Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. (...) We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures. (shrink)

The next World Congress of Bioethics will be held in Doha, Qatar. Although this location provides opportunities to interact with a more culturally diverse audience, to advance dialogue between cultures and religions, offer opportunities for mutual learning, there are also huge moral concerns. Qatar is known for violations of human rights ‐ including the treatment of migrant workers and the rights of women ‐ corruption, criminalization of LGBTQI+ persons, and climate impact. Since these concerns are also key (bio)ethical concern we (...) call for a broad debate within the bioethics community whether organizing and attending the World Congress in Qatar is ethically problematic and how ethical concerns should be dealt with. (shrink)

The concept of well-being is increasingly gaining acceptance as an object of science, and many different types of well-being measures have been developed. A debate has emerged about which measures are able to capture well-being successfully. An important underlying problem is that there is no unified conceptual framework about the nature of well-being—a hotly debated topic of philosophical discussion. I argue that while there is little agreement about the nature of well-being in philosophy, there is an important agreement on some (...) important principles relevant for its measurement. I argue that well-being science has good reasons to accommodate these principles, but currently fails to do so. (shrink)

Wellbeing describes how good life is for the person living it. Wellbeing comes in degrees. Subjective theories of wellbeing maintain that for objects or states of affairs to benefit us, we need to have a positive attitude towards these objects or states of affairs: the Resonance Constraint. In this article, we investigate to what extent subjectivism can plausibly account for degrees of wellbeing. There is a vast literature on whether preference-satisfaction theory – one particular subjective theory – can account for (...) degrees of wellbeing. This is generally taken to be problematic. However, other subjective theories – namely, desire-satisfaction, judgment- and value-fulfillment theories – do not suffer from the same difficulties. We introduce two models of degrees of wellbeing a subjectivist can employ: the Relative and the Absolute Model, and defend the claim that both models face difficulties. In particular, we argue that a subjectivist theory should describe instances of depression as instances of low degrees of wellbeing. We also argue that a reduction of desires may sometimes improve one’s degree of wellbeing, an idea we call the Epicurean Intuition. We then argue that the Relative Model fails to account for the disbenefit of certain types of depression, while the Absolute Model fails to meet a central commitment of subjectivism – the Resonance Constraint – and is unable to accommodate the Epicurean Intuition. The upshot of the paper is that subjectivist theories cannot account for degrees of well-being in a plausible way. (shrink)

This study argues for three main theses: (1) Immanuel Kant’s ethics is a social ethics; (2) the basic premises of his social ethics point to a socialist ethics; and (3) this socialist ethics constitutes a suitable platform for criticizing and improving Karl Marx’s view of morality. -/- Some crucial aspects of Kant’s social ethics are that we must promote the “realm of ends” as a moral society of co-legislators who assist each other in the pursuit of their individual ends, which (...) requires in turn that we seek the realization of the republican state and peace between the nations. Thus, hope for progress, as supported by the enthusiasm engendered among the spectators of the French Revolution, becomes pivotal to Kant’s ethics as well as other moral feelings such as moral indignation and solidarity with the victims of oppression. -/- Kant views the moral society in the final instance as an “inner” unification of good wills. In a decisive elaboration of Kant, the neo-Kantian Hermann Cohen argues that all our social institutions, and notably economic enterprises, must instantiate the “realm of ends,” leading him to support cooperative socialism in Wilhelmine Germany. In his own words, Kant “is the true and real originator of German socialism” (1896). -/- There are important evaluative similarities between Kantian socialist ethics and Marx, such as a condemnation of capitalism as a system of servitude and an understanding of the ideal society as a cooperative society, but only Marx contends that the ideal society does not set a moral task and that there is a dialectic operative in human history that inevitably leads to communist society. This dogmatic Hegelian understanding of history must be replaced by Kantian regulative understanding of progress in support of revolutionary praxis as moral praxis. -/- We need a “Kantianization” of Marx, as Cohen and other neo-Kantian socialists also proclaimed in the three decades leading up to World War I. This study concludes with “A Historical Note on Kantian Ethical Socialism,” addressing, among others, Cohen, Karl Vorländer, Eduard Bernstein, and Kurt Eisner and the Munich Revolution of 1918. Their voices were largely silenced by the rise of fascism, and this study hopes to show that their voices still need to be heard. -/- Awarded the 1985 Johnsonian Prize in Philosophy. (shrink)

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a (...) severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be. (shrink)

