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)

In this paper I will analyze several cases from the American Civil War, the two World Wars and the American Vietnam War, and contemporary research in enhancement substance, to determine how drug use can be analyzed and understood in both physical and moral (ethical) terms. This will require a discussion of drug use at different levels. First, I will address the consequences of drug use for the physical and mental sanity of soldiers, during and after wartime, irrespective of the reason (...) for drug use. Second, I will look into the moral questions related to drug use for the enhancement of soldiers, that is, as a method for modern warfare. The moral dimension has at least two different angles: (i) the moral responsibility of superiors administering drugs to their inferiors who are exposed to the rule of full obedience, and (ii) the ethical consequences of enhancement for moral judgment by soldiers in the gray zone between acts of war and war crimes (the difference between the Super soldier and the Killing machine). (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.

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)

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)

This is a case study on a series of at least thirty-four sixteenth-century notebooks from the Sloane collection, which reconsiders early modern note taking techniques and the organisation of knowledge. These notebooks were written by an anonymous compiler, a physician who read widely in the alchemical and medical literature available in his lifetime, the late sixteenth century. In the alchemica, he devotes individual volumes to specific alchemical substances, which are connected with each other by means of a complex system of (...) cross-referencing; they are constantly revised and change appearance according to the physician's latest ideas about alchemical medicines. As a result, the notebooks not only preserve received information — they also represent an equivalent to the alchemical workshop, where the combination of different textual elements generates knowledge. (shrink)

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)

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A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In this (...) paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

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)

Die Arbeit entwickelt erstmals eine von hermeneutischen Grundannahmen geleitete systematische Theorie des Films und reflektiert deren methodische Konsequenzen für die Analyse und Interpretation von Filmen. Auf der Grundlage einer zeichen- und sprechakttheoretischen Bestimmung filmischer Kommunikation werden die wichtigsten Strukturen filmischen Erzählens (Kameraführung, Montage, Erzählsituationen, verbale und nonverbale Figurenrede, Perspektivenstrukturen, uneigentliche Bilderrede) einer theoretischen und methodenpraktischen Reflexion unterzogen.

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage (...) and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

At present, the debate on global justice, a debate which is at the core of global ethics, is largely being conducted by European and American scholars from different disciplines without taking into account views and concepts from other regions of the world, particularly, from the Global South. The lack of a truly intercultural, interreligious, and international exchange of ideas provokes doubts whether the concepts of global justice introduced so far are able to transcend regional and cultural horizons. The article introduces (...) concepts of justice from African scholars, whose voices have remained marginal until now, like the Kenyan philosopher Henry Odera Oruka, the Ethiopian philosopher Teodros Kiros, and the debate on ubuntu, one of the most controversial concepts in southern Africa today. These concepts focus on issues that are seldom considered in the debate on global justice, such as the importance of bodily needs as a prerequisite for human beings to act as moral beings and the importance of human rel.. (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)

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)

Aus dem Motiv eines »Aufstandes der Dinge« leitet sich im linken russischen Konstruktivismus der Imperativ einer Befreiung der Dinge her, der sich von ihrer Repräsentation abkehrt und ein Bilderverbot verhängt, um neue Dinge für 〉neue Menschen〈 zu erschaffen. Diese Dinge – Universalkleidungsstücke und mobile Gebrauchsgegenstände – überspringen den Gegensatz zwischen Objekt und Dinglichkeit. Wie die zeitgenössische russische Phänomenologie (Gustav Špet, Nikolaj Žinkin) feststellt, macht kein 〉idealer Gegenstand〈 ihr Wesen aus, sondern der soziale Gebrauch, der es in einen unabschließbaren Veränderungsprozess involviert. (...) Russian constructivism's motif of an »insurgence of things« leads to the imperative of a liberation of things, which turns away from their representation and declares a Bilderverbot (prohibition of representation) in order to create new things for »new men.« These things – for example, clothing and articles of daily use – overleap the opposition between object and thingness. Their essence, as contemporary Russian phenomenology (Gustav Špet, Nikolaj Žinkin) affirms, is not constituted by any »ideal object«, but by social usage, which involves it in an interminable metamorphosis. (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)

