Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a ‘de-moralized’ discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models of addiction may seem (...) to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)

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

This article gives an overview of the influence of the work of Michel Foucault on the philosophy of Agamben. Discussed are Foucault’s influence on the Homo Sacer cycle, on (the development) of Agamben’s notion of power (and on his closely related notion of freedom and art of life), as well as on Agamben’s philosophy of language and methodology. While most commentaries focus on Agamben’s interpretation of Foucault’s concept of biopower, his work also contains many interesting references to Foucault on freedom (...) and possibilities—and I think that it is here that Foucault’s influence on Agamben is most deeply felt. This article focuses on the shifts Agamben takes while looking for the Entwicklungsfähigkeit in the work of Foucault. (shrink)

Zusammenfassung In der Langzeitbetreuung von Menschen mit Demenz finden kommunikative Handlungen, die das Potenzial haben, Menschen mit Demenz zu täuschen, auf der Seite des Personals eine unterschiedliche Akzeptanz. Bushaltestellen, an denen kein Bus fährt, falsche Zugabteile, in denen ein Film die vorbeiziehende Landschaft simuliert, das Verstecken von Medikamenten in Nahrungsmitteln sind Interventionen, die Menschen in die Irre führen können, ohne ihnen tatsächlich falsche Informationen zu geben. Derartige kommunikative Praktiken wie Täuschungen, aber auch Lügen, definiert als absichtlich mitgeteilte irreführende Nachrichten, werfen (...) die Frage auf, wie sie ethisch begründet werden können. Anhand einer fiktiven Fallschilderung, in dem eine Pflegeheimbewohnerin mit Hilfe eines vorgetäuschten Telefonanrufs daran gehindert wird, das Heim zu verlassen, zeige ich, dass die Täuschung, als eine von drei möglichen Handlungsoptionen, aus der Fürsorgeperspektive positiv bewertet werden kann, da die Bewohnerin ohne Zwang am Verlassen des Heimes gehindert wird. Das Prinzip der Autonomie aber wird verletzt, da die Bewohnerin nicht frei zwischen der Täuschung und der Realität wählen kann. Hinsichtlich der Verpflichtung gegenüber Dritten ist die Täuschung problematisch, da orientierte Bewohner und Bewohnerinnen die Szene beobachten und befürchten könnten, sie würden ebenfalls getäuscht. Die Synthese der verschiedenen Argumente zeigt, dass ein Spaziergang in Verbindung mit einem validierenden Gespräch als weitere Handlungsoption die Prinzipien der Fürsorge und Autonomie in Einklang bringt, aber aufgrund des Zeitaufwands das Risiko einer ungerechten Verteilung der Pflegeressourcen birgt. (shrink)

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

This paper explores some ideas of Wilfrid Sellars to raise two difficulties for a naturalistic approach to the mind. The first difficulty, which is methodological, is a corollary of Sellars’s distinction between two images of man-in-the-world, the manifest and the scientific image. For Sellars, taking science seriously requires that we think of it as constructing a unified image of man-in-the-world of its own. I argue that it is the rivalry between the manifest and the scientific image which gives rise to (...) the mind-body-problem. The challenge for a naturalistic solution to the mind-body-problem is that it is not legitimate to isolate single scientific results from their theoretical context in order to integrate them piecemeal into the manifest image. According to Sellars, a satisfactory solution to the mind-body-problem must attempt nothing less than a fusion of both images which somehow respects and preserves the unity of each. The second, substantial difficulty for a naturalistic approach to the mind is that of coming to terms with the normativity of the mental. Many interpreters take Sellars to hold that normativity sets the mental apart from the rest of nature. Against this I argue that according to Sellars the living is governed by norms of its own. It follows that normativity cannot serve as the mark of the mental. I argue that according to Sellars the distinguishing feature of the mental lies elsewhere, namely in the way in which normative force comes about. Unlike biological norms, the norms of thought owe their force to a common practice of mutual evaluation. However, the assumption that there are norms in animate nature should make it easier for naturalists to accept that the mental is characterized by norms of its own. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

This article examines the relation between the critical theory of Moishe Postone and the philosophy of Theodor Adorno. While the former is clearly influenced by the latter, these influences mostly stay implicit. When explicit, he does not so easily put his own thought in line with Adorno’s and is highly critical of him. I will investigate the ways in which ideas from Adorno made their way into Postone’s work, but also where the latter diverts from them. As will be shown, (...) Postone’s critical theory runs into a problem when one examines the immanent ground of his critical norm, freedom. Adorno, on the contrary, does succeed in employing the same norm in his own immanent critique. I will conclude that the problem Postone encounters can be avoided by being more of an ‘Adornian’, and that his theory allows this. (shrink)

Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)

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

Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care. Method Ten health-care workers participating in a Forum Play course took part in (...) this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison. Results The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency. Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation. (shrink)

This article critical examines Gilbert and colleagues’ study (Gilbert et al. 2017) claims on how deep brain stimulation (DBS) as a treatment for Parkinson’s disease (PD) can influence people’s self-concept.

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

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

This collection features eleven original essays, divided into three thematic sections, which explore the work of Wilfrid Sellars in relation to other twentieth-century thinkers. Section I analyzes Sellars’s thought in light of some of his influential predecessors, specifically Ludwig Wittgenstein, Rudolf Carnap, John Cook Wilson, and Kazimierz Ajdukiewicz. The second group of essays explores from different perspectives Sellars’s place within the analytic tradition, including his relation with analytic Kantianism and analytic pragmatism. The book’s final section extracts some of the most (...) significant lessons Sellars’s work has to offer for contemporary philosophy. These chapters address his views on inference, his views on truth and its connection to recent discussions about truth-relativism and truth-pluralism, his conception of self-knowledge, and his theory of perceptual experience. (shrink)

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Bowman-Smart and colleagues (2023) argue that techniques to screen and analyze the fetal genome are rapidly evolving, and are sometimes already offered commercially. These new developments will all...

Feminist scholars have identified pervasive gender discrimination in science as an institution, as well as gender bias in the very content of many scientific theories. An ameliorative project at heart, feminist philosophy of science has inquired into the social and epistemological roots and consequences of these problems and into their potential solutions. Most feminist philosophers agree on a need for diversity in scientific communities to counter the detrimental effects of gender bias. Diversity could thus serve as a unifying concept for (...) a potential consensus of the field. Yet there are substantial differences in the kinds and roles of diversity envisaged. This element argues that we need diversity, both in terms of social locations and of values, to overcome former biases and blind spots. Diversity as such, however, is insufficient. To reap its epistemic benefits, diversity also needs to be institutionalised in a way that counters various forms of epistemic injustice. (shrink)

In recent years, the practices of artists in non-artistic environments have set my mind in motion. Where before I could marvel at the visual outcomes of the artistic process and would want to understand how processes of creating meaning could be described, I am now particularly struck by the way in which artists are present, by their way of looking, how they make decisions, when and how they act, how they take responsibility. I have conversations with them and ask questions (...) to better understand their processes, and I explore literature to find people with a similar quest. This process of moving and being moved lies at the heart of the book 'The Artistic Attitude'"--Page 4 of cover. (shrink)

Looking at contemporary Japanese images of the self and how Japanese scholars have conceptualised the notion of the subjectivity three remarkable concepts of “the self” can be identified and distinguished from another: the Inner Self, the Political Self, the Social Self. In my paper I will discuss these concepts by high lightening their hybridity, plurality and their emphasis on the identity as an effect of self-realization. I shall argue that the investigation in the Japaneseunderstanding of the self is particularly fruitful (...) for a global understanding of subjectivity, because Japanese selfhood does not represent the “otherness” of the western thought but is actually crisscrossed by western and eastern ideas. What can be marked as the Inner Self combines ideas of the Buddhist “Non-Self” (anatman) and the European Idealistic Ego (Ich). Embedded in practises of meditation the Inner Self in the Japanese understanding is realized through the activity of finding and loosing oneself. The Political Self can be perceived as an amalgamation of the Asian art of the regime of the group and the western thought of Liberalism and personal identity. Somewhat discovered in Japan as a possibility of the self in the 19th century the Political Self comes into existence througheducational practise. Furthermore the Social Self brings together Chinese Confucian ethics and ancient Japanese Shintoism. Understood as a particle in the flow of social relations the Social Self is realized in Japan within the rituals of everyday live and physical hence tactical education in the childhood of a person. The Japanese concepts of the self exemplify on the level of their formal configuration the qualities of what can be called a plural anthropology. (shrink)

