The paper investigates whether it is plausible to hold the late stage demented criminally responsible for past actions. The concern is based on the fact that policy makers in the United States and in Britain are starting to wonder what to do with prison inmates in the later stages of dementia who do not remember their crimes anymore. The problem has to be expected to become more urgent as the population ages and the number of dementia patients increases. This paper (...) argues that the late-stage demented should not be punished for past crimes. Applicable theories of punishment, especially theories with an appropriate expressivist, or communicative element, fail to justify the imprisonment of the late-stage demented. Further imprisonment would require a capacity for comprehension on the part of the punished, and, under certain narrowly specified conditions, even a capacity to be at least in principle capable of recalling the crime again. (shrink)

Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID‐19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper (...) explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time‐limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care. (shrink)

Bettina Schöne-Seifert and Marco Stier present a host of detailed and intriguing arguments to the effect that potentiality arguments have to be viewed as outdated due to developments in stem cell research, in particular the possibility of re-setting the development potential of differentiated cells, such as skin cells. However, their argument leaves them without an explanation of the intuitive difference between skin cells and human beings, which seems to be based on the assumption that a skin cell is merely part (...) of a human organism, while an embryo is at some point a human organism. An appropriately designed concept of the human organism can explain the difference, but also has the potential of re-dividing the argumentative landscape along familiar lines. (shrink)

The most well-known goal of non-invasive prenatal testing (NIPT) is still to determine whether or not a fetus has trisomy 21. Since women often terminate the pregnancy upon a positive result, there is concern that the use of NIPT contributes to discrimination against persons with disabilities. If this concern is justified, it could have an impact on the wider social acceptability of existing testing practices and their potential further expansion. This paper demonstrates four different versions of the discrimination worry, indicates (...) how international policy papers have reacted to them, and identifies the ethically most relevant feature of the concern. (shrink)

In this contribution, I investigate the way in which our understanding of a dementia patient’s self holds relevance to issues of punishment and respon- sibility. This topic is motivated by the fact that some countries with particularly large prison populations—such as the United States—are starting to build special- ized prison tracts for inmates with dementia. In other countries that do not have such specialized facilities, authorities are trying to find the least badly-equipped facility for such patients, and they are turning (...) to ordinary retirement homes, forensic hospitals as well as ordinary psychiatric and geriatric hospital wards. The problem is expected to become increasingly urgent as the population ages and the number of dementia patients increases. I analyse the way in which justifications of legal (or private) punishment for offenders with dementia can depend on an account of relevant psychological features of the self. I argue that especially retributivist and expressivist justifications of punishment require the offender’s ability to comprehend that he or she is being punished for a particular action in the past and that it was him or herself who committed this action. In the second part of my paper, I distinguish between different accounts of responsibility and argue that accounts of relevant features of the self are also needed here to answer the question of whether offenders with dementia are still responsible for past or current inappropriate behavior. In the final part of the paper, I argue that potentially existing private punishment intuitions among care- takers as well as certain puzzles of responsibility interpretation can make it plausible to relieve certain caretakers from primary responsibility for offenders with dementia, especially caretakers who belong to a relevant former victim group of the offender. (shrink)

There is a widespread consensus that a commodification of body parts is to be prevented. Numerous policy papers by international organizations extend this view to the blood supply and recommend a system of uncompensated volunteers in this area—often, however, without making the arguments for this view explicit. This situation seems to indicate that a relevant source of justified worry or unease about the blood supply system has to do with the issue of commodification. As a result, the current health minister (...) of Ontario is proposing a ban on compensation even for blood plasma—despite the fact that Canada can only generate 30 % of the plasma needed for fractionation into important plasma protein products and has to purchase the rest abroad. In the following, I am going to suggest a number of alternative perspectives on the debate in order to facilitate a less dogmatic and more differentiated debate about the matter. Especially in light of the often over-simplified notions of altruism and commodification, I conclude that the debate has not conclusively established that it would be morally objectionable to provide blood plasma donors with monetary compensation or with other forms of explicit social recognition as an incentive. This is especially true of donations for fractionation into medicinal products by profit-oriented pharmaceutical companies. (shrink)