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)

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)

Die Frage nach einer globalen Ethik stellt sich heute verschärft unfgrund der neuen Qualität gegenseitiger Abhängigkeit der einzelnen Staaten und Regionen beruhend auf einer eng verknüpften Weltwirtschaft und dem weltumspannenden Netz modernen Kommunikationssysteme. Diese Verknüpfung zeigt sich am deutlichsten in der Vernetzung transnationaler Konzerne, deren Produktionsstätten nicht mehr an nationale Territorien gebunden sind. Die Entstehung einer globalen Interdependenz hängt jedoch nicht nur mit ökonomischen Entwicklungen oder der neuen Effizienz der Kommunikationstechniken zusammen, sondern auch mit der in diesem Jahrhundert entstandenen Möglichkeit (...) einer ökologischen oder militärischen Selbstzerstörung der Erde durch den Menschen. (shrink)

The aim of this chapter is to question the punitive approach towards substance dependent parents, especially substance dependent parents struggling with poverty, by outlining the complex ways in which poverty can shape reasoning, and hence capacities for self-control. I will outline two ways in which poverty can shape reasoning: a rational shift from a global to a local perspective, and a more invasive one: resignation. I will argue that when people with addictions become resigned, it is especially important to not (...) hold a punitive approach, but to treat them with compassion while simultaneously bootstrapping their sense of agency. I will argue that having children can be an important turning point for people struggling with addiction, and possibly resignation. In order to successfully turn their lives around, they must feel comfortable to seek professional support without fear for retribution or stigma. This paradigm shift in how we treat substance dependent parents will be an important contribution to breaking the circle of intergenerational transmission of resignation, poverty and substance abuse. (shrink)

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)

IntroductionBurnout is a growing problem among young researchers, affecting individuals, organizations and society. Our study aims to identify burnout profiles and highlight the corresponding job demands and resources, resulting in recommendations to reduce burnout risk in the academic context.MethodsThis cross-sectional study collected data from young researchers at five Flemish universities through an online survey measuring burnout risk, work engagement, sleeping behavior, and the most prominent job demands and resources. We conducted Latent Profile Analysis to identify burnout profiles in young researchers (...) and subsequently compared these groups on job demands and resources patterns.ResultsFive burnout profiles were identified: High Burnout Risk, Cynical, Overextended, Low Burnout Risk, and No Burnout Risk. Each burnout profile was associated with a different pattern of job demands and resources. For instance, high levels of meaningfulness decreased the odds to being classified in the Cynical profile.ConclusionOur findings show that the Cynical profile corresponds to a relatively high number of young researchers, which may imply that they are particularly vulnerable to the cynicism dimension of burnout. Additionally, work-life interference and perceived publication pressure seemed the most significant predictors of burnout risk, while meaningfulness, social support from supervisor and learning opportunities played an important protective role. (shrink)

ArgumentIn the spring of 1893, the Austrian writer and critic Hermann Bahr began interviewing various people on antisemitism, a subject of heated discussion in the European feuilleton around 1900. “Once again, I am travelling the world sounding out people’s opinions and listening to what they have to say,” he wrote in his introduction to a series of articles on that issue that appeared in the feuilleton of the Deutsche Zeitung between March and September 1893. A year later, the Berlin publishing (...) house S. Fischer turned Bahr’s articles into a book. Bahr conducted a total of thirty-eight interviews with prominent personages, such as August Bebel, Theodor Mommsen, Ernst Haeckel, Henrik Ibsen and Jules Simon. Bahr did not focus on the arguments in favour or against antisemitism. Instead, he set out explicitly to investigate the sentiments, perceptions and opinions on this topic within the cultured classes. Yet, as I will show in this article, Bahr tried to capture not only the “sentiments” [Empfindungen] aired by his interviewees, but also the settings and interiors in which the interviews took place. I argue that these descriptions of physical space served Bahr as authentication, as a three-dimensional certificate for the “facts of opinion” [Meinungstatsachen] he recorded. (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)