Debates on the moral status of human embryos have been highly and continuously controversial. For many, these controversies have turned into a fruitless scholastical endeavor. However, recent developments and insights in cellular biology have cast further doubt on one of the core points of dissent: the argument from potentiality. In this article we want to show in a nonscholastical way why this argument cannot possibly survive. Getting once more into the intricacies of status debates is a must in our eyes. (...) Not merely intellectual coherence but the standing and self-understanding of current stem cell research might profit from finally taking leave of the argument from potentiality. (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)

“Die Gedanken sind frei,” in the words of the old song. But in Germany, thoughts are no longer free. Peter Singer, the “death ethicist,” has become a special target for activists attempting to silence bioethical debate in Germany. In the context of the trauma inflicted by National Socialism, a profound unease over issues at the end of life is accompanied by an insistence that these issues are not to be discussed.

„Medizinische Notwendigkeit“ (MedN) ist der zentrale Steuerungsbegriff für die Finanzierung medizinischer Versorgung in der deutschen Gesetzlichen Krankenversicherung. Trotz seiner scheinbaren Objektivität und Bestimmtheit durch ärztliche Expertise ist der Begriff alles andere als eindeutig definiert. In diesem ersten von fünf geplanten Aufsätzen zur Begriffsklärung von MedN aus medizintheoretischer, -ethischer, rechtlicher und (sozial)medizinischer Perspektive geht es um eine Systematisierung der aktuellen Kontroversen. Damit soll eine Fundierung für Detaildebatten gelegt werden, die bisher fehlt. Geklärt werden sollen die begriffliche Struktur, Funktion, Kontextualität und Missverständlichkeit (...) von MedN sowie die grundsätzlichen Grenzen einer Begriffsanalyse für die anstehenden normativen Fragen medizinischer Leistungssteuerung. (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)

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)

ZusammenfassungDie Odysseus-Verfügung ist als besondere Form der Patientenverfügung zumindest in der Literatur hinlänglich bekannt. Die Verwendung des Begriffs und damit sein Gegenstandsbereich sind hingegen noch immer umstritten. Zudem wird oft nicht beachtet, dass es innerhalb dieses Gegenstandsbereichs Varianten von OVs zu differenzieren gilt, die sich auch in ihrer moralischen Rechtfertigung unterscheiden. Nicht zuletzt ist die Grundstrukturstruktur dieser Rechtfertigung umstritten. Vor diesem Hintergrund plädieren wir im Folgenden zunächst für eine Eingrenzung des Begriffs, mit der argumentative und klinisch-praktische Verwirrungen vermieden werden können. (...) Anschließend betrachten wir zwei Varianten von – Zwang legitimierenden – OVs, die sich in der individuellen Kompetenz des Destinatärs unterscheiden. Schließlich zeigen wir, dass deren Rechtfertigung ungeachtet des Umstandes, dass OVs auf Wiedererlangung der Urteils- und Steuerungsfähigkeit des Patienten angelegt sind, weder in einer gemutmaßten noch gar in einer faktischen retrospektiven Billigung von Zwang durch den Patienten liegt. Die primäre Legitimationsgrundlage von OVs besteht vielmehr in der ex ante erfolgenden Autorisierung durch den Betroffenen selbst. Die hier einzuräumende Autorität wiederum basiert auf dem Recht jeder Person auf lebensplanerische Selbstbestimmung. In einem kurzen abschließenden Teil skizzieren wir dann noch die besondere Bedeutung der Odysseus-Vereinbarung als einer Unterform der OV. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

The objective of Working Group 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote knowledge (...) exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability. To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable. (shrink)

Is Plato’s philosophy still relevant for current issues in politics and political science? In order to answer this question, the contributions to this volume endeavour to re-read the Platonic dialogues and to interpret them in terms of textual hermeneutics on the one hand. On the other hand, they refer to Plato from a systematic point of view and apply his philosophy, in particular the method of Socratic dialogue, to discussions on contemporary political issues. The volume is dedicated to Barbara Zehnpfennig, (...) whose works aim at making Socratic–Platonic philosophy fruitful for the present on the basis of a new interpretation of Plato’s philosophy. With contributions by Anke Adamik, Sarah Al-Taher, Viktoria Bachmann, Philip Breuer, Johanna Falk-Seifert, Bettina Fröhlich, Benjamin A. Hahn, Hendrik Hansen, Thomas Haslböck, Raul Heimann, Johannes Frank Hoerlin, Vanessa Jansche, Peter Kainz, Christina Kast, Eva-Maria Kaufmann, Ulrich Kühn, Laura Martena, Julian Obenauer, Victor Peneff und Thomas Wimmer. (shrink)

On 26 February 2020, the Federal Constitutional Court of Germany pronounced a judgement that the prohibition of assisted suicide services set out in § 217 of the Criminal Code is void. It thereby reestablished the legal state that had obtained before 2015. Furthermore, it defined the right to die as an autonomy-based right, thereby dissociating the right to take one???s life from states of extreme suffering caused by illness. The judgement implies that one can, in principle, resort to assistance for (...) suicide even in the absence of illness and suffering. In this contribution, I deal with the problems that arise as a consequence of dissociating legitimate assisted suicide from states of illness. I analyze Bettina Schöne-Seifert???s suggestion to regard an understandable (,,nachvollziehbar“) wish to die as a wish that is protected by the right to autonomy. It turns out that the criterion of understandability is deficient: it either commits us to regarding every wish to die as understable or it undermines the anti-paternalistic requirement of respecting the patient???s autonomy. (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)

Schoene-Seifert's and Stier's thought-provoking target article (2013) addresses so many complex issues that it seems impossible to provide a comprehensive commentary in this space. Therefore, we co...

