In a commentary published in Bioethics I defended Qatar as the location of the 2024 World Congress of Bioethics (Schuklenk 2023). I have since, reluctantly, changed my views on this.This brief resp...

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another “committee”. One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The (...) most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (shrink)

This paper examines the intrinsic relation between institutions and social justice. Its starting point is that processes of institutionalization invoke societal groups to articulate justice demands which, in their turn, give rise to processes of institutional redesign. In liberal democracies, demands for justice are articulated as a pursuit for emancipation and empowerment of groups that feel excluded by dominant categorizations. The imminent presence of this twin pursuit for justice can be explained by the conceptual inconsistencies that characterize the distinction between (...) the public and private sphere. These inconsistencies also explain why demands for emancipation and empowerment are intrinsically ambiguous and inconsistent. In order to reconsider the question how institutions are to be adapted to allow for social justice while acknowledging the plurality, ambiguity and volatility of justice demands, the paper will propose an empirical and normative research agenda. (shrink)

This paper makes a conceptual inquiry into the notion of ‘publics’, and forwards an understanding of this notion that allows more responsible forms of decision-making with regards to technologies that have localized impacts, such as wind parks, hydrogen stations or flood barriers. The outcome of this inquiry is that the acceptability of a decision is to be assessed by a plurality of ‘publics’, including that of a local community. Even though a plurality of ‘publics’ might create competing normative demands, its (...) acknowledgment is necessary to withstand the monopolization of the process of technology appraisal. The paper presents four ways in which such an appropriation of publicness takes place. The creation of dedicated ‘local publics’, in contrast, helps to overcome these problems and allows for more responsible forms of decision-making. We describe ‘local publics’ as those in which stakeholders from the different publics that are related to the process of technology implementation are brought together, and in which concerns and issues from these publics are deliberated upon. The paper will present eight conditions for increasing the effectiveness of such ‘local publics’. (shrink)

Developing World Bioethics, Volume 21, Issue 3, Page 99-99, September 2021.

Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned (...) out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended. (shrink)

Bioethics, Volume 36, Issue 1, Page 1-2, January 2022.

Knowing that technologies are inherently value-laden and systemically interwoven with society, the question is how individual engineers can take up the challenge of accepting the responsibility for their work? This paper will argue that engineers have no institutional structure at the level of society that allows them to recognize, reflect upon, and actively integrate the value-laden character of their designs. Instead, engineers have to tap on the different institutional realms of market, science, and state, making their work a ‘hybrid’ activity (...) combining elements from the different institutional realms. To deal with this institutional hybridity, engineers develop routines and heuristics in their professional network, which do not allow societal values to be expressed in a satisfactory manner. To allow forms of ‘active’ responsibility, there have to be so-called ‘accountability forums’ that guide moral reflections of individual actors. The paper will subsequently look at the methodologies of value-sensitive design and constructive technology assessment and explore whether and how these methodologies allow engineers to integrate societal values into the design technological artifacts and systems. As VSD and CTA are methodologies that look at the process of technological design, whereas the focus of this paper is on the designer, they can only be used indirectly, namely as frameworks which help to identify the contours of a framework for active responsibility of engineers. (shrink)

The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients’ rights of access to care and accommodating doctors’ deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary. This article explains why (...) that is the case. The view that conscientious objection accommodation has no place in modern medicine is defended. (shrink)

Healthcare professionals’ capacity to protect themselves, while caring for infected patients during an infectious disease pandemic, depends on their ability to practise universal precautions. In turn, universal precautions rely on the availability of personal protective equipment (PPE). During the SARS-CoV2 outbreak many healthcare workers across the globe have been reluctant to provide patient care because crucial PPE components are in short supply. The lack of such equipment during the pandemic was not a result of careful resource allocation decisions in the (...) global north, where the short supply could be explained through their high cost. Instead, they were the result of democratically elected governments prioritising low tax regimes over an adequate resourcing of their healthcare delivery systems. Such decisions were made despite global health experts warning about the high probability of pandemics like SARS-CoV2 occurring during our lifetimes. Avoidable allocation decisions by democratically elected political leaders resulted in a lack of sufficient PPE for healthcare professionals. After discussing and discounting various ethical arguments in support of a professional obligation to treat, even without or with suboptimal PPE, I conclude that these policy decisions were sufficiently grave that they provide a sound ethical rationale to justify healthcare workers’ refusal to provide care to infected patients. (shrink)

Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss (...) a few of the proposed solutions to the problem and conclude with an argument in support of our preferred course of action. In this article we argue for compulsory licensing of essential AIDS medications in the current conditions of public health emergency. We argue on broadly consequentialist grounds that compulsory licensing is preferable both morally and pragmatically to the alternatives, notably the currently offered price cuts and drug donation schemes. (shrink)

Name der Zeitschrift: Kant-Studien Jahrgang: 109 Heft: 1 Seiten: 72-100.

