An issue in current animal welfare ethics is the use of animals in medical education. At stake is the conflict of pain and suffering of the animals vs. the benefit to the students. The educator's role is to balance these two concepts. If the animals do suffer, this has to be justified by clearly establishing the necessity of their use. Neither this justification nor the methods for making the decision are clear. Addressed in this discussion are the arguments for and (...) against animal use, alternatives, and proposals for the resolution of the controversy. (shrink)

Si l'émergence des Etats au sortir du Moyen Age a progressivement conduit à une réduction des violences privées, le processus qui s'est alors mis en marche semble de no jours s'être enrayé. Ce tournant civilisationnel s'est traduit jusque-là par un refoulement de la pulsion de mort qui a pris la forme d'un monopole de l'Etat sur les guerres et d'une pacification diplomatique. Mais il témoigne à présent d'un épuisement inquiétant. Cela tient à l'affaiblissement des acteurs étatiques, si discrédités et contestés (...) qu'ils ne sont plus en mesure d'intervenir comme instances légitimes de régulation et de protection. Désormais, avec la mondialisation des violences non étatiques et des communautarismes, les sociétés doivent faire face à la brutalisation du monde - affrontements identitaires, destructions du lien social et des solidarités, exclusion de la communauté nationale d'individus lentement réifiés avant d'être socialement néantisés. Conjuguant les apports de la psychanalyse, de l'histoire et de la sociologie, cet essai propose un cadre d'analyse qui rend compte des reconfigurations actuelles d'une scène mondiale traversée par les forces destructrices de la décivilisation. (shrink)

Cet ouvrage est consacré aux principaux théoriciens marxistes. II montre comment ces penseurs ont rendu compte des conflits internationaux. Le paradigme marxiste se présente tout à la fois comme un cadre d'analyse, mais aussi une praxis. C'est pourquoi il a fait l'objet de tant de controverses théoriques et de luttes politiques. Cependant, il ne s'agit pas de se situer ici sur ce plan. Cette étude s'attache plutôt à montrer dans une première partie comment les pères fondateurs et les premiers théoriciens (...) marxistes (Marx, Engels, Lénine, Trotsky, Kautsky, Luxemburg, Liebknecht, Jaurès, Bernstein, Bauer) ont abordé la domination mondiale du capitalisme, et quelles approches ils ont élaborées sur la paix et la guerre. Dans la seconde partie, l'auteur traite de l'Ecole de la dépendance (Celso Furtado, André Gunder Frank, Fernando Henrique Cardoso) et des néomarxistes (Immanuel Wallerstein, Robert Cox, Stephen Gill, Eric Hobsbawm) pour évaluer les travaux critiques qu'ils ont menés sur les partages violents du monde. Par-delà les spécificités de chacun de ces penseurs, ce livre souligne la cohérence de la théorie marxiste en tant que matrice explicative des relations internationales. Cette dernière s'articule autour de quelques notions clés comme la lutte des classes, l'impérialisme et le capitalisme. Autant de concepts qui se retrouvent, avec la mondialisation de l'économie de marché, au coeur des questionnements actuels. (shrink)

Biobank research is potentially fruitful. It is argued that broad consent is acceptable for future research on biological material because a) the benefit is high, b) it pays respect to people’s autonomy, c) it is consistent with current practices and d) because the risk is low. Furthermore, broad consent should be allowed if information is handled safely, people can withdraw and expanded research should be approved by an ethics review board. However, these arguments are flawed and the criteria for broad (...) consent are either too restrictive to allow any research or fail to address important challenges with biobank research. Broad consent for biobank research can hide substantial ethical challenges and threaten trust in research. This does not mean that biobank research should be abandoned or that people cannot authorise future research on donated biological material. (shrink)

Between 1819 and 1832 Friedrich Schleiermacher was giving lectures on the life of Jesus at the University of Berlin. The following article includes two partial editions, which document the introductory parts of the lectures from 1819/20 and 1829/30. Both are based on manuscripts written by Schleiermacher’s listeners. Especially to explore the development of Schleiermacher’s conceptual considerations this two partial editions should be a useful addition to the new critical edition of Schleiermacher’s Vorlesungen über das Leben Jesu published in 2018 by (...) Walter Jaeschke (KGA II/15). (shrink)

