This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

Contemporary Christian ethics encounters the challenge to communicate genuinely Christian normative orientations within the scientific debate in such a way as to render these orientations comprehensible, and to maintain or enhance their plausibility even for non-Christians. This essay, therefore, proceeds from a biblical motif, takes up certain themes from the Christian tradition (in particular the idea of social justice), and connects both with a compelling contemporary approach to ethics by secular moral philosophy, i.e. with Axel Honneth's reception of Hegel, as (...) based on Hegel's theory of recognition. As a first step, elements of an ethics of recognition are developed on the basis of an anthropological recourse to the conditions of intersubjective encounters. These conditions are then brought to bear on the idea of social justice, as developed in the social-Catholic tradition, and as systematically explored in the Pastoral Letter of the United States Conference of Catholic Bishops, Economic Justice For All (1986). Proceeding from this basis, aspects of a Christian ethics of community service with regard to long-term care can be defined. (shrink)

The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and society interact. Most of this research regards the effects of societal responses to perceived problems in families, thus underlying policy on interventions such as adoption, foster care and temporary assumption of custodianship, but also support structures that help families cope with various challenges. However, reference (...) to the best interest of children can also be applied to a more basic issue in family policy, namely that of what is to be considered a family in the first place. This issue does not raise any questions regarding the proper conditions for when society should intervene in or change the family context of a child. Rather, it is about what social configurations should be recognized as a potentially fitting context for children to enter into and (if all goes well) eventually develop into adulthood within /.../ such that society’s default institutional arrangements allow it to have (by sexual and artificial reproduction, adoption, and combinations of these), care for and/or guard children. [This] will frame any further discussion of /.../ policies having further implications for, for example, the practices of adoption and reproductive technology, as well as regulation of custody in the event of separation or parental disagreement. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...) of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

Relational views of equality put forward a social and political ideal of equality that aims at being a better interpretation of what social justice requires than the prevailing distributive conceptions of equality, especially luck egalitarian views. Yet it is unclear what social justice as relational equality demands in distributive terms; Elizabeth Anderson's view seems to vacate a large part of the terrain of distributive justice in favor of a minimalist, sufficiency view. Against that, this paper argues that relational equality, properly (...) understood, requires setting stringent limits to distributive inequality, for both intrinsic and instrumental reasons. First, the relational egalitarian conception of society as a cooperative enterprise among equals gives rise to a presumption of equality in socially produced goods (and bads); inequalities in these goods have to be justified by justice-relevant reasons. Second, relational egalitarianism also delivers instrumental reasons to limit inequalities in income, wealth, and opportunities, because such inequalities may generate both opportunities for domination and inegalitarian status norms that threaten the social bases of self-respect of the worse off. (shrink)

Introduction -- Entering the world of medicine: contexts -- Why bioethics needs a philosophy (and theology) of medicien -- Perspectives on philosophy of medicine -- Perspectives on theology of medicine -- Finding the target: Messer's theology of health -- A philosophical-theological framework for medicine -- Human vulnerability and the goods of medicine -- Re-engaging the world of medicine: applying philosophy and theology of medicine.

How do mental states come to be about something other than their own operations, and thus to serve as ground for effective action? This papers argues that causation in the mental domain should be understood to function on principles of intelligibility (that is, on principles which make it perfectly intelligible for intentions to have a causal role in initiating behavior) rather than on principles of mechanism (that is, on principles which explain how causation works in the physical domain). The paper (...) considers Dharmakīrti’s kāryānumāna argument (that is, the argument that an inference is sound only when one infers from the effect to the cause and not vice versa), and proposes a naturalized account of reasons. On this account, careful scrutiny of the effect can provide a basis for ascertaining the unique causal totality that is its source, but only for reasoning that is context‐specific. (shrink)

Integrity, honesty, and truth seeking are important virtues that most people care about and want to see promoted in society. Yet surprisingly, there has been relatively little work among scholars today aimed at helping us better understand this cluster of virtues related to truth. This volume incorporates the insights and perspectives of experts working in a variety of disciplines, including philosophy, law, communication and rhetorical studies, theology, psychology, history, and education. For each virtue, there is a conceptual chapter, an application (...) chapter, and a developmental chapter. The resulting volume significantly deepens our knowledge about and appreciation for these central virtues. (shrink)