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public health policies (...) and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented. (shrink)

New network technologies are framed as eliminating ‘transaction costs’, a notion first developed in economic theory that now drives the design of market systems. However, the actual promise of the elimination of transaction costs seems unfeasible, because of a cyclical pattern in which network technologies that make that promise create processes of institutionalization that create new forms transaction costs. Nonetheless, the promises legitimize the exemption of innovations of network technologies from critical scrutiny.

In der sog. »aristotelischen Zeitaporie« (Physik IV) äußert sich Aristoteles zum Verhältnis von Zeit und Seele. Dieser Text gehört zu den umstrittensten Abschnitten seines Zeittraktates. Zur Interpretation rekonstruiert die vorgelegte Untersuchung die Entwicklungslinien der Analysen zur Zeitaporie von der Spätantike über die arabische Philosophie bis zur Frühphase der lateinischen Aristoteleskommentierung im 13. Jahrhundert. Der erste Abschnitt zeigt, wie die antike Physik-Kommentatoren diesen Text erklärten. Im Zentrum steht dabei die Auslegung des Alexander von Aphrodisias. Den der Spätantike diskutierten die Araber. Ein (...) zweite Abschnitt stellt daher die Analysen der arabischen Zeitphilosophie vor. Vermittelt durch lateinische Übersetzungen, beeinflussen arabische und jüdische Theoretiker die Zeitphilosophie des 13. Jahrhunderts. Die Geschichte des sukzessiven Vordringens der Konzeption des Averroes in die Auslegung der Zeitaporie im 13. Jahrhundert expliziert daher ein dritter Teil. Erst die Philosophen dieser Zeit konnten die These des Aristoteles zum Verhältnis von Zeit und Seele mit der Konzeption des Augustinus vergleichen. Sie haben das elfte Buch der Bekenntnisse neu entdeckt. (shrink)

It is a great loss to philosophy that Heraclitus’s writing was lost in antiquity, for the surviving fragments rarely contain more than one sentence. Often, they are succinct but concise statements that contain little text. So, when one succeeds in augmenting important fragments with a few words or illuminating their context, there is progress in Heraclitus research. Sometimes, however, this requires recourse to lineages outside the Greek-Latin tradition. An example of this is provided by fragment 123, which has played an (...) important role since its discovery in the Orationes of Themistius: in the 20th century, Martin Heidegger used it several times for his idiosyncratic interpretation of Heraclitus and the philosophy of the Pre-Socratics. However, he did not consider that an Armenian variant of this fragment had become available at the beginning of the 19th century. This Armenian variant derives from a treatise of Philo of Alexandria which has only been transmitted in Armenian and offers more text than the Greek version. As Diels-Kranz did not include this Armenian source in their edition of The Fragments of the Pre-Socratics, this Armenian variant fell into oblivion and was not known to Heidegger either. Now this article, after introductory remarks on the transmission of Heraclitus’s sayings in Themistius and Philo’s Heraclitea, focuses on the history of the Armenian version of fragment 123 and its primary interpretations. It concludes with a reconstruction of the remarks which Ferdinand Lassalle dedicated to this fragment in both its Greek and Armenian versions in 1858. (shrink)

ZUSAMMENFASSUNGDauer wird von Eckhart theoontologisch verstanden. Auf das Sein blickt die Dauer ständig. Dieser perennierende Blick ist nur Gott, dem einen Einen möglich, nicht dem zwischen Sein und Werden aufgespannten Menschen. Indem jedoch der Schöpfer die Geschöpfe in den Ersten Ursprung »zieht«, gibt er ihnen Anteil an der Dauer. Aeternitas, aevum und tempus sind differente modi durationum. Die ihnen zukommende duratio finita ergibt sich aus dem jeweils unterschiedlichen Grad der Identität von esse und essentia bei ihnen.SUMMARYEckhart understands duration “theoontologically” . (...) The duration looks constantly at being. Only God as the only One is capable of this perennial view, but no human beings who are stretched between being and becoming. However, by bringing creatures into the first beginning, the creator gives them a share of the duration. Aeternitas, aevum and tempus are different modi durationum. Duratio finita inherent in them results from different degrees of the identity of esse and essentia which aeternitas, aevum and tempus possess. (shrink)

"Der Vernunft kommt bei Eckhart fundamentalste Bedeutung zu. Sie bricht - so der Thüringer Meister - in den Grund. Ermöglicht wird sie durch das vernünftige Erkennen, das intelligere des Einen. In der Gottesgeburt wird der Mensch qualifiziert zu univokem Erkennen. Als Sohn Gottes wird der Mensch vernünftig zu weitem unbegrenztem Wissen geführt. Der Logos, das Wort ist substantiale und hermeneutische Grundlage vernünftigen Verstehens. Auch das Vergehen, die Sünde wird produktiv in dieses aufgenommen. Der Vernünftige ist der Demütige, Gelassene und Freie. (...) Das Höchste, was dem Menschen ontologisch und in seinem Wirken und Leben zuteil wird, ist das 'Draussen-wie-drinnen-Stehen'. Eckhart sagt: 'Lausche nun auf das Wunderbare! Welch wunderbares Stehen draußen wie drinnen, begreifen und umgriffen werden, schauen und das Geschaute selbst sein, es in sich haben und gehalten werden: das ist die Vollendung, wo der Geist voll Ruhe in der Einheit der lieben Ewigkeit bleibt'."--Page 4 of cover. (shrink)

Aus dem Inhalt: Epistemologische und ontologische Bedeutung der Liebe - Ich / Personalität - Du / Andere(s) - Das theologische Argument - Die entfremdete Liebe - Leiblichkeit / Praxis / Gefühl - Liebe als Kommunikation - Liebe und Existenz - Konstruktivität der Liebe.

