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)

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)

When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the (...) data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents’ problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers’ own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them. (shrink)

The value-freedom of scientific knowledge is commonly hold to be a necessary condition for objectivity. Helen Longino’s contextual empiricism aims to overcome this connection. She questions the suitability of the normative ideal of value-freedom and develops an alternative conception of objectivity, which integrates social and epistemic aspects of scientific enquiry. The function of this notion of ‘social objectivity’ is to make value-laden assumptions assessable through a process of criticism, even if there cannot be any guarantee of their elimination. This assessability (...) requires common standards of evaluation, which are threatened by Longino’s rejection of the distinction between cognitive and non-cognitive values guiding theory choice. I will argue that in order to resolve this inherent tension, social objectivity has to be understood as based on a procedural epistemology and, differing from Longino’s own approach, must include the normative requirement to strive for consensus instead of allowing for epistemological pluralism. (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)

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)

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)

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)

The reception and revival of Ibn Rušd in the Arab world of the 20th century provides a profound insight into the efforts of prominent Arab intellectuals to redefine Islamic culture and reveals the possibilities and limits of a dialogue with the West.

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)

People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction, because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis’s work (...) offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people’s agency can also result in people losing belief in their self-efficacy. Lewis’s strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent’s values and to available techniques of self-control. However, the agent can overcome this stage by developing new techniques of self-control, by building on their self-concept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent. (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 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)

ABSTRACTThis is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task, an Emotional Visual Search Task, and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: (...) evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying... (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.

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)

Die Frage nach einer globalen Ethik stellt sich heute verschärft unfgrund der neuen Qualität gegenseitiger Abhängigkeit der einzelnen Staaten und Regionen beruhend auf einer eng verknüpften Weltwirtschaft und dem weltumspannenden Netz modernen Kommunikationssysteme. Diese Verknüpfung zeigt sich am deutlichsten in der Vernetzung transnationaler Konzerne, deren Produktionsstätten nicht mehr an nationale Territorien gebunden sind. Die Entstehung einer globalen Interdependenz hängt jedoch nicht nur mit ökonomischen Entwicklungen oder der neuen Effizienz der Kommunikationstechniken zusammen, sondern auch mit der in diesem Jahrhundert entstandenen Möglichkeit (...) einer ökologischen oder militärischen Selbstzerstörung der Erde durch den Menschen. (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)

The aim of this chapter is to question the punitive approach towards substance dependent parents, especially substance dependent parents struggling with poverty, by outlining the complex ways in which poverty can shape reasoning, and hence capacities for self-control. I will outline two ways in which poverty can shape reasoning: a rational shift from a global to a local perspective, and a more invasive one: resignation. I will argue that when people with addictions become resigned, it is especially important to not (...) hold a punitive approach, but to treat them with compassion while simultaneously bootstrapping their sense of agency. I will argue that having children can be an important turning point for people struggling with addiction, and possibly resignation. In order to successfully turn their lives around, they must feel comfortable to seek professional support without fear for retribution or stigma. This paradigm shift in how we treat substance dependent parents will be an important contribution to breaking the circle of intergenerational transmission of resignation, poverty and substance abuse. (shrink)

The idea of an ethics of extreme emergency follows from the suspicion that what is morally permitted in the ordinary course of events could not cover what may seem supposedly morally required in a situation of emergency. There is claimed to be a demand for an ethics that gives reasons for moral permission for actions beyond what is generally morally permitted. The paper provides reasons for the argument that what is generally morally permitted does cover what is morally permitted in (...) situations of emergency and states that the rejection of entails a profound undermining of the ordinary moral code, the only resource available to legitimate action seemingly being beyond this code. (shrink)