Jennifer Nado has recently argued that conceptual engineers should focus on (re-)designing representations and may safely ignore issues of implementation. I make a general case for the methodological importance of implementation to conceptual engineering. Using the Social Norms Account as a foil, I argue for three claims. (1) Inquiring into methods of implementation is a theoretically challenging and philosophically worthwhile project in and of itself. (2) A sound theoretical understanding of implementation is imperative for theorists of conceptual engineering. It proves (...) vital for their assessment of the prospects for engineering interventions and the political risks inherent in them. (3) A sound theoretical understanding of implementation is imperative for practitioners of conceptual engineering. The usefulness of their representational (re-)designs depends on respecting broadly cognitive and social constraints on the part of the target population. I conclude that conceptual engineers have very good reasons to seriously engage with issues of implementation. (shrink)

Definition of the problemMedical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tübingen, to address the particular needs of such organizations.ArgumentsTherefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in order (...) to bring together two indispensable ways of ethical reflection in organizations: “top-down”/“bottom-up”. We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation.ConclusionConsidering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. (shrink)

This paper revisits the strained yet ubiquitous notion of sustainability to see where and how it can make a contribution to improved agricultural and natural resource management and policy making. The case of a three-year EU network on farm animal breeding and reproduction is used as a practical illustration. In this network, commercial breeders and breeding scientists were required, with professional assistance from philosophers and social scientists, to develop a definition of sustainable farm animal breeding. The word ‘sustainability’ does not (...) define a unique ethical perspective. At best it indicates a willingness to open an ethical agenda. However if the agenda is not specified in some detail, there is a real danger that necessary ethical discussion will be swept under the carpet. Even worse, the word may be used as a fig leaf in an attempt to legitimise projects which are ethically dubious. Used conscientiously, the framework of sustainability has two benefits: First, it invites parties involved in the planning of future activities in a company or sector to take a comprehensive look at potentially conflicting concerns and to face any difficult trade-offs. Second, it encourages concerns to be presented within a framework that is endorsed by society as a whole, and this enables the stakeholders to make room for communication to, and dialogue with, a broader audience than the rather narrow group of people directly involved. Adapting the definition of sustainability to specific conditions and circumstances is more than a technical or scientific task. It requires us to address carefully underlying questions about values. The fundamental dilemmas that emerge when the notion of sustainability is considered have no easy solutions, but they can be addressed by taking into account four key characteristics of sustainability discussed in this paper. (shrink)

La médecine personnalisée expérimente dans le cadre du cancer, ou thérapies ciblées, ou encore médecine prédictive, voire médecine de précision. toutes ces appellations sous-entendent un domaine qui s'ébauche tant au niveau de la recherche qu'à celui de la clinique. Ce domaine se constitue de pratiques, de normes qui s'élaborent et de règles qui établissent de véritables limites. Ce volume présente ce que les disciplines du droit, de la biologie, de la médecine et de la philosophie ont à dire conjointement sur (...) ce nouvel objet qui déjà intéresse au-delà du cancer toutes les maladies chroniques. Ce volume rassemble ainsi les réflexions de tous les pionniers de ce domaine sous la coordination de Michèle Jean-Stanton du Centre de Recherche de Droit Public (CRDP) de l'Université de Montréal et de Christian Hervé de l'Université Sorbonne Paris Cité. Leurs expressions, ainsi exposées à la suite d'un séminaire qu'ils ont tous suivi consciencieusement, affirment ainsi une certaine idée, une éthique même de ces nouvelles pratiques non encore totalement réglementées. (shrink)

In this paper my goal is to extend my earlier discussion, at least in a preliminary way, to two additional areas – fairness and stealing. In doing so, I will consider whether the existing research is compatible with my Mixed Trait model, or whether instead it gives me reason to be concerned with how broadly applicable the model really is. My conclusion will be that the results are, so to speak, a mixed bag. With respect to fairness research, some careful (...) conceived studies have been done which do in fact provide additional support for my model. But in the area of research of stealing, it will turn out that we are badly in need of new behavioral studies before we can draw any reasonable conclusions about people’s characters in this area. (shrink)