The increasing number of dementia cases has led to renewed interest in philosophical theories of personal identity, because these patients seem to “drop out” of their own identities in some ways. Philosophical positions that try to account for the phenomenon of identity loss include numerical theories of identity which argue for a psychological or a biological continuity criterion, narrative theories of identity, as well as reflections about different forms of memory, some of which have had influence in modern psychology and (...) in the neurosciences. This special issue brings together current articles by experts in these areas. ------ Die zunehmende Verbreitung von Demenzerkrankungen hat zu einem erhöhten Interesse an philosophischen Theorien der personalen Identität geführt, da diese Patienten in manchen Hinsichten aus ihrer eigenen Identität „herauszufallen“ scheinen. Zu den philosophischen Ansätzen, die sich hiermit beschäftigen, gehören Theorien der numerischen Identität, wie etwa das psychologische oder das biologische Kontinuitätskriterium, narrative Theorien der Identität, aber auch Refl exionen über verschiedene Formen des Erinnerns, die sich zum Teil in der modernen Psychologie und in den Neurowissenschaften niederschlagen. Dieses Schwerpunktheft enthält aktuelle Beiträge von Experten aus den genannten Bereichen. ​The increasing number of dementia cases has led to renewed interest in philosophical theories of personal identity, because these patients seem to “drop out” of their own identities in some ways. Philosophical positions that try to account for the phenomenon of identity loss include numerical theories of identity which argue for a psychological or a biological continuity criterion, narrative theories of identity, as well as reflections about different forms of memory, some of which have had influence in modern psychology and in the neurosciences. This special issue brings together current articles by experts in these areas. (shrink)

This paper argues that Henry Sidgwick's theory of the good is a form of enlightened preference hedonism. In order to support this conclusion, the paper argues that the correct interpretation of his notorious passage about the 'ideal element' of the good should get tied to his views about weakness of the will. Sidgwick believes that reaching your own good requires overcoming weakness of the will. An applied section illustrates the practical significance of this finding. In cases in which shooting down (...) a passenger plane can save a greater number of people on the ground, and no other relevant considerations apply, the passengers should desire their own destruction-not only to promote the general good, but also in order to reach the only good they can still secure for themselves: giving their inevitable deaths a positive meaning. This utilitarian position regarding some one-versusthe-many cases has been overlooked in the German Supreme Court ruling on the destruction of 9/11 airplanes in 2006. (shrink)

This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. We argue that sedation is ethically and legally permissible not (...) only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. -/- ----- Dieser Beitrag befasst sich mit Sedierungen von Patienten am Lebensende. In der Regel werden Sedierungen nur als ultima ratio vorgenommen, wenn die Betroffenen dem Tod bereits nahe sind und Leidenssymptome aufweisen, die anders nicht zu lindern sind. Doch wie sind Fälle zu beurteilen, in denen Patienten sich selbstbestimmt für einen Behandlungs- oder einen Flüssigkeits‑/Nahrungsverzicht entscheiden, um zu sterben, und dafür eine „Begleitsedierung“ erbitten oder erwarten – auch wenn dies aus medizinischer Sicht über eine Anwendung von Sedierung als letztes Mittel hinausgeht? Wir argumentieren hier dafür, dass Zusage wie Anwendung einer Begleitsedierung ethisch und rechtlich nicht nur als ultima ratio, sondern grundsätzlich zulässig sind. Eine klare Verpflichtung zu sedieren sehen wir darüber hinaus bei akutem Leiden jeder Art, während in einigen anderen Konstellationen Vorbehalte individueller Ärzte gegenüber vermeintlich verfrühten oder unnötigen Sedierungen respektiert werden müssen. Vor dem Hintergrund des ethischen und juridischen Grundrechts auf ein selbstbestimmtes Sterben plädieren wir allerdings dafür, auch solche Vorbehalte zu überdenken. Die medizinischen Leitlinien sollten entsprechend überarbeitet werden. (shrink)