TheoryDigital technologies have become an integral part of everyday life that children are exposed to. Therefore, it is important for children to acquire an understanding of these technologies early on by teaching them computational thinking as a part of STEM. However, primary school teachers are often reluctant to teach CT. Expectancy-value theory suggests that motivational components play an important role in teaching and learning. Thus, one hindrance to teachers’ willingness to teach CT might be their low expectancies of success and (...) high emotional costs, e.g., anxiety towards CT. Thus, introducing preservice teachers to CT during their university years might be a promising way to support their expectancies and values, while simultaneously alleviating their emotional costs. Prior CT competences might contribute to these outcomes.AimsWe investigated whether a specifically designed seminar on CT affected preservice teachers’ expectancies and values towards programming.Method: A total of 311 German primary school and special education preservice teachers took part in the study. The primary school preservice teachers received a seminar on CT and programming with low-threshold programming tasks, while the special education teachers served as a baseline group. The seminar was specifically designed to enhance expectancies and values and decrease emotional costs, following implications of research on expectancy-value theory.ResultsThe preservice teachers who visited the seminar gained higher expectancies and values towards CT and programming compared to the baseline group. Moreover, their emotional costs decreased. CT was positively related to change in expectancies and values and negatively related to emotional costs.DiscussionInterventions with low-threshold programming tasks can support primary school preservice teachers in finding trust in their abilities and values towards CT. Moreover, their anxiety towards CT and programming can be alleviated. Thus, first steps in preparing preservice teachers to teach CT in their future classrooms can be taken in university. (shrink)

Theory Young children have an understanding of basic science concepts such as stability, yet their theoretical assumptions are often not concerned with stability. The literature on theory theory and theory-evidence coordination suggests that children construct intuitive theories about their environment which can be adjusted in the face of counterevidence that cannot be assimilated into the prior theory. With increasing age, children acquire a Center theory when balancing objects and try to balance every object at their middle, succeeding with symmetrical objects. (...) Later, they acquire the basic science concept of stability through learning that the weight distribution of an object is of importance. Thus, they acquire a Mass theory and succeed in balancing asymmetrical objects as well. Fluid and crystallized intelligence might contribute to children’s acquisition of Mass theory. Moreover, their Mass theory might be supported by implementing a playful intervention including (a) material scaffolds and (b) verbal scaffolds. Aims We investigated which theories children have about stability and whether these theories can be adjusted to Mass theory by implementing a playful intervention. Method A total of 183 5- to 6-year-old children took part in the study with a pre-post-follow-up intervention design. Children’s Mass theory was assessed with an interview in which children explained constructions’ stabilities. The children received a playful intervention with two differing degrees of scaffolding (material scaffolds or material + verbal scaffolds) or no scaffolding. Results At first few children used a Mass theory to explain their reasoning. However, after being confronted with counterevidence for the asymmetrical constructions, children changed their explanation and applied a Mass theory. More children in the play group with the highest degree of scaffolding, i.e., material + verbal scaffolds, acquired a Mass theory compared to the other groups. Fluid as well as crystallized intelligence contributed to children’s acquisition of a Mass theory. Discussion Counterevidence can support children in their acquisition of a Mass theory. A playful intervention with scaffolding supports children even more. (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)

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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)

Die Wertfreiheit der Wissenschaft gilt als Bedingung ihrer Objektivitat. Eine Analyse des entsprechenden Wertfreiheitsideals zeigt jedoch, dass dieses auf einer Reihe von Voraussetzungen beruht wie der Trennbarkeit kognitiver von anderen Werten und der epistemischen Unabhangigkeit der Rechtfertigung die sich als problematisch erweisen. Eine Fallstudie zur Frauengesundheitsforschung untermauert zudem, dass die Moglichkeiten fur Werteinflusse in der Wissenschaft weit komplexer sind, als dieses Ideal zu erfassen vermag. Daher bietet ein sozialepistemologischer Ansatz, der auf Wertvielfalt statt Wertfreiheit setzt, die bessere Grundlage fur Objektivitat: (...) Epistemische Vertrauenswurdigkeit erfordert nicht Neutralitat, sondern einen pluralistischen und konsensorientierten kritischen Prozess.". (shrink)

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and (...) an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)

This paper gives insight into the Islamic bioethical discussion on harvesting and using human embryonic and adult stem cells. It describes some of the Islamic legal mechanisms involved in the bioethical discourse among Muslims. As the contemporary Islamic bioethical discourse is very diverse, the paper focuses on the critical discussion of related resolutions of the Saudi-based Islamic Fiqh Academy due to the esteem in which the IFA is held in the Islamic world and the pertinence of their rulings on this (...) issue. This study discusses the different sources of human adult and embryonic stem cells and their use from an Islamic perspective, while questioning some directions the Islamic bioethical discourse has taken. The paper invites interested parties to deliberate the use of some of the legal means resorted to in the ongoing Islamic bioethical discourse. (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)