New technologies facilitate the enhancement of a wide range of human dispositions, capacities, or abilities. While it is argued that we need to set limits to human enhancement, it is unclear where we should find resources to set such limits. Traditional routes for setting limits, such as referring to nature, the therapy-enhancement distinction, and the health-disease distinction, turn out to have some shortcomings. However, upon closer scrutiny the concept of enhancement is based on vague conceptions of what is to be (...) enhanced. Explaining why it is better to become older, stronger, and more intelligent presupposes a clear conception of goodness, which is seldom provided. In particular, the qualitative better is frequently confused with the quantitative more. We may therefore not need “external” measures for setting its limits – they are available in the concept of enhancement itself. While there may be shortcomings in traditional sources of limit setting to human enhancement, such as nature, therapy, and disease, such approaches may not be necessary. The specification-of-betterment problem inherent in the conception of human enhancement itself provides means to restrict its unwarranted proliferation. We only need to demand clear, sustainable, obtainable goals for enhancement that are based on evidence, and not on lofty speculations, hypes, analogies, or weak associations. Human enhancements that specify what will become better, and provide adequate evidence, are good and should be pursued. Others should not be accepted. (shrink)

Fifteen years ago, Ruth Macklin shook the medical community with her claim in the BMJ that dignity is a useless concept. Her essay provoked a storm of reactions. What have we learned from the debate? In this article I analyse the responses to her essay and the following debate to investigate whether she was right that “[d]ignity is a useless concept in medical ethics and can be eliminated without any loss of content.” While some of the commentaries misconstrued her claim (...) and argue against strawmen, others forcefully maintained that the concept of dignity has functions beyond “respect for persons and their autonomy.” One important point that came out of the debate is that dignity is a generic concept that covers more ground than “respect for persons or their autonomy.” In particular, dignity seems to have a wide range of protective functions as well as having reciprocal, relational, and social aspects. Dignity appears more attributional and norm‐formative than respect for persons and autonomy. While the claim that dignity is unclear, vague, and can be used sloganistically seems highly relevant, it is argued that this vagueness fulfils important functions in ethics. Moreover, dismissing dignity because of its lack of clarity has implications for “respect for persons” and “autonomy,” which are also used vaguely and sloganistically. No doubt medical ethics should use as a clear concept as the context requires. Nonetheless, dignity still seems to be a widely used generic concept in ethical debates and doing as much ethical work as “respect for persons” or “respect for autonomy.” Therefore, the death of dignity seems to be greatly exaggerated. (shrink)

This book is an introduction to and interpretation of the philosophy of language devised by Donald Davidson over the past 25 years. The guiding intuition is that Davidson's work is best understood as an ongoing attempt to purge semantics of theoretical reifications. Seen in this light the recent attack on the notion of language itself emerges as a natural development of his Quinian scepticism towards "meanings" and his rejections of reference-based semantic theories. Linguistic understanding is, for Davidson, essentially dynamic, arising (...) only through a continuous process of theory construction and reconstruction. The result is a conception of semantics in which the notion of interpretation and not the notion of knowing a language is fundamental. In the course of his book Bjorn Ramberg provides a critical discussion of reference-based semantic theories, challenging the standard accounts of the principle of charity and elucidating the notion of radical interpretation. The final chapter on incommensurability ties in with the discussions of Kuhn's work in the philosophy of science and suggests certain links between Davidson's analytic semantics and hermeneutic theory. (shrink)

Bariatric surgery is effective on short- and medium-term weight loss, reduction of comorbidities, and overall mortality. A large and increasing portion of the population is eligible for bariatric surgery, which increases instant health care costs. A review of the literature identifies a series of ethical challenges: unjust distribution of bariatric surgery, autonomy and informed consent, classification of obesity and selecting assessment endpoints, prejudice among health professionals, intervention in people's life-world, and medicalization of appearance. Bariatric surgery is particularly interesting because it (...) uses surgical methods to modify healthy organs, is not curative, but offers symptoms relief for a condition that it is considered to result from lack of self-control and is subject to significant prejudice. Taking the reviewed ethical issues into account is important when meeting persons eligible for bariatric surgery, as well as in the assessment of and decision making on surgery for obesity. (shrink)