Research into the genetic component of some complex behaviors often causes controversy, depending on the social meaning and significance of the behavior under study. Research into sexual orientation—simplistically referred to as “gay gene” research—is an example of research that provokes intense controversy. This research is worrisome for many reasons, including the fact that it has been used to harm lesbians and gay men. Many homosexual people have been forced to undergo “treatments” to change their sexual orientation. Others chose to undergo (...) them to escape discrimination and social disapprobation. But there are other reasons to worry about such research. The very motivation for seeking an “origin” of homosexuality reveals homophobia. Moreover, such research may lead to prenatal tests that claim to predict for homosexuality. For homosexual people who live in countries with no legal protections these dangers are particularly serious. (shrink)

This response addresses criticisms in this journal of an Editorial written by Willem Landman and Udo Schuklenk. I demonstrate that the UNESCO Declaration on Bioethics and Human Rights is in crucial aspects deficient, despite attempts in this journal to defend the Declaration against its critics. I focus on individual versus societal interests, research ethics, informed consent and the use of “human dignity” to illustrate the weaknesses of the UNESCO Declaration on Bioethics and Human Rights. This article concludes with reflections on (...) what documents such as the UNESCO Declaration on Bioethics and Human Rights ought to be called to avoid the mislabelling of what essentially are policy documents. (shrink)

Explores the understanding of self-consciousness and personal identity - two fundamendtal features of human subjectivity - as it developed in early modern philosophy. Udo Thiel presents a critical evaluation of these features as they were conceived in the sevententh and eighteenth centuries. He explains the arguments of thinkers such as Descartes, Locke, Leibniz, Wolff, and Hume, as well as their early critics, followers, and other philosophical contemporaries, and situates them within their historical contexts. Interest in the issues of self-consciousness and (...) personal identity is in many ways characteristic [of] and even central to early modern thought, but Thiel argues here that this is also an interest that continues to this day, in a form still strongly influenced by the conceptual frameworks of early modern thought. In this book he attempts to broaden the scope of the treatment of these issues considerably, covering more than a hundred years of philosophical debate in France, Britain, and Germany while remaining attentive to the details of the arguments under scrutiny and discussing alternative interpretations in many cases"--Publisher's description, p. [4] of dust jacket. (shrink)

Die »Entstellung« wird als Grundbegriff der Freud’schen Psychoanalyse dargestellt, der eine doppelte, ja gegensätzliche Bedeutung hat: Sie erscheint dem Bewusstsein als Verunstaltung oder Verfälschung, ist aber zugleich die spezifische Erscheinungsweise des Unbewussten. Der Artikel zeichnet nach, welche Bedeutung Freud der Entstellung für die Traumdeutung beimisst. Anschließend wird dargelegt, dass die zentralen Begriffe der Psychoanalyse (das Unbewusste, die Übertragung, der Trieb, die Wiederholung) aus einer Bewegung der Entstellung hervorgehen. Schließlich werden die psychoanalytische Grundregel und die ihr zugeordneten Begriffe der »freien Assoziation« (...) bzw. »gleichschwebenden Aufmerksamkeit« als ein technisches Verfahren vorgestellt, das wesentlich auf die Entdeckung und Analyse »entstellter Objekte« (Laplanche & Pontalis) ausgerichtet ist. (shrink)

This article provides a critical overview of the most important issues pertaining to the ongoing debate on international research ethics. It critically describes three problems of continuing concern: 1) the question of whether the distinction between therapeutic and non‐therapeutic research should be upheld; 2) the questions of whether the currently demanded best proven diagnostic and therapeutic method of treatment for all research subjects is feasible both in developed and in developing countries, and whether it should be upheld; 3) the questions (...) of who owns international research ethics guidelines and regulatory frameworks and, how decisions about changes to such international guidelines can possibly be achieved, given that it seems to be the case that genuine disagreement about issues of content is possible and likely. (shrink)

This paper discusses a number of critical ethical problems that arise in interactions between queer patients and health care professionals attending them. Using real-world examples, we discuss the very practical problems queer patients often face in the clinic. Health care professionals face conflicts in societies that criminalise same sex relationships. We also analyse the question of what ought to be done to confront health care professionals who propagate falsehoods about homosexuality in the public domain. These health care professionals are more (...) often than not motivated by strong religious convictions that conflict with mainstream medical opinion on homosexuality. We argue that they ought to be held accountable for their conduct by their professional statutory bodies, given that they abuse their professional standing to propagate sectarian views not representative of their profession. Lastly, we propose that medical schools have special responsibilities in training future health care professionals that will enable them to respond professionally to queer patients seeking health care. (shrink)