Compassion unites people during times of suffering and distress. Unfortunately, compassion cannot take away suffering. Why then, is compassion important for people who suffer? Nurses work in a domain where human suffering is evidently present. In order to give meaning to compassion in the domain of professional care, it is necessary to describe what compassion is. The purpose of this paper is to explore questions and contradictions in the debate on compassion related to nursing care. The paper reviews classical philosophers (...) as well as contemporary scientists' main arguments on compassion. First, I will examine the relationship between compassion and suffering. Second, how does one recognize serious suffering? This issue raises questions about the role of imagination and the need for identification. Third, literature describes compassion as an emotion. Some philosophers consider emotions uncontrollable feelings; others see a clear rational dimension in emotions. In order to determine what compassion is, it is necessary to weigh these contradictional arguments. Fourth, I will discuss motives for compassion. Is compassion an act of altruism or egoism? In this debate Nietzsche and Schopenhauer are well‐known opponents. Today, analysis of their arguments leads to some surprising conclusions. Fifth, there is the issue of fault and compassion. Can we only feel compassionate when people who suffer are not to blame for their own suffering? Such a condition faces professional caretakers with a dilemma which needs a thorough analysis if compassion is to be of use in the field of professional care. Finally, I will explore the moral meaning of compassion. Compassion, described as a concept with cognitive as well as affective dimensions, also has volitional and behavioural aspects. These aspects specifically are of importance to nursing care and further research of compassion in the nursing domain. (shrink)

Many political theorists, philosophers, social scientists, and other academics engage in political activism. And many think this is how things ought to be. In this essay, I challenge the ideal of the politically engaged academic. I argue that, quite to the contrary, political theorists, philosophers, and other political thinkers have a prima facie duty to refrain from political activism. This argument is based on a commonsense moral principle, a claim about the point of political thought, and findings in cognitive psychology.

Welfare in economics is generally conceived of in terms of the satisfaction of preferences, but a general, comparable index measure of welfare is generally not taken to be possible. In recent years, in response to the usage of measures of subjective well-being as indices of welfare in economics, a number of economists have started to develop measures of welfare based on preference-satisfaction. In order to evaluate the success of such measures, I formulate criteria of policy-relevance and theoretical success in the (...) context of preference-satisfaction measures of welfare. I present a detailed case study of the methodological choices put forward in a prominent generalized proposal for measuring welfare through preferences recently published in the American Economic Review. I contrast this with an alternative welfare measure which also uses preferences to weight aspects of welfare: the ICECAP-A measure. I assess the methodology of both approaches in detail and argue that the two goals of a preference... (shrink)

Courses on ethics and technology have become compulsory for many students at the three Dutch technical universities during the past few years. During this time, teachers have faced a number of didactic problems, which are partly due to a growing number of students. In order to deal with these challenges, teachers in ethics at the three technical universities in the Netherlands — in Delft, Eindhoven and Twente — have developed a web-based computer program called Agora (see www.ethicsandtechnology.com). This program enables (...) students to exercise their ethical understanding and skills extensively. The program makes it possible for students to participate actively in moral reflection and reasoning, and to develop the moral competencies that are needed in their later professional practice. The developers of the program have tried to avoid two traps. Firstly, they rejected, from the outset, a cookbook style of dealing with ethical problems that applied ethics is often taken to be and, secondly, they wanted to design a flexible program that respects the student’s as well as the teacher’s creativity, and that tries to engage students in moral reflection. Agora meets these requirements. The program offers possibilities that extend beyond the requirements that are usually accepted for case-exercises in applied ethics, and that have been realised in several other computer models for teaching ethics. In this article, we describe the main considerations in the development of Agora and the features of the resulting program. (shrink)

Since Gallie introduced the notion of essentially contested concepts, it has given rise to considerable debate and confusion. The aim of this paper is to bring clarity to these debates by offering a critical reconstruction of the notion of essential contestedness. I argue that we should understand essentially contestable concepts as concepts that refer to ideals or to concepts and phenomena that can only be fully understood in light of ideals and that are, as a consequence, open to pervasive contestation. (...) Moreover, some concepts are second-order essentially contested: it may be a matter of ongoing dispute as to whether they should be regarded as essentially contested. The concept of law is an example. Some authors argue that it is ideal-oriented, whereas others claim it is not. This insight that ‘law’ is a second-order essentially contested concept may explain some of the disagreements between legal positivism and its various opponents. (shrink)

