The remarkable increase in diagnoses of autism has paralleled an increase in scientific research and turned the syndrome into a kind of a new ‘trend’ within psychiatric and developmental conditions of childhood. At the same time, discursive technologies, such as DSM-IV, autobiographies, movies, fiction, etc., together with ‘educational’ interventions, such as TEACCH, PECS, Makaton, etc., seem to anticipate a form of an apparatus built around the condition named autism. Starting from this premise, the article proposes a new approach within autism (...) studies, which treats the condition in Foucauldian terms and focuses on the emergence of the autistic subjectivity following Foucault's methodology of archaeology, genealogy, and modes of subjectification. (shrink)

According to orthodoxy, there are two basic moods of supposition: indicative and subjunctive. The most popular formalizations of the corresponding norms of suppositional judgement are given by Bayesian conditionalization and Lewisian imaging, respectively. It is well known that Bayesian conditionalization can be generalized (via Jeffrey conditionalization) to provide a model for the norms of partial indicative supposition. This raises the question of whether imaging can likewise be generalized to model the norms of ‘partial subjunctive supposition’. The present article casts doubt (...) on whether the most natural generalizations of imaging are able to provide a plausible account of the norms of partial subjunctive supposition. (shrink)

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In this commentary I expand on the first of Noble’s illusions, the selection metaphor. Building on my work with Simona Ginsburg on the evolution of minimal consciousness, I argue that the existence of some complex sensory and motor patterns in the living world can be accounted for only through the evolution of conscious choice.

On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive (AED) for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the (...) Regional Review Committees for Termination of Life on Request and Euthanasia (RTE) and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)

With regard to current debates on the ethical implementation of AI, especially two demands are linked: the call for explainability and for ultimate human responsibility. In the medical field, both are condensed into the role of one person: It is the physician to whom AI output should be explainable and who should thus bear ultimate responsibility for diagnostic or treatment decisions that are based on such AI output. In this article, we argue that a black box AI indeed creates a (...) rationally irresolvable epistemic situation for the physician involved. Specifically, strange errors that are occasionally made by AI sometimes detach its output from human reasoning. Within this article it is further argued that such an epistemic situation is problematic in the context of ultimate human responsibility. Since said strange errors limit the promises of explainability and the concept of explainability frequently appears irrelevant or insignificant when applied to a diverse set of medical applications, we deem it worthwhile to reconsider the call for ultimate human responsibility. (shrink)

Complex technology has become an essential aspect of everyday life. We rely on technology as part of basic infrastructure and repeatedly for tasks throughout the day. Yet, in many cases the relation surpasses mere reliance and evolves to trust in technology. A new, disruptive technology is blockchain. It claims to introduce trustless relationships among its users, aiming to eliminate the need for trust altogether—even being described as “the trust machine”. This paper presents a proposal to adjust the concept of trust (...) in blockchain applications with the tools provided by conceptual engineering. Its goal is to propose a concept of trust, that offers more than a halo term, devoid of the normative depth that the original, philosophical term actually carries. To evaluate possible concepts of trust in blockchain applications, five criteria are proposed: These criteria ensure that the conceptual relation indeed embodies trust, thereby being richer than mere reliance, and that the chosen concept highlights the active role of the trustor. While the concepts of trust in engineers and trust in algorithms have to be discarded, institutional trust emerges as a viable candidate, given some refinements. Ultimately, the concept of trust by normative expectations and attribution is suggested to capture the essence of trust in blockchain applications. (shrink)

Current debates about reasons and reasoning often draw comparisons between epistemic and practical reasons and reasoning and presuppose substantial unity between the practical and epistemic domains. This stance seems to conflict with a stark Humean contrast between the two domains: With respect to practical reasons and reasoning, Hume highlights the role of impressions, especially the passions, in motivating and rationalizing action, while apparently downplaying the potential relevance of beliefs, reason, or reasons. With respect to epistemic reasons and theoretical reasoning, he (...) urges us to proportion our belief to the evidence (EHU 10.4), which suggests a significant epistemic role for evidential reasons. My contribution ar-gues that there is nonetheless a convincing and interesting unified Humean account of reasons and reasoning across both domains. To present my case, I first narrow down the unity claim that I am interested in. I then closely engage with Hume’s claims in epistemology, the philos-ophy of action, and metaethics to develop the unified Humean account. (shrink)