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. (...) Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis. (shrink)

According to the expressivist argument the choice to use biotechnologies to prevent the birth of individuals with specific disabilities is an expression of disvalue for existing people with this disability. The argument has stirred a lively debate and has recently received renewed attention. This article starts with presenting the expressivist argument and its core elements. It then goes on to present and examine the counter-arguments before it addresses some aspects that have gained surprisingly little attention. The analysis demonstrates that the (...) expressivist argument has a wide range of underpinnings and that counter-arguments tend to focus on only a few of these. It also reveals an important aspect that appears to have been ignored, i.e., that people do not select foetuses based on chromosomes or other biological traits, but based on characteristics of living persons with specific disabilities. This makes it more difficult to undermine the claim that negative selection of foetuses expresses a disvaluing of persons with such disabilities. It leaves the expressivist argument with a strong bite still. (shrink)

New technology generates fantastic possibilities which challenge traditional distinctions between good and bad. Genetic analysis of DNA for forensic purposes is but one example of this. Here society’s need for convicting criminals can conflict with the same society’s need to assure the confidentiality of information about its members and their trust in its institutions. In order to illustrate the complexity of such challenges, a case report from Norway is presented. The point is to reflect on the way we handle trailblazing (...) health technologies in general and on cases where law and order is gained by means that can be conceived of as immoral in particular. The case calls for careful ethical reflection. (shrink)

This important work of archaeological theory challenges us to reconsider our ideas about the nature of things, past and present, arguing that objects themselves possess a dynamic presence that we must take into account if we are to understand the world we and they inhabit.

Biographical note: The author is associate professor in ethics and political philosophy, Department of Philosophy, NTNU Trond.

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased (...) tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust. (shrink)

Aim of the paper is to present a new logic of technical malfunction. The need for this logic is motivated by a simple-sounding philosophical question: Is a malfunctioning corkscrew, which fails to uncork bottles, nonetheless a corkscrew? Or in general terms, is a malfunctioning F, which fails to do what Fs do, nonetheless an F? We argue that ‘malfunctioning’ denotes the modifier Malfunctioning rather than a property, and that the answer depends on whether Malfunctioning is subsective or privative. If subsective, (...) a malfunctioning F is an F; if privative, a malfunctioning F is not an F. An intensional logic is required to raise and answer the question, because modifiers operate directly on properties and not on sets or individuals. This new logic provides the formal tools to reason about technical malfunction by means of a logical analysis of the sentence “a is a malfunctioning F”. (shrink)

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person’s health. This study investigates how advancements in science (...) and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics. (shrink)

This paper addresses the mereological problem of the unity of structured propositions. The problem is how to make multiple parts interact such that they form a whole that is ultimately related to truth and falsity. The solution I propose is based on a Platonist variant of procedural semantics. I think of procedures as abstract entities that detail a logical path from input to output. Procedures are modeled on a function/argument logic, but are not functions. Instead they are higher-order, fine-grained structures. (...) I identify propositions with particular kinds of molecular procedures containing multiple sub-procedures as parts. Procedures are among the basic entities of my ontology, while propositions are derived entities. The core of a structured proposition is the procedure of predication, which is an instance of the procedure of functional application. The main thesis I defend is that procedurally conceived propositions are their own unifiers detailing how their parts interact so as to form a unit. They are not unified by one of their constituents, e.g., a relation or a sub-procedure, on pain of regress. The relevant procedural semantics is Transparent Intensional Logic, a hyperintensional, typed λ-calculus, whose λ-terms express four different kinds of procedures. While demonstrating how the theory works, I place my solution in a wider historical and systematic context. (shrink)