ABSTRACTThe remarkable philosophical present-day turn to Paul pays a lot of attention to the particular role played by the famous distinctions that structure Paul’s rhetoric such as the distinction between faith and law, life and death, and spirit and flesh. These distinctions lead to the question of whether Paul endorses a dualism or not. In this essay, the author investigates Badiou’s and Agamben’s readings of Paul and asks whether one cannot find a form of dialectics rather than dualism in these (...) readings. The concept of the exception seems to corroborate this suggestion. To examine whether this suggestion makes sense, the author first discusses Badiou’s focus on the antidialectics of death and resurrection as well as the dialectical remnants in Badiou’s reading of Paul. Subsequently, the author analyses Agamben’s dialectical account of the Pauline terms katargein, chrēsis and charis. (shrink)

Many researchers studying subjective wellbeing (SWB) understand SWB as a concept that is close to Bentham’s notion of happiness. This conception of happiness is philosophically controversial, because it treats pleasure as a homogenous experience. I analyze an important deviation from Bentham in John Stuart Mill’s Utilitarianism and its relevance for SWB research: qualitative differences in pleasurable experiences. I argue that in cases where lives involving qualitatively different experiences are compared, Mill’s qualitative perspective is incompatible with an important assumption in the (...) SWB literature: that happiness can be meaningfully rated by people on a scale. I illustrate the problem by means of the question of whether becoming a parent makes people happier. I analyze whether the problem can be avoided on alternative views of happiness, but argue that on all plausible accounts of happiness, the problem persists. I conclude that the problem it poses for self-reported happiness is genuine and should be acknowledged by SWB researchers. I end by discussing the ways in which this conclusion can help the study of happiness move forward. (shrink)

This paper examines the prevalence of the ideal of “independence” in intellectual disability care in the Netherlands. It responds to a number of scholars who have interrogated this ideal through the lens of Michel Foucault’s vocabulary of governmentality. Such analyses hold that the goal of “becoming independent” subjects people with intellectual disabilities to various constraints and limitations that ensure their continued oppression. As a result, these authors contend, the commitment to the ideal of “independence” – the “ethic of autonomy” – (...) actually threatens to become an obstacle to flourishing in the group home. This paper offers an alternative analysis. It does so by drawing on a case study taken from an ethnographic study on group home life in the Netherlands. Briefly put, the disagreement stems from differing conceptualizations of moral life. Put in the vocabulary of moral anthropologist Cheryl Mattingly, the authors propose to approach the group home more from a “first-person” perspective rather than chiefly from a “third-person” perspective. They then draw on Mattingly to cast the group home as a “moral laboratory” in which the ethic of autonomy is not just reproduced but also enacted, and in which the terms of (in)dependence constantly get renegotiated in practice. What emerges is not only a new perspective on the workings of the “ethic of autonomy” in the group home, but also an argument about the possible limitations of the vocabulary of governmentality for analysing care practices. (shrink)

Readers should note that the paper below - penned by one of the journal's editorial panellists - is being published with the aim of stimulating debate around the issue of using a phenomenological research paradigm in the study of education leadership. This is especially important in view of the multiple methodologies that are prevalent within the broad scope of the social sciences and, equally important, the seemingly ever-changing methodological scenarios that do not necessarily usher in any paradigmatic changes. Reader response (...) is encouraged in the hope that a special issue dealing with Phenomenology in Education can be published in the short to medium term. [Editor's note] Indo-Pacific Journal of Phenomenology , Volume 4, Edition 1 July 2004. (shrink)

Often called the first of its kind, Frankenstein paved the way for science fiction writing. Its depiction of a then impossible scientific feat has in our time become possible and is essentially recognizable in what we now refer to as bioengineering, biomedicine, or biotechnology. The fiction of Frankenstein has as it were given way to scientific fact. Of more importance, however, is the challenge Mary Shelley’s novel presents to the ostensibly high-minded and well-intentioned hopes and promises of the scientist/technologist. Finally, (...) the fictional character, Victor Frankenstein, has come to serve as the poster child and whipping boy for all scientific and technological irresponsibility, so much so that thanks to him we are able to free ourselves and our scientists from any real responsibility, since none of us ever would or could be as monstrous as Frankenstein. (shrink)

