BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes (...) both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

Paul applies apocalyptic language not only to the End and Christ's parousia but also to the gospel he proclaims and the faith it creates. The whole of God's saving activity in Jesus Christ, from beginning to end, is apocalyptic.

The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

Aristotle's highly influential work on the soul, entitled De anima, formed part of the core curriculum of medieval universities and was discussed intensively. It covers a range of topics in philosophical psychology, such as the relationship between mind and body and the nature of abstract thought. However, there is a key difference in scope between the so-called "science of the soul," based on Aristotle, and modern philosophical psychology. This book starts from a basic premise accepted by all medieval commentators, namely (...) that the science of the soul studies not just human beings but all living beings. As such, its methodology and approach must also apply to plants and animals. The Science of the Soul discusses how philosophers from Thomas Aquinas to Pierre d'Ailly dealt with the difficult task of giving a unified account of life and traces the various stages in the transformation of the science of the soul between 1260 and 1360. The emerging picture is that of a gradual disruption of the unified approach to the soul, which will ultimately lead to the emergence of psychology as a separate discipline. (shrink)

Dondeyne, A. Pluriformiteit en eenheid van de filosofie.--Peperzak, A. Wegwijzers naar een dialogiek?--Boer, T. de. De eindigheid van de mens en de oneindigheid van de waarheid.--Hollak, J. Wijsgerige reflecties over de scheppingsidee : St. Thomas, Hegel en de Grieken.--Plat, J. Kants kritiek op de rationele psychologie.--Melsen, A. van. Wijsgerige antropologie en de ontwikkeling van natuurwetenschap en techniek.--Buytendijk, F. Het pathisch aspect van de eindigheid.--Struyker Boudier, H. 's Bergbeklimmers einder.

Hegel is most famous for his view that conflicts between contrary positions are necessarily resolved. Whereas this optimism, inherent in modernity as such, has been challenged from Kierkegaard onward, many critics have misconstrued Hegel's own intentions. Focusing on the Science of Logic, this transformative reading of Hegel on the one hand exposes the immense force of Hegel's conception of tragedy, logic, nature, history, time, language, spirit, politics, and philosophy itself. Drawing out the implications of Hegel's insight into tragic conflicts, on (...) the other hand, De Boer brings into play a form of negativity that allows us to understand why the entanglement of complementary positions always tends to turn into their conflict, but not necessarily into its resolution. (shrink)

Science is highly dependent on the technologies needed to observe scientific objects. In How Scientific Instruments Speak, Bas de Boer develops a philosophical account of instruments in scientific practice, focusing on the cognitive neurosciences. He argues for an understanding of scientific instruments as mediating technology.

INTRODUCTION In the first part of this study I will deal with the publications of Husserl's first period, ie Ueber den Begriff der Zahl (his "Habilita- ...

Scholarly debates on the Critique of Pure Reason have largely been shaped by epistemological questions. Challenging this prevailing trend, Kant's Reform of Metaphysics is the first book-length study to interpret Kant's Critique in view of his efforts to turn Christian Wolff's highly influential metaphysics into a science. Karin de Boer situates Kant's pivotal work in the context of eighteenth-century German philosophy, traces the development of Kant's conception of critique, and offers fresh and in-depth analyses of key parts of the (...) Critique of Pure Reason, including the Transcendental Deduction, the Schematism Chapter, the Appendix to the Transcendental Analytic, and the Architectonic. The book not only brings out the coherence of Kant's project, but also reconstructs the outline of the 'system of pure reason' for which the Critique was to pave the way, but that never saw the light. (shrink)

Women intimately interact with various medical technologies and prosthetic artifacts in the context of breast cancer. While extensive work has been done on the agency of technological artifacts and how they affect users’ perceptions and experiences, the agency of users is largely taken for granted hitherto. In this article, we explore the agency of four women who engage with breast cancer technologies and artifacts by analyzing their narrative accounts of such engagements. This empirical discussion is framed within the tradition of (...) science and technology studies, philosophy of technological mediation and phenomenology of embodied agency as ‘I can/not’. This approach leads to the conclusions that women’s technologically mediated agencies range from being restricted to extended, take place on different bodily levels, within complex temporal structures, and are determined by certain socio-cultural contexts. Furthermore, it reveals that such agency shaping does not imply a one-way conditioning relationship between technologies and users, but rather involves a reciprocal relationship in which both subject and object are co-constituted. We therefore suggest that the ‘material turn’ in philosophy of technology also needs to take into account technologically mediated, material human beings in order to gain a better understanding of human existence. (shrink)

Nachdruck der Originalausgabe aus dem Jahr 1901.

