. Lyre (...) see EPSA Newsletter 2 2013]. The society was launched for several reasons. Albeit the German community of philosophers of science is quite large , it is at the same time a rather distributed and dispersed community. This has to do with the university landscape in Germany, which is dispersed rather t .. (shrink)

The nomadic Kazaks inhabiting Xinjiang Province, China, retain many aspects of their pre‐Islamic way of life, including the use of methods of traditional healing usually classified under the rubric of "shamanism." These practices are closely related to those in Kazakstan, Mongolia, and other parts of the former Soviet Union.The present study addresses aspects of traditional healing in use among the Xinjiang Kazaks in recent times, and presents a native taxonomy of these practices obtained during recent fieldwork in Xingjiang. Special attention (...) is paid to the use of words, sound, and movement in healing contexts by elders and specialized individuals. (shrink)

In this paper I will argue that liberal multiculturalism is neither a necessary nor a convincing extension of liberalism. In evaluating the two main strands of liberal multiculturalism, I will first analyse the approaches of Charles Taylor and Bhikhu Parekh as the main proponents of the version that focuses on the cultures themselves and raises the issue of the value of cultures in connection with public discourse. I will then turn to Amy Gutmann and Will Kymlicka as liberal multiculturalists who (...) use the liberal norm of individual equality as a starting point. I will show that the arguments adduced in favour of liberal multiculturalism fail, due to the following shortcomings. Taylor’s approach is underspecified with respect to the relationship between the process of evaluating cultures and its outcome. Gutmann’s theory fails to bridge the gaps between the individual, cultural belonging and positive duties of the state. Parekh’s and Kymlicka’s theories lead back to liberalism. I conclude that the idea of cultural difference has little of substance to add to the liberal view of social justice. (shrink)

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In this (...) paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

This article examines the relation between the critical theory of Moishe Postone and the philosophy of Theodor Adorno. While the former is clearly influenced by the latter, these influences mostly stay implicit. When explicit, he does not so easily put his own thought in line with Adorno’s and is highly critical of him. I will investigate the ways in which ideas from Adorno made their way into Postone’s work, but also where the latter diverts from them. As will be shown, (...) Postone’s critical theory runs into a problem when one examines the immanent ground of his critical norm, freedom. Adorno, on the contrary, does succeed in employing the same norm in his own immanent critique. I will conclude that the problem Postone encounters can be avoided by being more of an ‘Adornian’, and that his theory allows this. (shrink)

This collection features eleven original essays, divided into three thematic sections, which explore the work of Wilfrid Sellars in relation to other twentieth-century thinkers. Section I analyzes Sellars’s thought in light of some of his influential predecessors, specifically Ludwig Wittgenstein, Rudolf Carnap, John Cook Wilson, and Kazimierz Ajdukiewicz. The second group of essays explores from different perspectives Sellars’s place within the analytic tradition, including his relation with analytic Kantianism and analytic pragmatism. The book’s final section extracts some of the most (...) significant lessons Sellars’s work has to offer for contemporary philosophy. These chapters address his views on inference, his views on truth and its connection to recent discussions about truth-relativism and truth-pluralism, his conception of self-knowledge, and his theory of perceptual experience. (shrink)

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

In recent years, the practices of artists in non-artistic environments have set my mind in motion. Where before I could marvel at the visual outcomes of the artistic process and would want to understand how processes of creating meaning could be described, I am now particularly struck by the way in which artists are present, by their way of looking, how they make decisions, when and how they act, how they take responsibility. I have conversations with them and ask questions (...) to better understand their processes, and I explore literature to find people with a similar quest. This process of moving and being moved lies at the heart of the book 'The Artistic Attitude'"--Page 4 of cover. (shrink)

ArgumentIn the spring of 1893, the Austrian writer and critic Hermann Bahr began interviewing various people on antisemitism, a subject of heated discussion in the European feuilleton around 1900. “Once again, I am travelling the world sounding out people’s opinions and listening to what they have to say,” he wrote in his introduction to a series of articles on that issue that appeared in the feuilleton of the Deutsche Zeitung between March and September 1893. A year later, the Berlin publishing (...) house S. Fischer turned Bahr’s articles into a book. Bahr conducted a total of thirty-eight interviews with prominent personages, such as August Bebel, Theodor Mommsen, Ernst Haeckel, Henrik Ibsen and Jules Simon. Bahr did not focus on the arguments in favour or against antisemitism. Instead, he set out explicitly to investigate the sentiments, perceptions and opinions on this topic within the cultured classes. Yet, as I will show in this article, Bahr tried to capture not only the “sentiments” [Empfindungen] aired by his interviewees, but also the settings and interiors in which the interviews took place. I argue that these descriptions of physical space served Bahr as authentication, as a three-dimensional certificate for the “facts of opinion” [Meinungstatsachen] he recorded. (shrink)

In this paper I will analyze several cases from the American Civil War, the two World Wars and the American Vietnam War, and contemporary research in enhancement substance, to determine how drug use can be analyzed and understood in both physical and moral (ethical) terms. This will require a discussion of drug use at different levels. First, I will address the consequences of drug use for the physical and mental sanity of soldiers, during and after wartime, irrespective of the reason (...) for drug use. Second, I will look into the moral questions related to drug use for the enhancement of soldiers, that is, as a method for modern warfare. The moral dimension has at least two different angles: (i) the moral responsibility of superiors administering drugs to their inferiors who are exposed to the rule of full obedience, and (ii) the ethical consequences of enhancement for moral judgment by soldiers in the gray zone between acts of war and war crimes (the difference between the Super soldier and the Killing machine). (shrink)

Pickard (2012) claims that the neurobiological or disease model of addiction hinders the recovery of people because it undermines their feeling of self-efficacy and agency. Sub- stance users are “not aided by being treated as victims of a neurobiological disease, as opposed to agents of their own recovery” (40).Although Pickard acknowledges that claims of powerlessness or loss of agency can have a functional role in the self-narratives of substance users in excusing them from blame, she primarily focuses on the negative (...) effects of the diseasemodel on the recovery of substance users. Preliminary evidence from in-depth interviews with heroin-dependent participants in our current cohort study on addiction and moral identity supports Pickard’s claims in part: Substance users describe grades of control, psychological distress, and loss of options, and an ambivalent attitude toward their belief in self-efficacy. However the interviews also provide points of critique. While Pickard is right to dismiss the more extreme claims of proponents of the disease model—namely, that drug use in addicts is literally compelled—user responses suggest that an understanding of the neurobiology of addiction might in some respects support rather than undermine a sense of agency. Moreover, there is reason to suppose that the relation be- tween substance use and psychological distress is not as straightforward as Pickard claims. In this respect we believe the debate must become more nuanced and move beyond a simple opposition between the disease model and the rational choice model endorsed by Pickard. (shrink)

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)

Psychiatric classification is highly controversial, as could be witnessed again with the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These controversies comprise multiple kinds of critiques by a variety of actors. It is unlikely that all these issues will be overcome by one perfect solution in the future. Rather, it is precisely the DSM’s “one-size-fits-all-approach” that lies at the root of many of the current problems. To restore the scientific and public credibility of psychiatric classification, (...) a multi-dimensional pluralist response is thus needed: (1) theoretical pluralism, meaning a promotion of different research projects and heuristic strategies, (2) taxonomic pluralism, which allows for different classifications used in research versus clinical practice, and (3) participatory pluralism, which concerns the diversity of perspectives and stakeholders in DSM-revisions. (shrink)