Medical reproductive technologies have generated two new types of patients: ‘couples’ in infertility treatment and ‘fetuses’ in prenatal medicine. Using concepts from science and technology studies, specifically Latour’s (1993) notions of hybridity, mediation and purification, this article argues that these new patients are constructed in the very process of technological intervention in women’s bodies, while at the same time their constitutive role is erased from the medico-scientific accounts of these practices. Focusing on two discursive patterns found in the scientific discourses (...) on IVF as a treatment for male infertility, and fetal surgery for various congenital problems, the article shows how conceiving of couples and fetuses as patients allows many of the actual interventions on women to be ‘deleted’ from the accounts, while simultaneously presenting these interventions as being primarily about the treatment of men and children. The article exemplifies how a (feminist) constructivist analysis of the co-constitutive relation between technology and bodies (‘nature’) can avoid essentalism while retaining a critical perspective. (shrink)

Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

Background: Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. Objectives: (1) To identify and compare the five ethical issues considered most important by surveyed expert panellists in non-genetic and genetic AD research and (2) to compare our empirical findings with ethical issues in genetic research in general as described in the literature. (...) Method: A modified Delphi study in two rounds Results: Genetic and non-genetic research into AD generated an approximately equal number of topics with a considerable overlap. Different priorities in the ethics of both types of research were found. Genetic research raised new topics such as “confidentiality of genetic information” and “implications of research for relatives” which changes the impact and application of existing ethical topics such as “informed consent” and is judged to have more impact on both individuals and society. A difference with the results of more theoretical approaches on ethical aspects related to AD research was also found. Conclusions: Different priorities are given to ethical issues in genetic and non-genetic research. These arise partly because genetic research causes unique and new questions, mostly related to the position of family members and the status of and access to genetic information. Differences found between the results of our empirical study and the more theoretical literature, suggest an additional value for empirical research in medical ethics. (shrink)

Both the concept of a Darwinian tree of life (TOL) and the possibility of its accurate reconstruction have been much criticized. Criticisms mostly revolve around the extensive occurrence of lateral gene transfer (LGT), instances of uptake of complete organisms to become organelles (with the associated subsequent gene transfer to the nucleus), as well as the implications of more subtle aspects of the biological species concept. Here we argue that none of these criticisms are sufficient to abandon the valuable TOL concept (...) and the biological realities it captures. Especially important is the need to conceptually distinguish between organismal trees and gene trees, which necessitates incorporating insights of widely occurring LGT into modern evolutionary theory. We demonstrate that all criticisms, while based on important new findings, do not invalidate the TOL. After considering the implications of these new insights, we find that the contours of evolution are best represented by a TOL. (shrink)

This paper was presented at the Second World Congress on Logic and Religion on the sub-topic of logics vis-à-vis illogicalities in religion. It deals with fourteenth-century-logician Thomas Manlevelt’s Ockhamist approach to logic (the ars vetus, strictly speaking) and its ontological outcome: rejection of the existence of substance. Although God, the Trinity, the Blessed Virgin, the Antichrist and the consecrated host keep popping up within the domain of logic, it is argued that Manlevelt kept clear water between logic and theology. Things (...) divine, and especially the transubstantiation of the consecrated host, do however play a crucial role in the development of his idea of the non-existence of substance. It is suggested that this might imply the miraculous nature of the whole universe. (shrink)

Due to huge advancements in natural language processing (NLP) and machine learning, chatbots are gaining significance in the field of customer service. For users, it may be hard to distinguish whether they are communicating with a human or a chatbot. This brings ethical issues, as users have the right to know who or what they are interacting with (European Commission in Regulatory framework proposal on artificial intelligence. https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai, 2022). One of the solutions is to include a disclosure at the start (...) of the interaction (e.g., “this is a chatbot”). However, companies are reluctant to use disclosures, as consumers may perceive artificial agents as less knowledgeable and empathetic than their human counterparts (Luo et al. in Market Sci 38(6):937–947, 2019). The current mixed methods study, combining qualitative interviews (n = 8) and a quantitative experiment (n = 194), delves into users’ responses to a disclosed vs. undisclosed customer service chatbot, focusing on source orientation, anthropomorphism, and social presence. The qualitative interviews reveal that it is the willingness to help the customer and the friendly tone of voice that matters to the users, regardless of the artificial status of the customer care representative. The experiment did not show significant effects of the disclosure (vs. non-disclosure). Implications for research, legislators and businesses are discussed. (shrink)