A central issue in postphenomenology is how to explain the multistability of technologies: how can it be that specific technologies can be used for a wide variety of purposes (the “multi”), while not for all purposes (the “stability”)? For example, a table can be used for the purpose of sleeping, having dinner at, or even for staging a fencing match, but not for baking a cake. One explanation offered in the literature is that the (material) design of a technology puts (...) constraints on the purposes for which technologies can be used. In this paper, I argue that such an explanation—while partly correct—fails to address the role of the environment in which human beings operate in putting constraints on technology use. I suggest that James Gibson’s affordance theory helps highlighting how stabilities in technology use arise in the interaction between human being and environment. Building on more recent approaches in affordance theory, I suggest that the environment can be conceptualized as a “rich landscape of affordances” that solicits certain actions, which are not just cued by the environment’s material structure, but also by the normativity present in the form of life in which a human being participates. I briefly contrast the approach to affordances developed in this paper with how Klenk (2020) and Tollon (2021) have conceptualized the “affordance character” of technological artifacts, and highlight how a focus on the situated nature of affordances augments these earlier conceptualizations. (shrink)

In current phenomenology of medicine, health is often understood as a state of transparency in which our body refrains from being an object of explicit attention. In this paper, I argue that such an understanding of health unnecessarily presupposes an overly harmonious alignment between subjective and objective body, resulting in the idea that our health remains phenomenologically inaccessible. Alternatively, I suggest that there are many occasions in which one’s body in health does become an object of attention, and that technologies (...) mediate how a relation with one’s body is formed. First, I show prominent accounts in current phenomenology of medicine understand health in terms of a harmonious alignment between objective and subjective body. Second, I argue that there are many occasions in which there is a disharmony between objective and subjective body, and suggest that also in health, we cannot escape being an object that we often relate to. Then, I draw on postphenomenology to show how technologies such as digital self-tracking applications and digital twins can be understood as mediating the relationship with one’s own body in a specific way. In conclusion, I argue that both technologies make present the objective body as a site for hermeneutic inquiry such that it can be interacted with in terms of health parameters. Furthermore, I point to some relevant differences in how different technologies make aspects of our own body phenomenologically present. (shrink)

By drawing on Jean-Luc Nancy’s philosophy of ontological relationality, this article explores what it means to be a ‘we’ in breast cancer. What are the characteristics—the extent and diversity—of couples’ relationally lived experiences of bodily changes in breast cancer? Through analyzing duo interviews with diagnosed women and their partners, four ways of sharing an embodied life are identified. (1) While ‘being different together’, partners have different, albeit connected kinds of experiences of breast cancer. (2) While ‘being there for you’, partners (...) take care of each other in mutually dependent ways. (3) While ‘being reconnected to you’, partners (re-)relate to each other through intimacy and sexuality. (4) While ‘being like you’, partners synchronize their embodied daily lives to one another, sometimes up to the point that the self cannot be distinguished from the other anymore. These ways reveal that being a ‘we’ involves complex affective, bodily encounters in which the many fault lines that both separate partners into individual selves and join them together as a unity are continuously reshaped and negotiated. Being a ‘we’ may be understood as something we have to do. Therefore, in being true to the legacy of Nancy, we argue at the end of this article for a sensible praxis of sharing a life and body, particularly in breast cancer. (shrink)

English summary: In this volume, Jan-Hendryk de Boer investigates the upheaval in the world of scholars in the Roman-German Empire at the end of the fifteenth and beginning of the sixteenth centuries. He shows how during this time hegemonic humanism developed as a new discursive formation. This re-organised the humanistic movement as well as its relationship to scholasticism and ultimately the place of humanism in the scholarly world as a whole. After humanistic ideas were initially taken on board as (...) being relatively unproblematic, the representatives of hegemonic humanism, such as poets, grammarians and philologists, claimed that they alone were in possession of useful skills and relevant knowledge. In a cultural transfer of the corresponding developments in Italy, a scholastic-humanist antagonism was generated that is still reflected in today's research. German description: Jan-Hendryk de Boer untersucht in dieser Studie den Umbruch in der Gelehrtenwelt des romisch-deutschen Reichs am Ende des 15. und zu Beginn des 16. Jahrhunderts. Er zeigt, wie sich in diesem Zeitraum der hegemoniale Humanismus als eine neue diskursive Formation ausbildete. Diese organisierte die humanistische Bewegung wie auch deren Verhaltnis zur Scholastik und schliesslich den Ort des Humanismus in der Gelehrtenwelt insgesamt um. Nachdem humanistische Ideen zunachst relativ problemlos Aufnahme gefunden hatten, beanspruchten die Vertreter des hegemonialen Humanismus als Dichter, Grammatiker und Philologen fur sich allein, uber nutzliche Fertigkeiten und relevantes Wissen zu verfugen. In einem Kulturtransfer der entsprechenden italienischen Entwicklungen wurde so ein scholastisch-humanistischer Antagonismus erzeugt, der bis in die heutige Forschung nachwirkt. (shrink)