There are many- not just one- periodic laws in chemistry. These laws correspond to non-accidental regularity relations about physical and chemical properties of (sets of) chemical elements. I support this by showing how these regularity relations can be understood from the perspective of a philosophical analysis of laws. Specifically, I show that these relations instantiate standard features associated with laws; they can be spelled out in terms of two standard accounts of laws; and, they can coherently figure in debates about (...) the reality of laws as plausible candidates of ceteris paribus laws. (shrink)

One of the most plausible and widely discussed examples of strong emergence is molecular structure. The only detailed account of it, which has been very influential, is due to Robin Hendry and is formulated in terms of downward causation. This paper explains Hendry’s account of the strong emergence of molecular structure and argues that it is coherent only if one assumes a diachronic reflexive notion of downward causation. However, in the context of this notion of downward causation, the strong emergence (...) of molecular structure faces three challenges that have not been met and which have so far remained unnoticed. First, the putative empirical evidence presented for the strong emergence of molecular structure equally undermines supervenience, which is one of the main tenets of strong emergence. Secondly, it is ambiguous how the assumption of determinate nuclear positions is invoked for the support of strong emergence, as the role of this assumption in Hendry’s argument can be interpreted in more than one way. Lastly, there are understandings of causation which render the postulation of a downward causal relation between a molecule’s structure and its quantum mechanical entities, untenable. (shrink)

Patient RP suffers a unilateral right homonymous quadrant anopia but demonstrates better than chance discrimination for stimuli presented in the blind field at temporal frequencies between 33 and 47 Hz . Examination of her reports of visual experience during blind-field discrimination suggests a more complex picture in which experiences particular to correct discrimination are not found at low-mid-gamma frequencies, but are significantly more likely than average at a lower frequency at which blindsight is not observed. We believe that visual experience (...) may serve to support blindsight if discrimination tasks are generally impaired at frequencies outside of the low-mid-gamma band. If this is so, although generally experienced as non-specific and unstructured light, the visual experience that accompanies discrimination performance must be based upon a neural representation which includes information on the visual features present in the stimulus. (shrink)

There is a persisting debate about what chemical bonds are and whether they exist. I argue that chemical bonds are real patterns of interactions between subatomic particles. This proposal resolves the problems raised in the context of existing understandings of the chemical bond and provides a novel way to defend the reality of chemical bonds.

This case describes a recent iteration of the Ponzi scheme originated in 1920 by Charles Ponzi: creating a plausible investment, attracting investors, using the money from more recent investors to pay off earlier investors, and earning a substantial profit, estimated to be $15 million (worth $220 million today).1 While not as big as Bernie Madoff’s Ponzi scheme, as a result of which he was sentenced to 150 years in prison and ordered to pay restitution of $170 billion to his victims,2 (...) the Federal district court in Miami was asked to order Par Funding’s cofounders, Joseph W. LaForte and his wife, Lisa McElhone, to pay $337 million to Par Funding investors and to declare they engaged in a Ponzi scheme in defrauding those investors.3 Ultimately the Federal district court in Miami ordered Par cofounders to pay “$219 million in ‘ill-gotten gains,’ fines and interest so the funds can be used to help reimburse 1,200 investors who were duped into buying the risky, unregistered securities used to finance the high-fee loan company.”4 How LaForte and McElhone executed their scheme is an intriguing story which provides helpful insight into ethical and U.S. securities law principles. (shrink)

Harold Kincaid in Individualism and the Unity of Science postulates a model of unity-without-reduction in order to accurately describe the relation between individualism and macroeconomics. I present this model and apply it to the description of the relation between chemistry and quantum mechanics. I argue that, when it comes to the description of molecular structure, chemistry and quantum mechanics are unified in Kincaid’s sense. Specifically, the two disciplines contribute to the formation of a unified body of knowledge with respect to (...) molecular structure. (shrink)

A collegial procedure refers to the fact that, before making a delicate medical decision, the opinion of the entire care team responsible for the patient is sought, including nurses and orderlies, among others. The Claeys-Leonetti end-of-life law (2016) enshrines this in French law as mandatory when implementing deep and continuous sedation until death (DCSD). The aim of the study was to take stock of the awareness of this aspect of the law among all the healthcare staff of a cancer institute (...) and to identify how collegiality was established for a DCSD decision, depending on the department. We administered an anonymous online questionnaire to all those involved in healthcare (knowledge of the Claeys-Leonetti Act), and then met healthcare workers from the various departments in discussion groups (managers, nursing staff and orderlies) or in individual interviews (doctors). The results show that young healthcare staff (with less than 5 years’ experience) are more familiar with the law, across all professions, and that nurses and orderlies are more likely to assert their rights than doctors. We report on the diversity of the implementation of collegiality for sedation decisions, in terms of formalisation, standardisation and inter-professionalisation. We conclude that the implementation of collegiality in advance of a decision broadens the methods of multi/inter-professional communication and helps to alleviate the suffering of patients, doctors and care givers. (shrink)

A comprehensive look at the decline of the United States offers non-ideological remedies on how to overcome national self-doubt, reclaim optimism, and secure a prosperous future for American citizens.

Among contemporary religious believers, some follow in the footsteps of Newton, allowing their religious understanding to fill in gaps left by the sciences. Others take a more Wittgensteinian approach, discretely separating religious from scientific ways of thinking. Because neither of these relatively irenic positions captures the important element of cultural reform that is prevalent in so much of the religious life of the past, George Lakoff's recent work in cognitive studies is used to suggest ways that religious ideas may be (...) used to challenge and enrich scientific thought. A scrutiny of Richard Dawkins's biological analyses of human behavior reveals the distorting limitations of exclusively scientific understanding, thereby clearing conceptual space for genuinely religious values, actions, responsibilities, and forms of human life. (shrink)