BackgroundResearch using data from medical care promises to advance medical science and improve healthcare. Academia is not the only sector that expects such research to be of great benefit. The research-based health industry is also interested in so-called ‘real-world’ health data to develop new drugs, medical technologies or data-based health applications. While access to medical data is handled very differently in different countries, and some empirical data suggest people are uncomfortable with the idea of companies accessing health information, this paper (...) aims to advance the ethical debate about secondary use of medical data generated in the public healthcare sector by for-profit companies for medical research (ReuseForPro).MethodsWe first clarify some basic concepts and our ethical-normative approach, then discuss and ethically evaluate potential claims and interests of relevant stakeholders: patients as data subjects in the public healthcare system, for-profit companies, the public, and physicians and their healthcare institutions. Finally, we address the tensions between legitimate claims of different stakeholders in order to suggest conditions that might ensure ethically sound ReuseForPro.ResultsWe conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients’ informational rights and their actions need to be compatible with the public’s interest in health benefit from ReuseForPro. (shrink)

Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, (...) we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about ‘futile’ treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families. (shrink)

As moral decision making in financial markets incorporates moral considerations into investment decisions, some rational decision theorists argue that moral considerations would introduce inefficiency to investment decisions. However, market demand for socially responsible investment is increasing, suggesting that investment decisions are influenced by both financial and moral considerations. Several models can be applied to explain moral behavior. We test the suitability of (a) multiple attribute utility theory (MAUT), (b) theory of planned behavior, and (c) issue-contingent model of ethical decision making (...) in organizations. In an experimental setting, 141 participants traded company shares in a computerized asset market. Over 12 periods, companies varied in morality (i.e., treatment of employees) and in profitability (i.e., expected dividends per share). Participants’ bids and asks for shares were recorded. Results indicate that moral considerations influence investment decisions, controlling for profit. Differences between the three models are discussed. (shrink)

In this chapter, I clarify the notions of mental content and of concept. I present competing views on these notions and indicate my own position. I introduce content in terms of correctness conditions and distinguish several kinds of propositions, as well as non-propositional scenario content, with which perceptual content might be identified. I relate this discussion to a wide-spread commitment in philosophy of perception to respect the subject’s perceptual perspective in ascriptions of perceptual content. Then I compare views of concepts (...) as Fregean senses, as mental representations, and as cognitive abilities and investigate how they relate to the central idea that concepts are possessed by subjects. I suggest that our talk of concept possession and exercise is anchored in subjects’ abilities for re-identification and for general thought and in their inferential abilities. I clarify how possession and exercise of these three conceptual abilities relate. (shrink)

The children of today live in a time when the images of themselves and their childhood, their needs, interests, and skills, are discussed, researched, challenged, and changed. Childhood, education and educational settings for young children are to a great extent governed by temporality. In this paper, temporality and temporal notions in education are explored and discussed. We especially illuminate two different ways of thinking about children in education and care for younger children in the West— the predominant biased notions of (...) the child as becoming or being. The child as becoming, is manifested primarily in classical developmental psychology while the notion of the child as being, has been highlighted mainly by sociological researchers in their critique of developmental psychology. This latter notion is also visible in a totally different manner in the philosophy of Rousseau, emphasizing the free and natural child. In addition, we explore an alternative way of thinking about temporality and children. Drawing upon the philosophy of Maurice Merleau-Ponty and Gilles Deleuze, we argue for a rethinking of temporality beyond linear views on time and biased notions of children as ‘either or’. A movement towards a perspective which not only combines notions, but where the whole is more than merely the sum of the parts, is proposed. This leads to an ambiguous, intertwined and ongoing connection between the temporal notions of have been, being and becoming, described by a novel concept—a chiasmic be(com)ing. We suggest that this alternative may be a fruitful way to overcome binary approaches and expand the discussion of temporality, and temporal notions of children, in education. Such an alternative could function as a counterweight to the predominant notions of education and teachers’ work. It may also be seen as a significant foundation for an ethical education since it is built upon ongoing and intertwined relationships, which appreciate openness and unpredictability. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