In the medical-technological practice of in vitro fertilization, it is increasingly the couple, rather than an individual patient, that is considered the unit of treatment. This article traces some mechanisms involved in the construction of medical interventions on female bodies as appropriate and effective therapeutic solutions to problems and diagnoses pertaining to male bodies. It traces the transformation of male infertility through shifts in localization and definition of the problem, concomitant reconceptualizations of the techniques involved, redistributions of properties, and specific (...) ways of constructing "success. " It is argued that both the notion of the couple as the patient in cases of male infertility and the claim that IVF techniques are appropriate solutions to this couple's problem simultaneously presuppose and legitimize medical interventions on women's bodies. This double movement is produced by leaving exactly the required material work of physical interventions—and, consequently, the uneven distribution of costs between the sexes—out of scientific accounts of these practices. (shrink)

This chapter contains sections titled: Law Morality From Morality to Law From Law to Morality Converging Law and Morality Diverging Law and Morality: Beyond the Liberal Model References Further reading.

This paper deals with transnational Hindu and Muslim movements. It rejects the common assertion that migrant communities are conservative in religious and social matters by arguing that ‘traditionalism’ requires considerable ideological creativity that transforms previous practices and discourses considerably. It suggests instead that religious movements, active among migrants, develop cosmopolitan projects that can be viewed as alternatives to the cosmopolitanism of the European Enlightenment. This raises a number of challenges concerning citizenship, integration and political loyalty for governmentality in the nation-states (...) in which these cosmopolitan projects are carried out. The paper suggests that instead of looking at religious migrants as at best conservative and at worst terrorist one should perhaps pay some attention to the creative moments in human responses to new challenges and new environments. (shrink)

Synthetic biology is an emerging technology that asks for inclusive reflection on how people frame the field. To unravel how we can facilitate such reflection, this study evaluates the Frame Reflection Lab. Building upon playfulness design principles, the FRL comprises a workshop with video-narratives and co-creative group exercises. We studied how the FRL facilitated frame reflection by organizing workshops with various student groups. Analysis of 12 group conversations and 158 mini-exit surveys yielded patterns in first-order reflection as well as patterns (...) in second-order reflection. Also patterns in participants’ framing of synthetic biology could be induced; participants’ viewpoints converged to some extent, yet with openness to individual viewpoint differences. Although the FRL method fortified the reflection processes of participants, the narratives and the workshop’s flexible format could inhibit the reflection too. Therefore, we advise designers of future frame reflection methods to apply stronger conversational facilitation and narratives of slightly mysterious yet identifiable narrators, in case e.g. video-narratives are created and used to scaffold the reflection process. Nevertheless, we argue that the use of a playful frame reflection method like the FRL could function well as a step to precede more application-specific deliberation or decision-making on synthetic biology and as a method for the collection of contemporary citizen viewpoints plus rationales underlying these, for the further responsible development of the emerging field. (shrink)

In a previous publication, this author investigated the code as well as the objectives of holiness in the Gospel of John. This research deals with the en route to and character of holiness. The research starts with a concise characterisation of Jesus for the en route and character of holiness is embedded in the character of Jesus. Secondly, reference is made to the mimesis theories of Plato, Aristotle and Ricoeur. This facilitates a better understanding of the en route and character (...) of holiness in John. Thirdly, Jesus could exhorted them to follow him because he has set them an example (ὑπόδειγμα) in showing (καθώς) them the way. Fourthly, the research scrutinises those features in John that relate closely to the character of Jesus to provide more light to the en route and character of holiness. Finally, the Spirit (παράκλητος) will enable and will continue to sanctify the disciples of Jesus. The contribution of this research lies not only in providing a holistic overview of sanctification in John, but also in connecting the en route to and character of holiness in John with the character of Jesus which revolves around his mission of revelation and salvation. (shrink)

Nelson Goodman’s attempt to analyse the expressiveness of artworks in semantic terms has been widely criticised. In this paper I try to show how the use of an adapted version of his concept of exemplification, as proposed by Mark Textor, can help to alleviate the worst problems with his theory of expression. More particularly I argue that the recognition of an intention, which is central to Textor’s account of exemplification, is also fundamental to our understanding of expressiveness in art. Moreover (...) I propose that the recognition of this intention depends on our interpretation of the artwork – an insight Goodman tried to capture with his assertion that our attributions of expressive properties to artworks function metaphorically. The realisation of the context-dependence of our expressive judgements about art and, hence, of the central role interpretation plays in these judgements, I contend, counts in favour of theories of expression like Goodman’s that focus on semantic concerns. (shrink)