I will assess earlier approaches to the morphology of the G-stem imperative in Semitic and mount a reconstruction that supports a specific set of disyllabic patterns for the imperative of the basic stem in Proto-Semitic, i.e., qutul, qitil, and qital. The most common process envisioned for the formation of the imperative is clipping from the prefix conjugation, but the most recent full treatment of the topic is Elitzur Bar-Asher Siegal’s revision and expansion of a century-old proposal that qatul, qatil, and (...) qital are the patterns of the imperative in Proto-Semitic. I refute both the clipping approach and Bar-Asher’s patterns in favor of qutul, qitil, and qital, which are the most economical and precise reconstruction in accounting for the realizations of the imperative in the various branches of Semitic. (shrink)

The number of diagnoses and the number of persons having diagnoses have increased substantially, and studies indicate that diagnoses are given or upheld even if they are unwarranted, that is, that they do not satisfy professionally accepted diagnostic criteria. In this article, the authors investigate the ethics of withholding and withdrawing unwarranted diagnoses. First, they investigate ethical aspects that make it difficult to withhold and to withdraw such diagnoses. Second, they scrutinize whether there are psychological factors, both in persons/patients and (...) healthcare professionals, making it difficult to withdraw and withhold unwarranted diagnoses. Lastly, they use recent elements of the withholding-versus-withdrawing treatment debate in medical ethics to investigate whether there are any differences between withholding and withdrawing treatment and withdrawing and withholding unwarranted diagnoses. The authors conclude that it is crucial to acknowledge and address all these issues to reduce and avoid unwarranted diagnoses. (shrink)

In recent decades there has been an increased emphasis on non-technical skills in medical teams. One promising approach that relates teamwork to medical efficiency is the theory of Shared Mental Models. The aim of the present study was to investigate the suitability of the Shared Mental Model approach for teamwork between operators in emergency medical communication centers and the first line ambulance personnel in real-life settings. These teams collaborate while working from geographically dispersed positions, which makes them distinct from the (...) kinds of teams examined in most previous research on team effectiveness. A pressing issue is therefore whether current models on co-located teams are valid for medical distributed teams. A total of 240 participants from 80 emergency medical teams participated in the study. A team effectiveness model was proposed based on identified team coordinating mechanisms and the “Big five” team processes. Path analyses showed that SMM was positively associated with team effectiveness and negatively related to mission complexity. Furthermore, the coordinating mechanisms of SMM and Closed Loop Communication was positively related to “Big five” team scores. However, no effects were found for the “Big five” team processes on effectiveness, which could indicate that the model needs to be adjusted for application to geographically dispersed teams. Possible implications for team training of distributed emergency response teams are discussed. (shrink)

Logical semantics includes once again structured meanings in its repertoire. The leading idea is that semantic and syntactic structure are more or less isomorphic. A key motive for reintroducing sensitivity to semantic structure is to obtain fine‐grained meanings, which are individuated more finely than in possible‐world semantics, namely up to necessary equivalence. Just getting the truth‐conditions right is deemed insufficient for a full semantic analysis of sentences. This paper surveys some of the most recent contributions to the program of structured (...) meaning, while providing historical background. I suggest that to make substantial advances the program needs to solve the problem of propositional unity and develop an intensional mereology of abstract objects. (shrink)

This article argues that anthropology may represent untapped perspectives of relevance to social theory. The article starts by critically reviewing how anthropology has come to serve as the ‘Other’ in various branches of social theory, from Marx and Durkheim to Parsons to Habermas, engaged in a hopeless project of positing ‘primitive’ or ‘traditional’ society as the opposite of modernity. In contemporary debates, it is becoming increasingly recognized that social theory needs history, back to the axial age and beyond. The possible (...) role of anthropology in theorizing modernity receives far less attention. That role should go much beyond representing a view from ‘below’ or a politically correct appreciation of cultural diversity. It involves attention to key theoretical concepts and insights developed by maverick anthropologists like Arnold van Gennep, Marcel Mauss, Victor Turner and Gregory Bateson, concepts that uniquely facilitate an understanding of some of the underlying dynamics of modernity. (shrink)