The debate on abortion has tended to avoid the psychological significance of an unwanted pregnancy, dominated istead by the strong emotions the subject excites. Eva Pattis Zoja examines the thoughts that surround a woman's decision to end a pregnancy, and presents the challenging thesis that voluntary abortion can often be a violent and unconscious act of self-realisation. Treating a theme which is central to our existence, the author makes no attempt to argue for or against, or to deny the painful (...) nature of the subject which she tackles, but instead looks at the way in which a decision to abort can affect a woman's inner life. (shrink)

This article offers a narrative analysis of the contributing factors of moral distress (MD) and moral injury (MI) among mental health clinicians working amidst humanitarian crises. It discusses the impact of moral stress on therapeutic relationships in mental health trauma. The article originated from the author's experience developing a peer-to-peer support program at a nongovernmental organization (NGO) and conducting peer-to-peer support for mental health clinicians and healthcare providers in Ukraine and Turkey. A significant amount of literature has documented the detrimental (...) effects of MD and MI on mental health, job sustainability, and resilience of healthcare providers and first responders. The negative effects of MD and MI are particularly relevant in trauma counseling, where clinicians must draw upon the use of self to develop therapeutic relationships with their clients. This process demands a high level of moral reasoning and self-awareness, which can be severely tested under the morally challenging conditions of a humanitarian crisis. There is an imperative need to deepen our understanding and to swiftly address the factors that precipitate MD and MI in mental health clinicians working in crisis zones. By doing so, we aim to bolster their resilience and the enduring nature of their commitment to help and save others. This, in turn, will not only contribute to saving more lives but also enable those who are affected by trauma to flourish in the aftermath of their experiences. (shrink)

Focusing on ‘real actions’ of ‘real people’, normative behaviourism turns facts about observable patterns of behaviour into grounds for specific normative political principles. For this reason, this way of doing normative political theory has strong political realist credentials, given its methods, values and ambitions. In fact, according to its supporters, normative behaviourism is an improvement of political realism since it solves two problems that allegedly face many realists, namely, the ‘legitimacy problem’, i.e., how we should distinguish genuine acceptance of a (...) political system from false acceptance, and ‘the institutional problem’, i.e., how we should translate political principles into viable political institutions. In this paper, we make two claims. First, normative behaviourism does not solve the legitimacy problem encountered by realists, because its solution rests on a flawed distinction between foundational principles and ‘principles that matter’, together with a problematic use of a Humean internal reasons approach. Second, normative behaviourism does not solve the institutional problem encountered by realists, because its solution is in fact much more unfeasible than realist prescriptions, since feasibility is interpreted as mere possibility. We wind up our analysis by showing that normative behaviourism encounters new problems that realist approaches typically do not face. (shrink)

The global economy has an impact on female beauty today, regardless of the multicultural and historical factors in its formation and construction, resulting in monolithic crazes in women's fashion and appearance. but female beauty in china has been greatly contested with China's turbulent modern history, and this contestation deserves serious consideration, together with the politics by which the Chinese state apparatus has promoted and regulated female beauty. I argue that certain factors have been constant in contemporary discourses of female beauty. (...) Ideal bodies, in all their specifics, are defined by physical standards very few women can attain. These standards are accompanied by demeaning characterizations of women who fail to achieve them, and who are therefore destined to be discontent. It is now necessary for feminist theorists to examine the social and cultural roles of the body in terms of gender, power, the established patriarchy, and its oppression of women. (shrink)