While other parts of medicine and health care seems traditionally to be primarily directed at preventing losses of bodily functions, repairing said functions in the case of such losses, or at least to provide ailment for unpleasant symptoms, sports medicine has allready from the beginning been involved with the project of enhancing bodily functions with regard to sports performance. First, when sports medicine involve itself in the traditional health care activity of prevention, therapy and ailment, the aim is often very (...) different from ordinary medical activities in that it tries to secure bodily functions far beyond what is required to reach what would normally be seen as a non-pathological state of a person. Second, sports medicine actively involves itself in the project of extending and enhancing human performance capacities through medical knowledge and technology. This raises several issues both with regard to medical ethics and the ethics of sports. For example, how should the goals of sports medicine be viewed from the perspective of rationing scarce health care resources? Should sports medicine be restricted by rules from the sports community as to which performance enhancing activities are tolerated in that sector? Or should sports medicine rather direct what is to be accepted within the world of sports? Both lines of reasoning are to be found in debates about, e.g., doping, controversial training methods and the potential use of gene technology in sports. The paper will address these issues and analyse them from a philosophical point of view. (shrink)

In his important recent book, Aaron James has defended a principle ? Collective Due Care ? for determining when a form of economic integration is morally objectionable because it causes unjustified harm (including unemployment, wage suppression and diminished working conditions). This essay argues that Collective Due Care would yield implausible judgements about trade practices and would be too indeterminate to play the practical role for which it is intended.

This essay focuses on the early phases of romantic love and investigates the phenomenon that is often referred to as ‘Love at First Sight’, where typically very little information about the other is available, yet intensely felt causal processes are at work. It argues that the phenomenon called ‘Love at First Sight’ is not love in a proper sense, even if it may resemble love in certain aspects, and even if, under certain conditions, it may lead into love proper. The (...) discussion touches on questions regarding depth, vulnerability and personal history, regarding the object of love at first sight and its attractive features, the role of perception or sight, and the phenomenon’s relation to infatuation, crystallisation and the erotic. (shrink)

I am very grateful to Jason Baehr and Bella DePaulo for the careful attention they have paid to my chapter. As I noted, this is my initial foray into providing a conceptual account of the virtue of honesty, and for that matter it is about the only such attempt any philosopher has offered in the past forty years. If others start to go down this road too, I would be thrilled. -/- Following the structure of my paper, I will start (...) with conceptual matters before turning to the implications of the empirical studies and then ending with more on mixed traits. (shrink)

This article aims to explore the relations between equality of opportunity and early childhood. By referring to the work of contemporary philosophers, i.e. Rawls, Sen, Dworkin, Cohen and Roemer, we argue for different possible interpretations, based on political discussions, concerning how to operationalize equality of opportunities. We represent these diverging options on a continuum, ranging from Responsibility-oriented Equality of Opportunity and Circumstances-oriented Equality of Opportunity. We then analyse how early childhood care and education policies can be constructed in relation to (...) these conceptualisations and argue that the CEOp is a more plausible interpretative framework to operationalize equality of opportunity in early childhood. (shrink)

This broad and insightful book presents current scholarship in important subfields of philosophy of science and addresses an interdisciplinary and multidisciplinary readership. It groups carefully selected contributions into the four fields of I) philosophy of physics, II) philosophy of life sciences, III) philosophy of social sciences and values in science, and IV) philosophy of mathematics and formal modeling. Readers will discover research papers by Paul Hoyningen-Huene, Keizo Matsubara, Kian Salimkhani, Andrea Reichenberger, Anne Sophie Meincke, Javier Suárez, Roger Deulofeu, Ludger Jansen, (...) Peter Hucklenbroich, Martin Carrier, Elizaveta Kostrova, Lara Huber, Jens Harbecke, Antonio Piccolomini d'Aragona and Axel Gelfert. This collection fosters dialogue between philosophers of science working in different subfields, and brings readers the finest and latest work across the breadth of the field,illustrating that contemporary philosophy of science has successfully broadened its scope of reflection. It will interest and inspire a wide audience of philosophers as well as scholars of the natural sciences, social sciences and the humanities. The volume shares selected contributions from the prestigious second triennial conference of the German Society for Philosophy of Science/ Gesellschaft für Wissenschaftsphilosophie (GWP.2016, March 8, 2016 - March 11, 2016). (shrink)