The concept of disease has been the subject ofa vast, vivid and versatile debate. Categoriessuch as ``realist'', ``nominalist'', ``ontologist'',``physiologist'', ``normativist'' and``descriptivist'' have been applied to classifydisease concepts. These categories refer tounderlying theoretical frameworks of thedebate. The objective of this review is toanalyse these frameworks. It is argued that thecategories applied in the debate refer toprofound philosophical issues, and that thecomplexity of the debate reflects thecomplexity of the concept itself: disease is acomplex concept, and does not easily lenditself to definition.

We demonstrate how to validly quantify into hyperintensional contexts involving non-propositional attitudes like seeking, solving, calculating, worshipping, and wanting to become. We describe and apply a typed extensional logic of hyperintensions that preserves compositionality of meaning, referential transparency and substitutivity of identicals also in hyperintensional attitude contexts. We specify and prove rules for quantifying into hyperintensional contexts. These rules presuppose a rigorous method for substituting variables into hyperintensional contexts, and the method will be described. We prove the following. First, it (...) is always valid to quantify into hyperintensional attitude contexts and over hyperintensional entities. Second, factive empirical attitudes validate, furthermore, quantifying over intensions and extensions, and so do non-factive attitudes, both empirical and non-empirical , provided the entity to be quantified over exists. We focus mainly on mathematical attitudes, because they are uncontroversially hyperintensional. (shrink)

Dieser Beitrag bietet eine umfassende Diskussion des Textes “Humanismus und Christentum” (1950) des dänischen Philosophen und Theologen Knud E. Løgstrup. Er verortet den Text in seinem geistesgeschichtlichen Kontext und analysiert seine wichtigsten Argumente wie auch seine zentrale These, der zufolge Humanismus und Christentum einen entscheidenden Grundsatz teilen, insofern beide die Ethik als “stumm“ oder “unausgesprochen“ verstehen. Darüber hinaus wird dargelegt, wie Løgstrups Text zentrale Überlegungen in dessen späteren Publikationen, besonders in dem Hauptwerk Die ethische Forderung (1956), vorwegnimmt.

In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the (...) future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards. (shrink)

Medicalization is frequently defined as a process by which some non-medical aspects of human life become to be considered as medical problems. Overdiagnosis, on the other hand, is most often defined as diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person’s lifetime. Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used normatively to critique unwarranted or contested expansion of (...) medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of medicalization traditionally has been non-medical (social or cultural everyday life) phenomena, while the subject matter of overdiagnosis has been biological or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike. Medicalization is expanding, encompassing the more “technical” aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal, and participatory) medicine, medicalization will become all-encompassing, while overdiagnosis more or less may dissolve. In the end they may converge in some total “iatrogenization.” In doing so, the concepts may lose their precision and critical sting. (shrink)

To approach the philosophical anthropology of Donald Davidson is to get ready for an unusually high number of laps around the hermeneutic circle. Apparently a problem-oriented philosopher, Davidson presents his views in a continuing series of dense, tightly focussed papers on narrowly circumscribed topics. The lines of the big picture are mostly implicit. Yet it is the scope and the power of this picture that has made Davidson one of the most significant philosophers of this century. Naturally, this makes Davidson's (...) work an extremely tempting—and extremely treacherous—target for the exegete with synthesizing tendencies. Until now, the sense of danger seems to have won out; secondary expositions have largely confined themselves to particular aspects of his thought. For those seeking to appreciate the cohesion and comprehensiveness of Davidson's vision, there has been no alternative but, as Ted Honderich says, to “struggle and learn,” working their way through Davidson's papers, continually calibrating and recalibrating interpretations of Davidson's detailed philosophical proposals with the emerging pattern of their interrelationships. (shrink)