Weyma Lübbe is one of the most resolute contemporary critics of interpersonal welfare aggregation, as it lies at the heart of most consequentialist ethical theories. Her latest book is a rich extension of her numerous articles on this matter. The main object of criticism is the often-presumed moral relevance of welfare efficiency, for instance in rescue conflicts as they occur in health care systems with limited resources. The central philosophical starting point of her discussion is the ‘numbers debate’ introduced by (...) Philippa Foot and John Taurek, which questions the moral relevance of numbers, as opposed to fairness, when it comes to rescue conflicts between groups of different sizes. In decidedly anti-consequentialist fashion, Lübbe argues that (a) interpersonal welfare efficiency cannot play any foundational role in normative ethics (ch. 3). She also tries to prove (b) the inconsistency of any attempt to supplement welfarist axiologies by fairness aspects, denying the possibility to assign independent moral relevance to both aspects (ch. 4 and 5). In the constructive part of the book (ch. 5 and 6), she presents (c) her own account of distributive ethics based on the principle of equal concern for persons (“Gleichachtung”). (shrink)

A particularly significant criticism of utilitarian and consequentialist moral theories is that they are overly demanding. According to the epistemic variant of this critique, it is overly demanding to have to determine which of one's possible actions would promote the good in the best possible way. A particularly striking articulation of this concern was put forward by James Lenman, who argued that not only is it difficult to predict the consequences of actions, but it is often outright impossible. The reason, (...) according to Lenman, is that we are simply ignorant of what the consequences of an action will be—especially in the distant future, after long and highly complex causal chains. In From Value to Rightness, Vuko Andrić defends an act-consequentialism with a subjective decision criterion designed to avoid these objections. According to this position, agents should decide based on the outcomes they can reasonably expect to occur, rather than the outcomes that actually occur. -/- ----- Eine besonders einschlägige Kritik an utilitaristischen und konsequentialistischen Moraltheorien besagt, dass sie überfordernd sind. Der epistemischen Variante dieser Kritik zufolge ist es überfordernd, wenn man grundsätzlich herausfinden muss, welche der eigenen Handlungsmöglichkeiten das Gute auf die bestmögliche Weise befördern würde. Eine besonders einschlägige Zuspitzung dieser Sorge wurde von James Lenman vorgebracht, demzufolge es nicht nur schwierig ist, Handlungsfolgen abzuschätzen, sondern regelmäßig unmöglich. Der Grund dafür ist laut Lenman, dass wir schlicht ahnungslos sind, welche Folgen eine Handlung haben wird – besonders in der fernen Zukunft nach langen und sehr komplexen Kausalketten. In From Value to Rightness verteidigt Vuko Andrić einen Handlungskonsequentialismus mit subjektivem Entscheidungskriterium, der diesen Vorwürfen entgehen soll. Dieser Position zufolge sollen Handelnde auf Grundlage derjenigen Handlungsfolgen entscheiden, mit deren Eintreten sie vernünftigerweise rechnen können und nicht auf Grundlage der tatsächlich eintretenden Folgen. (shrink)

There is a concern according to which analyzing crime scene DNA to determine biogeographic origin and skin color of suspects can lead to discrimination against minority populations. This article summarizes and explains some of those parts of the investigation process that can give rise to discrimination. The second part of the paper offers an analysis of the notion of discrimination and presents different accounts of the exact ground of its moral wrongness. As it will emerge, these different accounts lead to (...) different assessments of the use of DNA phenotype analyses in police investigations. -/- ----- Dieser Beitrag befasst sich mit der Befürchtung, dass eine Erweiterung der DNA-Analyse von Tatortspuren für Zwecke der Polizeiarbeit zu Diskriminierungen führen wird. Diese Erwartung bezieht sich insbesondere auf die Ermittlung der sogenannten biogeografischen Abstammung und der Hautschattierung. In dieser Untersuchung werden einige Stellen im Ermittlungsprozess, an denen auf Grundlage solcher Analysen Diskriminierungspotential auftreten könnte, zunächst gesammelt und dargelegt. Im zweiten Teil wird dann der Diskriminierungsbegriff genauer beleuchtet. Dabei wird sich zeigen, dass verschiedene Positionen zu der Frage, was genau eine Diskriminierung moralisch problematisch macht, zu unterschiedlichen Einschätzungen der DNA-Phänotypisierung in der Polizeiarbeit führen. (shrink)