While health care goals are usually formulated in terms of the securing of good health for the population, the goal of public health is to an increasing extent, at least in Western countries, being formulated in terms of the provision of societal preconditions for securing of good health. This goal may be attained although no one enjoys good health as a result, namely if people choose not to make use of the preconditions provided. However, reaching this goal may still seem (...) desirable in that it promotes the autonomy of people with regard to health-related choices. In this presentation, I address the questions: 1) whether or not the promotion of autonomy may be supported as goal of public health on the basis of ethical theories dealing with autonomy, 2) whether this support is equally strong regardless of the economic, social and cultural conditions of different countries. I will argue that the first question may be answered affirmatively only if certain important revisions are made in the ethical theories in questions but that these revisions at the same time raise a number of very complicated issues in theory as well as in practice. Regarding the second question, I will claim that in so far as the goal of promoting autonomy may be morally justified, there are a number of reasons supporting the suggestion that this justification is much stronger in societal settings where reasonably high health and welfare levels are allready secured. (shrink)

In this paper it is argued that courts must, where appropriate, take into account the fact that National Health Service hospitals are under‐funded when they determine the standard of care owed by such hospitals and their professional staff to patients. Although this suggestion is inconsistent with the traditional view of the courts, its adoption would bring negligence cases into harmony with judicial review decisions. It would also cohere with a new understanding of accident causation within complex organisations, which suggests that (...) many of the injuries suffered by patients in under‐funded hospitals are the result of systemic failures that cannot necessarily be attributed to those who are the last actors in the causal chain leading to damage. (shrink)

Public health is often distinguished from heaslth care in that it is said to serve more 'collective' goals, such as 'the common good' rather than the good of individual people. However, it is not clear what this good is supposed to be (although it is supposed to be 'common'). In regular health care we see in the West a gradual expansion of traditional goals exclusively in terms of length and quality of life to goals having to do more with autonomy (...) - the ability of people to control and direct their own lives. This has lead to a number of questions regarding how such an ethical ideal of promotion of autonomy may be construed, whether or not it really is an ideal, what practical consequences it has etc. (shrink)

The aim of this article is to explore the spatial constitution of the university today, its relation to Bildung in the university, and the way that changes of the universities are conceptually articulated or even programmatically demanded. In the first part of the article, the concept of the so-called ‘non-places’ advanced by the French ethnologist Marc Augé is used in order to set a conceptual framework for reflecting on the place of the university. In the second part of the article, (...) it is demonstrated that the university is currently being reshaped as a non-place and more specifically, as a transit lounge. Using the example of Minerva University, it is shown how mobilization, optimization, and functionalization of learning become dominant at the expense of forming its own place. In the third part of the article, the relations between Bildung and place are reflected on following Ronald Barnett’s ecological approach of the university. In this approach, care and curation are central, as is shown in the final part of the article. (shrink)

This volume brings together a collection of essays on the philosophy of love by leading contributors to the discussion. Particular emphasis is placed upon the relation between love, its character and appropriateness and the objects towards which it is directed: romantic and erotic partners, persons, ourselves, strangers, non-human animals and art. It includes contributions by Aaron Ben Ze’ev (‘Ain’t Love Nothing but Sex Misspelled?’), by Angelika Krebs (‘Between I and Thou – On the Dialogical Nature of Love’), Aaron Smuts (‘Is (...) it Better to Love Better Things?’) and Jan Bransen (‘Loving a Stranger’). By focusing upon the different objects of love, and how the lover enters into a relation with them, the collection pushes beyond the recent debates on reasons for love and breaks new and important ground. (shrink)

A frenetic search for equality lies at the center of much secular and even “Christian” bioethics. In a secular world, if one does not believe in God, if this life is one's whole existence, it would seem that one could not settle for less than equal approbation, especially equality before the risks of suffering and death, which medicine promises to ameliorate. Yet, the concern for equality in health care is puzzling. After a modest level of access to health care there (...) is little difference in average life expectancy. Are concerns for equality in health care even vaguely Christian? The pursuit of Christian perfection has never been correctly equated with state-imposed egalitarianism. Furthermore, an all-encompassing, secular, egalitarian health care system may provide equal access to significantly immoral medical treatments. In contrast to secular thought, the call of Christianity is a call to holiness, not a call to an egalitarianism that superficially resonates with certain elements of Christian thought. (shrink)