This article presents and evaluates arguments supporting that an approval procedure for genome-edited organisms for food or feed should include a broad assessment of societal, ethical and environmental concerns; so-called non-safety assessment. The core of analysis is the requirement of the Norwegian Gene Technology Act that the sustainability, ethical and societal impacts of a genetically modified organism should be assessed prior to regulatory approval of the novel products. The article gives an overview how this requirement has been implemented in the (...) regulatory practice, demonstrating that such assessment is feasible and justified. Even in situations where genome-edited organisms are considered comparable to non-modified organisms in terms of risk, the technology may have—in addition to social benefits—negative impacts that warrant assessments of the kind required in the Act. The main reason is the disruptive character of the genome editing technologies due to their potential for novel, ground-breaking solutions in agriculture and aquaculture combined with the economic framework shaped by the patent system. Food is fundamental for a good life, biologically and culturally, which warrants stricter assessment procedures than what is required for other industries, at least in countries like Norway with a strong tradition for national control over agricultural markets and breeding programs. (shrink)

In this article we discuss what we call the deliberative division of epistemic labor. We present evidence that the human tendency to engage in motivated reasoning in defense of our beliefs can facilitate the occurrence of divisions of epistemic labor in deliberations among people who disagree. We further present evidence that these divisions of epistemic labor tend to promote beliefs that are better supported by the evidence. We show that promotion of these epistemic benefits stands in tension with what extant (...) theories in epistemology take rationality to require in cases of disagreement. We argue that the epistemic benefits that result from the deliberative division of epistemic labor can provide epistemic reason to maintain confidence in cases of disagreement. We then show that the deliberative division of epistemic labor constitutes a distinct kind of epistemic dependence. (shrink)

Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of geographical variations in the provision of health (...) services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services. (shrink)

Richard Rorty (1931–2007) developed a distinctive and controversial brand of pragmatism that expressed itself along two main axes. One is negative—a critical diagnosis of what Rorty takes to be defining projects of modern philosophy. The other is positive—an attempt to show what intellectual culture might look like, once we free ourselves from the governing metaphors of mind and knowledge in which the traditional problems of epistemology and metaphysics (and indeed, in Rorty's view, the self-conception of modern philosophy) are rooted. The (...) centerpiece of Rorty's critique is the provocative account offered in Philosophy and the Mirror of Nature (1979, hereafter PMN). In this book, and in the closely related essays collected in Consequences of Pragmatism (1982, hereafter CP), Rorty's principal target is the philosophical idea of knowledge as representation, as a mental mirroring of a mind-external world. Providing a contrasting image of philosophy, Rorty has sought to integrate and apply the milestone achievements of Dewey, Hegel and Darwin in a pragmatist synthesis of historicism and naturalism. Characterizations and illustrations of a post-epistemological intellectual culture, present in both PMN (part III) and CP (xxxvii-xliv), are more richly developed in later works, such as Contingency, Irony, and Solidarity (1989, hereafter CIS), in the popular essays and articles collected in Philosophy and Social Hope (1999), and in the four volumes of philosophical papers, Objectivity, Relativism, and Truth (1991, hereafter ORT); Essays on Heidegger and Others (1991, hereafter EHO); Truth and Progress (1998, hereafter TP); and Philosophy as Cultural Politics (2007, hereafter PCP). In these writings, ranging over an unusually wide intellectual territory, Rorty offers a highly integrated, multifaceted view of thought, culture, and politics, a view that has made him one of the most widely discussed philosophers in our time. (shrink)