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)

This article raises the question of whether bioethics qualifies as a discipline. According to a standard definition of discipline as “a field of study following specific and well-established methodological rules” bioethics is not a specific discipline as there are no explicit “well-established methodological rules.” The article investigates whether the methodological rules can be implicit, and whether bioethics can follow specific methodological rules within subdisciplines or for specific tasks. As this does not appear to be the case, the article examines whether (...) bioethics’ adherence to specific quality criteria (instead of methodological rules) or pursuing of a common goal can make it qualify as a discipline. Unfortunately, the result is negative. Then, the article scrutinizes whether referring to bioethics institutions and professional qualifications can ascertain bioethics as a discipline. However, this makes the definition of bioethics circular. The article ends by admitting that bioethics can qualify as a discipline according to broader definitions of discipline, for example, as an “area of knowledge, research and education.” However, this would reduce bioethics’ potential for demarcation and identity-building. Thus, to consolidate the discipline of bioethics and increase its impact, we should explicate and elaborate on its methodology. (shrink)

The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (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)

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)

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads to the very (...) uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny. (shrink)

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)

This paper defends the view that in a certain sense evidence is normative. Neither a bit of evidence nor the fact that it is evidence for a certain proposition is a normative fact, but it is still the case that evidence provides normative reason for belief. An argument for the main thesis will be presented. It will rely on evidentialist norms of belief and a Broomean conception of normative reasons. Two important objections will be discussed, one from A. Steglich-Petersen on (...) whether having evidence is sufficient for having a normative reason for belief and another one from S. Street. (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)

As recently stakeholders complain about the use of conflict minerals in consumer products that are often invisible to them in final products, firms across industries implement conflict mineral management practices. Conflict minerals are those, whose systemic exploitation and trade contribute to human right violations in the country of extraction and surrounding areas. Particularly, supply chain managers in the Western world are challenged taking reasonable steps to identify and prevent risks associated with these resources due to the globally dispersed nature of (...) supply chains and the opacity of the origin of commodities. Supply chain due diligence represents a holistic concept to proactively manage supply chains reducing the likelihood of the use of conflict minerals effectively. Based on an exploratory study with 27 semi-structured interviews within five European industries, we provide insights into patterns of implementation, key motivational factors, barriers and enablers, and impacts of SCDD in mineral supply chains. Our results contribute to both theory and practice as we provide first insights to SCDD practices and make recommendations for an industry-wide implementation of SCDD. Altogether, this study provides the basis for future theory testing research in the context of SCDD and conflict mineral management. (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.

In this paper I present an account of the rational abilities that make our decisions free. Following the lead of new dispositionalists, a leeway account of free decisions is developed, and the rational abilities that ground our abilities to decide otherwise are described in detail. A main result will be that the best account of the relevant rational abilities makes them two-way abilities: abilities to decide to do or not to do x in accordance with one’s apparent reasons. Dispositionalism about (...) rational abilities will be vindicated, since it helps to see why and how these two-way abilities entail an ability to decide otherwise and, thus, free will. (shrink)