The virtue of honesty has been stunningly neglected in contemporary philosophy, with only two papers appearing in the last 40 years. The first half of this paper is a conceptual exploration of one aspect of the virtue, namely the honest person’s motivational profile. I argue that egoistic motives for telling the truth or not cheating are incompatible with honest motivation. At the same time, there is no one specific motive that is required for a person to be motivated in a (...) virtuously honest way. Instead I advance a pluralistic theory of honest motivation, which allows for motives of caring, fairness, and virtue, among others. The second half of the paper then turns briefly to the empirical literature in psychology and behavioral economics on cheating, to see to what extent honest motives appear to be operative. The upshot is that we have good preliminary evidence for the claim that most people are not virtuously honest. (shrink)

Background Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse’s ability to fulfill the duty to care without compromising on personal obligations. Research Aim The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients. Research Design The study design was a (...) cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area. Participants and Research Context Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic. Ethical Considerations The study was reviewed by the institution’s clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey. Results Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic. Conclusions Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study. (shrink)

Cases involving amoralists who no longer care about the institution of morality, together with cases of depression, listlessness, and exhaustion, have posed trouble in recent years for standard formulations of motivational internalism. In response, though, internalists have been willing to adopt narrower versions of the thesis which restrict it just to the motivational lives of those agents who are said to be in some way normal, practically rational, or virtuous. My goal in this paper is to offer a new set (...) of counterexamples to motivational internalism, examples which are effective both against traditional formulations of the thesis as well as against many of these more recent restricted proposals. (shrink)

This essay offers a reaction to the recent resurgence of presentism in the philosophy of time. What is of particular interest in this renaissance is that a number of recent arguments supporting presentism are crafted in an untypically naturalistic vein, breathing new life into a metaphysics of time with a bad track record of co-habitation with modern physics. Against this trend, the present essay argues that the pressure on presentism exerted by special relativity and its core lesson of Lorentz symmetry (...) cannot easily be shirked. A categorization of presentist responses to this pressure is offered. As a case in point, I analyze a recent argument by Monton (2006) presenting a case for the compatibility of presentism with quantum gravity. Monton claims that this compatibility arises because there are quantum theories of gravity that use fixed foliations of spacetime and that such fixed foliations provide a natural home for a metaphysically robust notion of the present. A careful analysis leaves Monton's argument wanting. In sum, the prospects of presentism to be alleviated from the stress applied by fundamental physics are faint. (shrink)

The concept of human dignity, despite its growing importance in legal texts and declarations in the last decades, is notoriously contested in moral philosophy and legal theory. There is no agreement either on what human dignity is or whether one should care much about it. We will show how these questions could be answered given the assumption that the expression ‘human dignity’ is to be read literally, as dignity of humans, where ‘dignity’ is understood as dignity proper, i.e. dignity as (...) it is usually ascribed outside of legal contexts. Dignity proper has played an important role in the history of mankind. It is sometimes also called ‘social dignity’ because it is bound to social relations, or ‘contingent dignity’, on the assumption that having dignity proper is due to contingencies of life and one's own behaviour (in contrast to human dignity as an essential feature of humankind). Dignity proper therefore depends on being treated with respect by others and on being able to present oneself as being of equal dignity in various practical contexts. Dignity proper is part of an extended conceptual space of evaluative terms which are important in moral life, including, among others, decency, nobility, rank, honour, respect, esteem, grace, decorum, merit, self-respect, coolness, offence, humiliation, degradation, shame. It is obvious, historically, that the concept of dignity proper must have played some role in the development of the concept of human dignity. (shrink)