The aim of this article is to study the relationship between Epicureanism and pandemic priority-setting and to explore whether Epicurus's philosophy is compliant with the later developed utilitarianism. We find this aim interesting because Epicurus had a different way of valuing death than our modern society does: Epicureanism holds that death—understood as the incident of death—cannot be bad (or good) for those who die (self-regarding effects). However, this account is still consistent with the view that a particular death can be (...) bad for everyone else but those who die, such as family, friends, and society (other-regarding effects). During the pandemic, the focus has been on the number of deaths more than on the suffering and reduced well-being of those infected and the rest of society. However, since the pandemic requires prioritization, it is, on a utilitarian account, important to consider priorities that do the most good overall. In this article, we approach the harm of death from an Epicurean point of view, seeking to flesh out potential implications for pandemic priority-setting, and healthcare in general, using a case study of COVID-19 priority-setting. We also explore whether this would conflict with utilitarianism. We conclude that an Epicurean pandemic priority-setting approach would be different but, surprisingly, not radically different from many of the actual priority-setting decisions we saw under the COVID-19 pandemic. (shrink)

_This article presents an experiment in using Socratic dialogue as a methodological approach to Responsible Research and Innovation (RRI) in an interdisciplinary life sciences research project. The approach seeks to avoid imposing a set of predetermined substantive norms by engaging the researchers in knowledge-seeking group discussions. We adapted Svend Brinkmann’s method of epistemic interviewing, in order to facilitate reflection on normative issues concerning responsibility in research and innovation in two research group sessions. Two elements characterize this approach, relating it to (...) empirical ethics methodologies: (1) the aim is not to map and analyse opinions, but to develop knowledge based on the dialogue; and (2) the facilitators of the discussion are also active participants in the dialogue rather than mere “spectators”. Through a description of the approach and discussion of some key challenges, we __show the method’s potential as a supplement to the catalogue of RRI approaches and argue that it serves a dual purpose of contributing to knowledge production and reflexivity._ _Keywords_: Epistemic interviewing, bioethics, responsibility, reflexivity. (shrink)

In the debate on conscientious objection in healthcare, proponents of conscience rights often point to the imperative to protect the health professional’s moral integrity. Their opponents hold that the moral integrity argument alone can at most justify accommodation of conscientious objectors as a “moral courtesy”, as the argument is insufficient to establish a general moral right to accommodation, let alone a legal right. This text draws on political philosophy in order to argue for a legal right to accommodation. The moral (...) integrity arguments should be supplemented by the requirement to protect minority rights in liberal democracies. Citizens have a right to live in accordance with their fundamental moral convictions, and a right to equal access to employment. However, this right should not be unconditional, as that would unduly infringe on the rights of other citizens. The right must be limited to cases where the moral basis is more fundamental in a sense that all reasonable citizens in a liberal democracy should accept, such as the constitutive role of the inviolability of human life in liberal democracies. There should be a legal, yet circumscribed, right to accommodation for conscientious objectors refusing to provide healthcare services that they reasonably consider to involve the intentional killing of a human being. (shrink)

Background The edge metaphor is ubiquitous in describing the present situation in the world, and nowhere is this as clearly visible as in medicine. “The edge of medicine” has become the title of books, scholarly articles, media headlines, and lecture series and seems to be imbued with hype, hope, and aversion. In order better to understand what is at stake at “the edge of medicine” this article addresses three questions: What does “the edge of medicine” mean in contemporary debates on (...) modern medicine? What are the challenges “on the edge of medicine” (in these various meanings of “on the edge”)? How can philosophy and ethics contribute with addressing these challenges? Methods Literature searches in PubMed and Google Scholar are used to identify uses of the phrase “the edge of medicine” while conventional content analysis is used to analyze meanings of and challenges with “the edge of medicine.” These results are then investigated with respect to how philosophy and ethics can address the identified challenges. Results The literature reveals that “the edge of medicine” has many meanings, such as: Border; Margin (of life); Frontier; Forefront; Fringes; Plunge (abyss); Brink (verge); Conflict; and Balancing. In general, the various meanings address four basic challenges: setting limits, keeping control, make meaning, and handling conflicts or aporias. The analysis of each of the meanings of “the edge of medicine” identifies a wide range of important and urgent tasks for the humanities in general, and for philosophy and ethics in particular: 1) clarifying concepts; 2) clarifying assumptions and premises of arguments, methods, advice, and decisions; 3) elaborate new concepts and new theories; 4) conceptualize and handle uncertainty, moral regret, and residue; 5) reveal “the emperor’s new clothes;” 6) identify trends and reflect on their implications; 7) demarcation; and 8) reflecting on goodness in medicine. Conclusion The phrase “the edge of medicine” expresses a wide range of challenges for modern health care. Together with other disciplines philosophy and ethics can and should make crucial contributions at “the edge of medicine,” which is where the future of human beings and societies is created and formed. (shrink)