In this paper I will argue that liberal multiculturalism is neither a necessary nor a convincing extension of liberalism. In evaluating the two main strands of liberal multiculturalism, I will first analyse the approaches of Charles Taylor and Bhikhu Parekh as the main proponents of the version that focuses on the cultures themselves and raises the issue of the value of cultures in connection with public discourse. I will then turn to Amy Gutmann and Will Kymlicka as liberal multiculturalists who (...) use the liberal norm of individual equality as a starting point. I will show that the arguments adduced in favour of liberal multiculturalism fail, due to the following shortcomings. Taylor’s approach is underspecified with respect to the relationship between the process of evaluating cultures and its outcome. Gutmann’s theory fails to bridge the gaps between the individual, cultural belonging and positive duties of the state. Parekh’s and Kymlicka’s theories lead back to liberalism. I conclude that the idea of cultural difference has little of substance to add to the liberal view of social justice. (shrink)

»Artistic Research« ist in aller Munde - ein Modewort der Gegenwartsdebatte, das Vereinnahmungen ebenso provoziert wie Zurückweisungen. Doch was meinen wir, wenn wir von der Kunst als Forscherin sprechen? Kann Kunst als eine Einsichten generierende, reflexive Praxis angesehen werden, die sich in ästhetischen Artikulationen formuliert? Welche Einsicht über welche Welt könnte sie bereitstellen? Eine umfassende epistemologische Ästhetik, die sich dem künstlerischen Forschen als Methode und Praxis annimmt, gibt es bisher nicht. In diesem Grundlagenwerk stellt sich Anke Haarmann den Fragen (...) nach den originären Methoden, historischen Vorläufern, spezifischen Artikulationsformen und konkreten Handlungsweisen künstlerischen Forschens. (shrink)

The need for a shift toward healthier and more sustainable diets is evident and is supported by universalized standards for a “planetary health diet” as recommended in the recent EAT-Lancet report. At the same time, differences exist in tastes, preferences and food practices among diverse ethnic groups, which becomes progressively relevant in light of Europe’s increasingly multi-ethnic cities. There is a growing tension between current sustainable diets standards and how diverse ethnic resident groups relate to it within their ‘culturally appropriate’ (...) foodways, raising questions around inclusion. What are dynamics of inclusiveness in migrant food practices? And what does this mean towards the transition to healthy and sustainable food? We study this question among Syrian migrants with different lengths of stay in the Netherlands. Our theoretical framework is based on practice theories, which emphasize the importance of socio-material context and of bodily routines and competences. We use qualitative methods, combining in-depth semi-structured life-history interviews with participant observation. Our findings indicate that inclusiveness takes different forms as migrants’ food practices and the food environment change. Regarding health and sustainability in food practices, understandings and competences around particularly fresh food change over time among both short- and long-term migrants, replacing making things from scratch with seasonal products with buying more processed products and out-of-season vegetables and fruits. We conclude that the performances of food practices and their configurations in food environments and lifestyles are dynamic and cannot unequivocally be interpreted as in- or exclusive, but that a more nuanced understanding is required. (shrink)

While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences (...) of the proposed moral obligation to actively reinterpret variant classifications that carry a higher risk of being false positives. Such reclassification is likely to result in ‘downgrades’: previously pathogenic variants (pathogenic/likely pathogenic, P/LP) reclassified to benign (likely benign/benign, LB/B) or uncertain variants (variant of uncertain significance, VUS). Any laboratory policy to actively reinterpret (specific sets of) classifications will confront the clinician with the question whether the person tested should be recontacted on a reinterpretation of previously reported results. As others have pointed out, recontacting in general comes with challenges, since patients may not want to be recontacted or have forgotten about their genetic test.2 3 Recontacting in case of a downgrade, however, is particularly impactful. Previous studies on the psychosocial impact of reclassification on patients …. (shrink)

Psychiatric classification is highly controversial, as could be witnessed again with the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These controversies comprise multiple kinds of critiques by a variety of actors. It is unlikely that all these issues will be overcome by one perfect solution in the future. Rather, it is precisely the DSM’s “one-size-fits-all-approach” that lies at the root of many of the current problems. To restore the scientific and public credibility of psychiatric classification, (...) a multi-dimensional pluralist response is thus needed: (1) theoretical pluralism, meaning a promotion of different research projects and heuristic strategies, (2) taxonomic pluralism, which allows for different classifications used in research versus clinical practice, and (3) participatory pluralism, which concerns the diversity of perspectives and stakeholders in DSM-revisions. (shrink)