This paper addresses the so-called Taurek debate on whether or not to save the greater number of victims in rescue conflicts. In this controversy we take a consequentialist and aggregationist pro-numbers position and defend it against various objections. In particular, we consider it to be compatible with the principle of equal concern. Given that the pro-numbers position hinges to a significant extent on the acceptance of the person-neutral value of personal well-being, we offer a coherentist justification for this value claim. (...) Systematically though, we argue that neither pure welfare aggregationism nor its strict rejection are convincing. Rather, rejoining the two ethical dimensions of individual claims and collective well-being requires a hybrid position. Identifying three possible ways of constructing such a position, we briefly defend them against a recent version of the charge that they cannot be coherently expressed in a rational choice framework. -/- ----- Im Rahmen der sogenannten Taurek-Debatte wird die Frage diskutiert, ob in Rettungskonflikten die größere Anzahl an Opfern gerettet werden sollte oder nicht. Wir beziehen in dieser Kontroverse eine konsequentialistische und aggregationistische Pro-Anzahl-Position und verteidigen diese gegen verschiedene Einwände. Insbesondere halten wir die Position für kompatibel mit dem Prinzip gleicher Achtung. Angesichts des Umstandes, dass die Pro-Anzahl-Position in maßgeblicher Weise von der Annahme eines personenneutralen Wertes persönlichen Wohlergehens abhängt, bieten wir eine kohärentistische Rechtfertigung für diese Wertbehauptung. Systematisch argumentieren wir, dass weder ein reiner Wohlergehensaggregationismus noch seine komplette Zurückweisung überzeugend sein können. Die Vereinigung der beiden ethischen Dimensionen individueller Ansprüche und kollektiven Wohlergehens erfordert stattdessen eine hybride Position. Wir identifizieren drei mögliche Wege für die Konstruktion einer solchen Hybridposition und verteidigen diese abschließend kurz gegen einen aktuellen Vorwurf, demzufolge diese nicht auf kohärente Weise im Rahmen der rationalen Entscheidungstheorie abgebildet werden können. (shrink)

Michael Quante’s book Person offers a systematic and argumentative assessment of the question what a person is and accounts for the multiple aspects that play a role in our everyday understanding of the term. Quante is skeptical about the possibility of constructing a purely psychological account of the person and proposes to base the diachronic unity conditions of persons on the human organism. At the same time he acknowledges that psychological considerations, including the notion of a person’s personality, are important (...) for practical purposes. However, one may wonder why he proposes the human organism as the remedy for the alleged shortcomings of the psychological approach, rather than introducing an additional physical continuity requirement of the cerebrum or other parts of the brain. (shrink)

Dieser Aufsatz beleuchtet schlaglichtartig einige der gängigsten Kritikpunkte an Mills Theorie des Guten und zeigt auf, wie genau Sidgwicks detaillierterer Ansatz diese Stolpersteine umgeht. Kritiker haben schon immer moniert, (i) Mills »Beweis des Utilitarismus« stelle einen naturalistischen Fehlschluss dar und (ii) Mills qualitativer Hedonismus sei inkonsistent. Sidgwick vermeidet diese Vorwürfe mittels der Einführung eines »idealen Elements« des Guten. Dieser Schachzug wirft darüber hinaus ein neues Licht auf die weit verbreitete Annahme, der Hedonismus des klassischen Utilitarismus stelle ein rein naturalistisches Konzept (...) dar. Angesichts des Sidgwick’schen Hauptwerks des klassischen Utilitarismus ist davon auszugehen, dass der Begriff ›Hedonismus‹ stattdessen als Bezeichnung eines modernen, liberalen Verständnisses des individuellen Guten in Abgrenzung vom Gemeinwohl, beziehungsweise dem utilitaristischen Guten, zu verstehen ist. (shrink)

Among the most surprising claims in The Methods of Ethics is Sidgwick’s assertion that his key ethical axioms are corroborated by Kant. This article analyses Sidgwick’s claim that his axioms of justice and benevolence closely correspond to particular features in Kant. I shall argue that his claim of agreement with Kant was a serious overstatement. In particular, the restrictions which Sidgwick places on his acceptance of Kant’s universal law formula of the categorical imperative (FUL) seem to call into question whether (...) the alleged convergence with the axiom of justice has a solid basis. Further, Sidgwick seemed unaware of a crucial aspect of Kant’s conception of the humanity formula that constitutes a substantial divide between their views on benevolence. The upshot is that the divide between Kantian and Sidgwickian ethics appears deeper than Sidgwick seemed to realize. This analysis is confirmed by Sidgwick’s famous worries regarding freedom and the existence of God in Kant’s work. (shrink)

