Background: The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended-at the time-on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data: Existing ethics and health policy literature on the topic (...) of access to experimental drugs. Areas of agreement: The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. Areas of controversy: At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients-the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Growing points: Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. Areas timely for developing research: We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods. (shrink)

Emotions are often met with suspicion in political debates about risky technologies, because they are seen as contrary to rational decision making. However, recent emotion research rejects such a dichotomous view of reason and emotion, by seeing emotions as an important source of moral insight. Moral emotions such as compassion and feelings of responsibility and justice can play an important role in judging ethical aspects of technological risks, such as justice, fairness, and autonomy. This article discusses how this idea can (...) be integrated into approaches for political decision making about risk. The article starts with an analysis of the dichotomous view of reason and emotion in risk theory, in approaches to participatory risk assessment as well as in relevant approaches to political philosophy. This article then presents alternative approaches in political philosophy and political theory that do explicitly endorse the importance of emotions. Based on these insights, a procedural approach for policy making is presented, in which emotional responses to technological risks, and the ethical concerns that lie behind them, are taken seriously. This approach allows for morally better political decisions about risky technologies and a better understanding between experts and laypeople. (shrink)

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...

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)

This article provides an analysis of moral emotions from an attributional point of view, guided by the metaphors of man as a naïve scientist (Heider, 1958) and as a moral judge (Weiner, 2006). The theoretical analysis focuses on three concepts: (a) The distinction between the actor and the observer, (b) the functional quality of moral emotions, and (c) the perceived controllability of the causes of events. Moral emotions are identified (admiration, anger, awe, contempt, disgust, elevation, embarrassment, envy, gratitude, guilt, indignation, (...) jealousy, pity, pride, rage, regret, remorse, resentment, respect, schadenfreude, scorn, shame, and sympathy). A classification of these moral emotions is suggested and the empirical evidence briefly summarized. In discussing our results, we identify unresolved issues awaiting further analyses and research. (shrink)

Der Autor untersucht das Paar Repräsentation/Nichtrepräsentation über mehrere Sprachen (Deutsch, Englisch, Französisch) und verschiedene theoretische Perspektiven hinweg (u. a. Lacan, Laplanche, Botella, Levine). Dabei kommt er zu dem Ergebnis, dass es unangemessen ist, Freuds Psychoanalyse als eine »Theorie der Repräsentation« zu bezeichnen: Weder gibt es im Unbewussten Repräsentationen, noch lässt sich das Unbewusste selbst repräsentieren. Die Sphäre des Unbewussten und die der Repräsentation sind miteinander radikal inkompatibel. Für den Autor benennt Lacans Begriff des Realen jene Zone des Psychischen, in der (...) die Darstellungsmittel des psychischen Apparates an seine Grenze stoßen. Dies wird an mehreren Traumbeispielen gezeigt. (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)

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)

We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded by monopoly providers of such healthcare services. It is implausible that professionals who voluntarily join (...) a profession should be endowed with a legal claim not to provide services that are within the scope of the profession's practice and that society expects them to provide. We discuss common counterarguments to this view and reject all of them. (shrink)

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 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)

In recent years policy makers and public health professionals have described obesity and its associated diseases as a major global public health problem. Bioethicists have tried to address the normative implications of proposed public health interventions by developing guidelines or proposing ethical principles that ethically grounded health policy responses should take into consideration. We are reviewing here relevant literature and conclude that while there are clearly health implications resulting from the increasing number of seriously obese people across the globe, there (...) appear to be legitimate questions about the scope of the problem as well as questions about whether particular demonstrable correlations are indicative of causations. These empirical questions require further clinical and epidemiological research. We then review currently discussed public health ethics guidance documents and proposals. Suffering from the same conceptual problems that are known features of principle-based bioethics, insofar as their capacity to ground ethically justifiable policies is concerned, they are unsuitable for actual policy development. Even if the empirical questions were resolved, health policy makers could not rely on currently existing prominent public health ethics guidance documents to develop ethically defensible policies. Further empirical and ethics research is necessary to develop ethically defensible public health policies targeting obesity. (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.

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)

"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.