Many types of `other-regarding' acts and beliefs cannotbe accounted for satisfactorilyas instances of sophisticated selfishness, altruism,team-reasoning, Kantian duty, kinselection etc. This paper argues in favour ofre-inventing the notion of solidarity as ananalytical category capable of shedding importantnew light on hitherto under-explainedaspects of human motivation. Unlike altruism andnatural sympathy (which turn theinterests of specific others into one's own), orteam-reasoning (which applies exclusivelyto members of some team), or Kantian duty (whichdemands universalisable principlesof action), the essence of solidarity lies in thehypothesis that people (...) are capable ofresponding sympathetically to (or empathising with)a condition afflicting ‘others’,irrespectively of who those others are or whetherone cares for them personally. Andwhen that condition is a social artefact, we argue,solidarity turns radical. (shrink)

A number of philosophers have become convinced that the best way of trying to understand human agency is by arriving at an account of identification. My goal here is not to criticize particular views about identification, but rather to examine several assumptions which have been widely held in the literature and yet which, in my view, render implausible any account of identification that takes them on board. In particular, I argue that typically identification does not involve either reflective consideration of (...) our mental states or endorsement of those states. If it did, we would rarely be agents. (shrink)

Nanomedicine plays a prominent role among emerging technologies. The spectrum of potential applications is as broad as it is promising. It includes the use of nanoparticles and nanodevices for diagnostics, targeted drug delivery in the human body, the production of new therapeutic materials as well as nanorobots or nanoprotheses. Funding agencies are investing large sums in the development of this area, among them the European Commission, which has launched a large network for life-sciences related nanotechnology. At the same time government (...) agencies as well as the private sector are putting forward reports of working groups that have looked into the promises and risks of these developments. This paper will begin with an introduction to the central ethical themes as identified by selected reports from Europe and beyond. In a next step, it will analyse the most frequently invoked ethical concerns–risk assessment and management, the issues of human identity and enhancement, possible implications for civil liberties (e.g. nanodevices that might be used for covert surveillance), and concerns about equity and fair access. Although it seems that the main ethical issues are not unique to nanotechnologies, the conclusion will argue against shrugging them off as non-specific items that have been considered before in the context of other biomedical technologies, such as gene therapy or xenotransplantation. Rather, the paper will call on ethicists to help foster a rational, fair and participatory discourse on the different potential applications of nanotechnologies in medicine, which can form the basis for informed and responsible societal and political decisions. (shrink)

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with “genomic medicine” nor with “precision medicine”, but with “data medicine”. The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The “transformation” of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision (...) of care. Molecular tumor boards are one response to these changes and are now providing better access to next-generation sequencing and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent documents at all academic medical centers and to introduce dynamic and electronic informed consent. (shrink)

This article develops theory on responsible leadership based on a model involving three leadership roles: an expert who displays organizational expertise, a facilitator who cares for and motivates employees and a citizen who considers the consequences of her or his decisions for society. It draws on previous responsible leadership research, stakeholder theory and theories of behavioral complexity to conceptualize the roles model of responsible leadership. Responsible leadership is positioned as a concept that requires leaders to show behavioral complexity in addressing (...) all three roles. In three studies, we provide a first empirical test of antecedents and outcomes of the roles model of responsible leadership. The results of the studies indicate that responsible leadership is positively related to the leader’s perceived effectiveness, favorable stakeholder evaluations and employee engagement with the organization and society. Responsible leadership behavior, in turn, seems to be facilitated by leader empathy, positive affect and universal value orientation. (shrink)

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern (...) physician behavior—beneficence, nonmaleficence, autonomy, and social justice—are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur. (shrink)

In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be (...) combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications. (shrink)

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity.MethodsWe developed an instrument (...) for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

Critics sometimes claim that Catholic moral principles unreasonably oblige patients to adopt life-preserving medical treatments “at all costs,” even when the treatments are excessively burdensome or futile and when their adoption may badly disadvantage patients’ family members or caregivers. The author argues that this is a mischaracterization. Because of obligations arising from our relationships, not only is it sometimes licit to refuse lifesustaining medical care, but we sometimes have a duty to refuse it. This is the case when the treatments (...) are morally extraordinary and when adopting them would unfairly disadvantage someone for whom we have responsibility. The author argues that this conclusion is not inconsistent with the duty we have to properly care for our own lives or with moral principles prohibiting self-killing. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 621–630. (shrink)