As we have all learned in recent years, a pandemic can produce shortages in intensive care units. In our jurisdiction, this has led to a ruling by the federal constitutional court, according to which the lawmaker has to provide better protection for persons with disabilities in the event of medical priority setting. From an ethical perspective, this task requires a choice among various competing accounts on what exactly it is that makes a case of discrimination morally problematic. In addition, these (...) accounts require amendments in order to encompass instances of indirect discrimination. As this article demonstrates by appeal to a number of concrete triage criteria, a moderate account of discrimination does the best job of focusing attention on the core of the current issues. Among these issues are the extent to which perceptions of persons with specific pre-existing challenges generally have an impact on the structure of their social interactions. -/- ----- Im Falle von Pandemien können die Kapazitäten auf den Intensivstationen bekanntlich knapp werden. In Deutschland hat dieser Umstand zu einem Urteil des Bundesverfassungsgerichts geführt, in dem vom Gesetzgeber verlangt wurde, Menschen mit Behinderungen für solche Fälle besser vor Diskriminierung zu schützen. Aus ethischer Sicht hängt die Frage nach den Diskriminierungspotentialen von Priorisierungskriterien stark davon ab, worin genau das Übel einer Diskriminierung verortet werden muss – eine Frage, zu der es in der Ethik mehrere konkurrierende Theoriegruppen gibt. In diesem Aufsatz soll gezeigt werden, dass diese Theorien darüber hinaus jeweils einer Ergänzung bedürfen, um dem Phänomen der indirekten Diskriminierung gerecht werden zu können. Wie hier am Beispiel einiger konkreter Triage-Kriterien gezeigt werden soll, ist ein Ansatz mittlerer Breite besonders geeignet, um die Aufmerksamkeit auf den Kern der aktuellen Probleme zu lenken. Dazu zählt insbesondere das Ausmaß, in dem soziale Gepflogenheiten gegenüber Menschen mit bereits zuvor bestehenden konkreten Schwierigkeiten generell Auswirkungen auf die Struktur ihrer sozialen Interaktionen haben. (shrink)

Refugee migration to Europe reached peak levels in 2015. During this time, more than 260,000 children applied for asylum in Germany; over 40,000 of whom arrived without parents or other legal guardians. This article takes a broadly descriptive legal approach to focus on the resulting legal and ethical problems in Germany, and to highlight a variety of ethically relevant issues within the legal system. In particular, refugee children below the legal age of 18, have special needs with regard to health (...) care, guardianship and appropriate custody, but the legal framework produces questionable inequalities that require further research. (shrink)

The scarcity of donor organs for transplantation purposes is now a widely known fact. The number of people on transplant waiting lists regularly far exceeds the number of available organs. This situation has led to decades of recurring discussions about how this shortage could be addressed. The undersupply results in situations within the Eurotransplant network as well as on national levels where patients often wait for years, enduring significant losses in quality of life, or never receive an organ allocation at (...) all. On a global scale, the shortage also contributes significantly to illegal organ trafficking, exposing vulnerable populations in poorer countries to considerable and often opaque risks. ----- Die Knappheit an Spenderorganen für Transplantationszwecke ist mittlerweile ein allgemein bekanntes Faktum. Auf der Warteliste für Transplantationen stehen regelmäßig sehr viel mehr Menschen als Organe verfügbar werden. Dieser Umstand führt seit Jahrzehnten immer wieder zu Diskussionen darüber, auf welche Weise dem Mangel entgegengetreten werden könnte. Die Unterversorgung führt sowohl im Eurotransplant-Verbund als auch auf jeweils nationaler Ebene zu Situationen, in denen Patienten teils jahrelang unter beträchtlichen Verlusten von Lebensqualität auf ein Organ warten oder eine Zuteilung erst gar nicht mehr erleben. Auf globaler Ebene führt der Mangel darüber hinaus in signifikantem Umfang zu illegalem Organhandel und setzt vulnerable Bevölkerungsgruppen in ärmeren Ländern teils beträchtlichen und intransparenten Risiken aus. (shrink)