Les personnes présentant des troubles psychiques rencontrent des difficultés à s’insérer sur le marché du travail. Dans cette étude, nous évaluons dans quelle mesure les employeurs se préoccupent de l’accès des jeunes adultes qui présentent des troubles psychiques au travail salarié. Nous mettons l’emphase notamment sur les facteurs contextuels qui influencent les jugements et les comportements des employeurs durant le processus de l’embauche. Les résultats montrent que l’adhésion à l’Accord Norvégien sur la Vie Professionnelle Inclusive et le degré de formalisation (...) des procédures d’embauche vont de pair avec l’adoption de mesures inclusives en matière de recrutement de jeunes adultes qui présentent des troubles psychiques. Cependant, malgré cet accord, peu d’entreprises norvégiennes embauchent de jeunes adultes ainsi classés. De même, seul un petit nombre d’entreprises invitent à un entretien d’embauche un candidat qualifié présentant ces troubles. Notre étude concorde ainsi avec les recherches suggérant que les réticences ou les préjugés des employeurs au recrutement des personnes avec des troubles psychiques contribuent à leurs difficultés sur le marché du travail. (shrink)

The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

The widespread application of technology in health care has imposed a broad range of challenges. The field of health technology assessment (HTA) is developed in order to face some of these challenges. However, this strategy has not been as successful as one could hope. One of the reasons for this is that social and ethical considerations have not been integrated in the HTA process. Nowadays however, such considerations have been included in many HTAs. Still, the conclusions and recommendations of the (...) HTAs are not followed. The reason for this may be that the methods for integrating ethics for HTA are not sufficiently developed, or that they are not adequate. This article presents a supplementary approach to the ethical inquiry in HTA. It is argued that a value analysis is crucial in order to address the ethical issues of health care technology in a fruitful way and to make viable decisions about such technology. (shrink)

Trust can be understood as a precondition for a well-functioning society or as a way to handle complexities of living in a risk society, but also as a fundamental aspect of human morality. Interactions on the Internet pose some new challenges to issues of trust, especially connected to disembodiedness. Mistrust may be an important obstacle to Internet use, which is problematic as the Internet becomes a significant arena for political, social and commercial activities necessary for full participation in a liberal (...) democracy. The Categorical Imperative lifts up trust as a fundamental component of human ethical virtues – first of all, because deception and coercion, the antitheses of trust, cannot be universalized. Mistrust is, according to Kant, a natural component of human nature, as we are social beings dependent on recognition by others but also prone to deceiving others. Only in true friendships can this tendency be overcome and give room for unconditional trust. Still we can argue that Kant must hold that trustworthy behaviour as well as trust in others is obligatory, as expressions of respect for humanity. The Kantian approach integrates political and ethical aspects of trust, showing that protecting the external activities of citizens is required in order to act morally. This means that security measures, combined with specific regulations are important preconditions for building online trust, providing an environment enabling people to act morally and for trust-based relationships. (shrink)

In a 2010 paper Daley argues, contra Fodor, that several syntactically simple predicates express structured concepts. Daley develops his theory of structured concepts within Tichý’s Transparent Intensional Logic . I rectify various misconceptions of Daley’s concerning TIL. I then develop within TIL an improved theory of how structured concepts are structured and how syntactically simple predicates are related to structured concepts.