The Figure of the Slave as an Ethical Paradigm in the Work of Agamben There is an extensive history of reflections on the nature of slavery and the dehumanising politics surrounding it. Rarely, however, is the figure of the slave proposed as a paradigm for the good life. Yet this is precisely how it occurs in the later work of controversial Italian thinker Giorgio Agamben. This counter-intuitive approach has invited various types of criticism. This article argues that, although limited and (...) historically deficient in its treatment of slavery, Agamben’s revaluation is nonetheless allied with the decolonial call for a new consciousness liberated of ‘colonial logics’ and a new relation to the environment. The radical intuition guiding Agamben is that, as long as we recognise in the slave only the figure of the abject and the dehumanised, we unwittingly value human life from the viewpoint of the master, which is one of the fundamental ‘errors’ that keeps systematic exclusion and institutional violence in place. (shrink)

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

My response to Gabriele Gava’s Kant’s Critique of Pure Reason and the Method of Metaphysics (2023) focuses on Kant’s conception of the role of critique in the Critique of Pure Reason. On my account, Gava’s emphasis on the constructive elements of the Critique downplays the critique of former metaphysics elaborated in all three parts of the Transcendental Doctrine of Elements. After some comments on Kant’s conception of the Critique as a doctrine of method, I support this view by discussing the (...) relation between transcendental philosophy and transcendental critique, Kant’s analysis of the faculties, and his transcendental deduction of space. (shrink)

In this paper, we examine the qualitative moral impact of machine learning-based clinical decision support systems in the process of medical diagnosis. To date, discussions about machine learning in this context have focused on problems that can be measured and assessed quantitatively, such as by estimating the extent of potential harm or calculating incurred risks. We maintain that such discussions neglect the qualitative moral impact of these technologies. Drawing on the philosophical approaches of technomoral change and technological mediation theory, which (...) explore the interplay between technologies and morality, we present an analysis of concerns related to the adoption of machine learning-aided medical diagnosis. We analyze anticipated moral issues that machine learning systems pose for different stakeholders, such as bias and opacity in the way that models are trained to produce diagnoses, changes to how health care providers, patients, and developers understand their roles and professions, and challenges to existing forms of medical legislation. Albeit preliminary in nature, the insights offered by the technomoral change and the technological mediation approaches expand and enrich the current discussion about machine learning in diagnostic practices, bringing distinct and currently underexplored areas of concern to the forefront. These insights can contribute to a more encompassing and better informed decision-making process when adapting machine learning techniques to medical diagnosis, while acknowledging the interests of multiple stakeholders and the active role that technologies play in generating, perpetuating, and modifying ethical concerns in health care. (shrink)

From the time of his very first courses, Heidegger seeks to thematize the radically finite dynamic for human life. As he considers traditional metaphysics to be incapable of facing this finitude, he engages in a critical examination of its most fundamental presuppositions. This article attempts to elucidate Heidegger's critique by means of twodifferent detours. First I show that the idea of self-realization, which Aristotle understood to be the most perfect movement, is unable to account for the tragic, unstable and internally (...) divided structure of human life. Whereas the idea of self-realization determined the ensuing history of metaphysics — including Hegel — to a considerable extent, I understand Heidegger to develop against the background of this tradition a dynamic principle which allows us to conceive of every human striving as essentially threatene by the very principle that makes it possible. I then turn to Greek tragedy, especially to Oedipus Rex, to clarify this radically finite principle in terms of the essential structure of the tragic as such. The tendency of both human life and philosophy to turn away from this essentially tragic movement can be understood as the 'fall' which is inherent in all efforts of the human being to raise itself above itself. Heidegger's own thinking, on the other hand, can be characterized as a finite attempt to withstand this predominant tendency of western philosophy. (shrink)

This article challenges the prevailing interpretations of Hegel's account of the concept "contradiction" in the Science of Logic by arguing that it is concerned with the principle of Hegel's method rather than with the classical law of non-contradiction. I first consider Hegel's Doctrine of Essence in view of Kant's discussion of the concepts of reflection in the first Critique. On this basis, I examine Hegel's account of the logical principles based on the concepts "identity," "opposition," and "contradiction." Finally, I point (...) out how the principle Hegel derives from the concept of contradiction actually informs his own method. (shrink)

This essay re-examines Hegel's account of Greek culture in the section of the _Phenomenology of Spirit_ devoted to “ethical action”. The thrust of this section cannot be adequately grasped, it is argued, by focusing on Hegel's references to either Sophocles' _Antigone_ or Greek tragedy as a whole. Taking into account Hegel's complex use of literary sources, the essay shows in particular that Hegel draws on Aristophanes' comedies to comprehend the collapse of Greek culture, a collapse he considered to result from (...) the tragic conflict constitutive of Greek culture as a whole. The essay thus aims to shed light on Hegel's abstruse remarks on womanhood and, more generally, to demonstrate that Hegel's peculiar employment of literary sources constitutes an essential element of the method he employs throughout the _Phenomenology of Spirit_. (shrink)