Population growth and demographic change are two distinct but interconnected phenomena of population development. Population growth refers to the quantitative change of a population over time and is usually expressed as a growth rate in percentage terms relative to the respective population. A population growth rate greater than 0 indicates that the population is increasing, while negative population growth signifies a numerical decline. Demographic change encompasses shifts in birth and death rates, age structure, gender ratios, and migration (emigration and immigration). (...) Population growth and demographic change can lead to ethical challenges in areas such as the environment and nutrition, reproduction, intergenerational and gender equity, and migration. ------ Bevölkerungswachstum und demographischer Wandel sind zwei distinkte, aber zusammenhängende Phänomene der Bevölkerungsentwicklung. Das Bevölkerungswachstum bezeichnet die quantitative Veränderung einer Population über die Zeit und wird meist als Wachstumsrate in Prozent der jeweiligen Bevölkerung ausgedrückt. Ein Bevölkerungswachstum, dessen Wert größer als 0 ist, bedeutet, dass die Bevölkerung zunimmt; negatives Bevölkerungswachstum bedeutet eine zahlenmäßige Abnahme. Verschiebungen hinsichtlich der Geburten- und Sterberaten, der Altersstruktur, der Geschlechterverhältnisse sowie der Migration (Emigration und Immigration) machen den demographischen Wandel aus. Bevölkerungswachstum und demographischer Wandel können u.a. zu ethischen Problemen in den Bereichen Umwelt und Ernährung, Reproduktion, Generationen- und Geschlechtergerechtigkeit sowie Migration führen. (shrink)

Quite early in the Covid-19 pandemic, a recommendation was issued in Germany to address potential scarcity scenarios in hospital intensive care units. At its core, the recommendation from Germany’s medical professional societies stated that, in the event of overcrowded ICUs, physicians should base the selection of patients who could still be admitted on the likelihood of success for each individual in need (DIVI 2021). The purpose of focusing on the likelihood of success is to use the available resources to help (...) the greatest possible number of people in need effectively. However, legal scholars have repeatedly argued that a lottery-based solution would be far more suitable for such tragic rescue conflicts. This perspective was also adopted by some disability advocates, who fear the risk of discrimination against people with disabilities in scarcity scenarios, as their chances of success are often presumed to be systematically lower than those of people without disabilities. From an ethical standpoint, this raises the legitimate question of the conditions under which a decision-making criterion implies indirect discrimination against a particular group of people. ----- Schon recht früh in der Covid-19-Pandemie wurde in Deutschland eine Empfehlung für mögliche Knappheitsszenarien auf den Intensivstationen der Krankenkenhäuser herausgegeben. Im Kern besagt die Empfehlung der deutschen medizinischen Fachgesellschaften, die Ärzteschaft solle im Falle überfüllter Intensivstationen die Auswahl derjenigen, die in einem solchen Fall nochmal aufgenommen werden können, an der Erfolgsaussicht der einzelnen Bedürftigen festmachen. Der Zweck einer Orientierung an der Erfolgsaussicht besteht darin, mit den vorhandenen Ressourcen einer möglichst großen Anzahl an Bedürftigen erfolgreich helfen zu können. Insbesondere von Juristen wurde jedoch auch immer wieder argumentiert, eine Lotterie-Lösung sei sehr viel geeigneter für derartige tragische Rettungskonflikte. Eine solche Auffassung wurde auch von einigen Behindertenvertreter:innen übernommen, die eine Gefahr der Benachteiligung von Menschen mit Behinderung in Knappheitsszenarien befürchten, denn bei ihnen dürften die Erfolgsaussichten regelhaft schlechter sein als bei Menschen ohne Behinderung. In ethischer Hinsicht wurde hier also die berechtigte Frage aufgeworfen, unter welchen Bedingungen ein Entscheidungskriterium eine indirekte Diskriminierung einer bestimmten Personengruppe impliziert. (shrink)