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)

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)

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)

The archive of the Nobel Assembly for Physiology or Medicine in Solna, Sweden, is a remarkable repository that contains reports and dossiers of the Nobel Prize nominations of senior and junior physicians from around the world. Although this archive has begun to be used more by scholars, it has been insufficiently examined by historians of surgery. No other German surgeon was nominated as often as Ferdinand Sauerbruch for the Nobel Prize for Physiology or Medicine in the first half of the (...) 20th century. This contribution reconstructs why and by whom Sauerbruch was nominated, and discusses the Nobel committee evaluations of his work. Political factors did not play an obvious role in the Nobel committee discussions, in spite of the fact that Adolf Hitler in 1937 had prohibited all German citizens to accept the Nobel Prize. The main reasons why Sauerbruch ultimately was not considered prize-worthy were that Sauerbruch’s achievements were marked by scientific priority disputes, and that his work was not seen as original enough. (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)

Between Wolff and Kant: Merian's Theory of Apperception UDO THIEL IT IS WELL KNOWN that the nodon of apperception or self-consciousness is central to Kant's theoretical philosophy. Kant introduces the notion in one of the crucial parts of the Critique of Pure Reason, the Transcendental Deduction of the Categories, and assigns it an important role in his critique of traditional metaphysics of the soul in the Transcendental Dialectic.' It is also well known that Kant did not invent the term "apperception." (...) Leibniz had introduced the French 'Tapperception" into philosophical terminology early in the eigh- teenth century. Kant scholars generally stress, rightly, that Kant's notion of apperception differs significandy from that of his predecessors. However, the precise relation between Kant's concept of apperception and earlier accounts has not been considered in any detail. Wolfgang Carl, for example, simply states that the main difference is that, prior to Kant, apperception was under- stood as relating only to mental acts and their contents, and not to the subject that thinks and has ideas, whereas in Kant apperception relates essentially to the thinking subject. 2 This very general thesis is questionable even in regard to some of the philosophers that Carl cites in this context . It is clearly not true of some other pre-Kantian philoso- phers who deal with self-consciousness. ' References to the Critique of Pure.. (shrink)

In few other areas of bioethical inquiry exists as close a connection between bioethical professional advice and policy development as is the case with HIV and AIDS. Historically, the reasons for this have much to do with one of the groups initially affected most severely by HIV and AIDS, namely well-educated middle-class gay men in developed countries. This particular group of people, highly sophisticated and used to political activism in its pursuit of civil rights-related objectives, engaged the medical profession as (...) well as regulatory agencies such as the US Food and Drug Administration, and legislators (more so in the USA than in other countries) in a number of bioethically interesting policy areas. Many of the controversies of the times were framed as civil rights and/or ethical disputes. The initial areas of concern and inquiry focused on: informed consent to HIV testing and trial participation, the confidentiality of HIV test results, access to trials as a means of access to experimental drugs, the length of time it took to get an experimental drug to the market approval stage, and end-of-life decision-making. This line-up of issues explains why AIDS has become such an interesting topic for bioethicists. Bioethicists concerned about the traditional breadand- butter themes of medical ethics themes of the doctor - patient relationship (e.g., Daniels, 1991; Boyd, 1992), as well as bioethicists more concerned about policy and regulatory issues in the drug research and approval process (e.g., Edgar & Rothman, 1990; Salisbury & Schechter, 1990), found research topics worthy of vigorous pursuit. No surprise, then, that HIV/AIDS led to a probably unprecedented number of books and articles in professional journals (Manuel et al., 1990). HIV/AIDS has become a permanent fixture in all major mainstream bioethics textbooks (e.g., Kuhse & Singer, 1998; Arras & Steinbock, 1999). Reference series in medicine, ethics and law provide for dedicated volumes on AIDS.1 Even specialist bioethics textbooks, for instance those directed at dentistry students, carry chapters on HIV/AIDS (Ozar & Sokol, 2002). 128 Udo Schuklenk AIDS, designated by the medical profession a pandemic lives up to its classification. It did not stop at the borders of developed countries. As one would expect of a primarily sexually transmitted illness in the age of globalisation, it spread rapidly across the globe. Indeed, in many countries it has become one of the main causes of death, as in sub- Saharan Africa (Shisana & Simbayi, 2002). Dramatic increases in the number of AIDS cases are predicted for many Eastern European countries as well as for the two most populous nations on earth, India and China. Some of the HIV/AIDS-related bioethical and policy issues of concern to developed countries remain the same for developing countries. However, in ethically important ways they are dwarfed by concerns over drug prices, intellectual property rights, and affordable access to essential AIDS drugs for the impoverished masses of infected people in such countries. Of increasing importance have become ethical issues pertaining to the ever-growing research industry associated with clinical trials undertaken in developing countries. Indeed, major funding initiatives both in the USA and UK have brought clinical research in developing countries into focus. Some have questioned whether this attention is appropriate, considering other bioethical problems of arguably greater importance to developing countries (Chadwick & Schuklenk, 2003). Standards of clinical care in a study, and after a trial has concluded, as well as community benefits and access to the trial regime after the trial’s conclusion remain contentious issues. It is worth noting that more often than not it was an AIDS-related trial or policy decision that led to a great deal of bioethical analysis, yet the issues discussed almost always have ramifications far beyond AIDS. For instance, decisions about the question of what (if any) standards of care failures in preventive trials (of HIV vaccines or microbicides) ought to receive have important implications for non-AIDS prevention trials. (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)

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)