This paper argues that Henry Sidgwick’s account of the relationship between the right and the good, as well as his theory of the good are still undervalued in many respects. An applied section illustrates the practical significance of this finding. In cases in which shooting down a passenger plane can save a greater number of people on the ground, and no other relevant considerations apply, the passengers should desire their own destruction—not only to promote the general good, but also in (...) order to reach the only good they can still secure for themselves: giving their inevitable deaths a positive meaning. This utilitarian position regarding some one-versus-the-many cases has been overlooked in the German Supreme Court ruling on the destruction of 9/11 airplanes in 2006. (shrink)

Scientific findings nowadays often rely on statistical analyses, are expressed in terms of probabilities, and are frequently developed based on model calculations. These circumstances contribute to a disconnect between scientific predictions and people's everyday risk assessments. Situations such as the COVID-19 pandemic, climate issues, or the downsides of global trade are particularly affected by this phenomenon. In these areas especially, the growth of knowledge implies new and far-reaching ethical (preventive) obligations for humanity. This chapter argues that a successful relationship between (...) scientific knowledge and people's everyday decision-making behavior in these domains can only emerge if several demanding prerequisites are met: understanding statistical findings and probabilities must be generally improved; the ethical implications resulting from this understanding must be recognized as moral progress; and the challenging delineations of new ethical obligations and political necessities that arise in risk contexts require careful and patient consideration, rather than being used as an excuse to maintain the status quo. -/- ----- Wissenschaftliche Erkenntnisse basieren heutzutage oft auf statistischen Auswertungen, werden in Wahrscheinlichkeit angegeben und sind nicht selten auf Grundlage von Modellrechnungen entwickelt. Diese Umstände tragen zu einer Abkoppelung der wissenschaftlichen Prognosen von den lebens- weltlichen Risikoeinschätzungen der Menschen bei. Situationen wie die COVID-19-Pandemie, die Klimaproblematik oder auch die Nachteile des globalen Handels sind von diesem Phänomen in besonderem Maße betroffen. Gerade auf diesen Gebieten impliziert der Wissenszuwachs neue und weitreichende ethische (Verhinderungs-)Pflichten für die Menschen. In diesem Kapitel wird argumentiert, dass ein gelingendes Verhältnis zwischen wissenschaftlicher Erkenntnis und dem alltäglichen Entscheidungsverhalten der Menschen in diesen Bereichen nur dann entstehen kann, wenn mehrere anspruchsvolle Voraussetzungen erfüllt sind: Das Verständnis von statistischen Erkenntnissen und Wahrscheinlichkeiten muss generell verbessert werden; das Verständnis der hierdurch resultierenden ethischen Implikationen muss als moralischer Fortschritt verstanden werden; und die schwierigen Grenzziehungen für die neuen ethischen Pflichten sowie politischen Notwendigkeiten, die im Rahmen von Risikokontexten notwendig werden, bedürfen einer differenzierten und geduldigen Bearbeitung, anstatt als Ausflucht in ein Weiter-so genutzt zu werden. -/- . (shrink)

This book addresses the medical-ethical dilemma of distributive justice. The focus is on situations where patients compete for limited resources and not everyone can be helped, as was recently observed in connection with the coronavirus. Such conflicts of assistance are characterized by a fundamental tension between the principles of fairness and efficiency. Dufner demonstrates how these opposing principles can be balanced and what such a position means for medicine, for example, in the allocation of donor organs or in triage situations. (...) -/- ----- Dieses Buch befasst sich mit dem medizinethischen Dilemma der Verteilungsgerechtigkeit. Im Fokus stehen dabei Situationen, in denen Patient*innen um begrenzte Ressourcen konkurrieren und nicht allen geholfen werden kann, wie es zuletzt auch im Zusammenhang mit dem Corona-Virus zu beobachten war. Derartige Hilfskonflikte sind gekennzeichnet durch ein elementares Spannungsverhältnis zwischen den Geboten der Fairness und der Effizienz. Dufner zeigt, wie diese gegenläufigen Gebote ins Verhältnis gesetzt werden können und was eine solche Position für die Medizin etwa bei der Verteilung von Spenderorganen oder in Triage-Situationen bedeutet. (shrink)