Background: The knowledge of scientific dishonesty is scarce and heterogeneous. Therefore this study investigates the experiences with and the attitudes towards various forms of scientific dishonesty among PhD-students at the medical faculties of all Norwegian universities.MethodAnonymous questionnaire distributed to all post graduate students attending introductory PhD-courses at all medical faculties in Norway in 2010/2011. Descriptive statistics. Results: 189 of 262 questionnaires were returned (72.1%). 65% of the respondents had not, during the last year, heard or read about researchers who committed (...) scientific dishonesty. One respondent had experienced pressure to fabricate and to falsify data, and one had experienced pressure to plagiarize data. On average 60% of the respondents were uncertain whether their department had a written policy concerning scientific conduct. About 11% of the respondents had experienced unethical pressure concerning the order of authors during the last 12 months. 10% did not find it inappropriate to report experimental data without having conducted the experiment and 38% did not find it inappropriate to try a variety of different methods of analysis to find a statistically significant result. 13% agreed that it is acceptable to selectively omit contradictory results to expedite publication and 10% found it acceptable to falsify or fabricate data to expedite publication, if they were confident of their findings. 79% agreed that they would be willing to report misconduct to a responsible official. Conclusion: Although there is less scientific dishonesty reported in Norway than in other countries, dishonesty is not unknown to doctoral students. Some forms of scientific misconduct are considered to be acceptable by a significant minority. There was little awareness of relevant policies for scientific conduct, but a high level of willingness to report misconduct. (shrink)

Human enhancement is ontologically, epistemologically, and ethically challenging and has stirred a wide range of scholarly and public debates. This article focuses on some conceptual issues with HE that have important ethical implications. In particular it scrutinizes how the concept of human enhancement relates to and challenges the concept of health. In order to do so, it addresses three specific questions: Q1. What do conceptions of HE say about health? Q2. Does HE challenge traditional conceptions of health? Q3. Do concepts (...) of health set limits to or direct HE? Addressing Q1 reveals that HE tends to frame and form our conception of health. Thereby it challenges traditional conceptions of health. Accordingly, health does not provide strong sources for setting limits to HE. On the contrary HE seems to define and expand the concept of health. Common to the concepts of HE and health is that both depend on vague value concepts, such as happiness, well-being, or goodness. There seems to be a tendency in the HE literature to define the goal of human life in terms of what is bigger, stronger, faster, more intelligent, and more resilient. However, this is confusing “goodness” with “more” and quality with quantity. Until HE more appropriately defines happiness, HE will fail to provide a relevant compass for improving the life of human beings. On the contrary, if we let simplified conceptions of “enhancement” come to define goodness or health, we may do more harm than good. Until doing so, we may well learn from Tithonus, listen to Douglas Adams’ Wowbagger, and pay attention to Virginia Woolf’s Orlando. Enhanced life may not be better. The same goes for health. (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)

In business as elsewhere, “ugly people” are treated worse than ”pretty people.” Why is this so? This article investigates the ethics of aesthetic injustice by addressing four questions: 1. What is aesthetic injustice? 2. How does aesthetic injustice play out? 3. What are the characteristics that make people being treated unjustly? 4. Why is unattractiveness (considered to be) bad? Aesthetic injustice is defined as unfair treatment of persons due to their appearance as perceived or assessed by others. It is plays (...) out in a variety of harms, ranging from killing (genocide), torture, violence, exclusion (social or physical), discrimination, stigmatization, epistemic injustice, harassment, pay inequity, bullying, alienation, misrecognition, stereotyping, and to prejudice. The characteristics that make people treated unjustly are (lack of) attractiveness, averageness, proportion, and homogeneity. Furthermore, prejudice, psychological biases, logical fallacies, and unwarranted fear of disease are some reasons why unattractiveness is (considered to be) bad. In sum, this study synthesizes insights from a wide range of research and draws attention to aesthetic injustice as a generic term for a form of injustice that deserves more systematic attention. Having a definition, description, and explanation of the concept makes it easier to target the problems with aesthetic injustice. As the business world is an arena of ubiquitous aesthetic injustice business ethics can take the lead in identifying, explaining, and addressing the problem. (shrink)

How should we handle ethical issues related to emerging science and technology in a rational way? This is a crucial issue in our time. On the one hand, there is great optimism with respect to technology. On the other, there is pessimism. As both perspectives are based on scarce evidence, they may appear speculative and irrational. Against the pessimistic perspective to emerging technology, it has been forcefully argued that there is a status quo bias (SQB) fuelling irrational attitudes to emergent (...) science and technology and greatly hampering useful development and implementation. Therefore, this article starts by analysing the SQB using human enhancement as a case study. It reveals that SQB may not be as prominent in restricting the implementation of emergent technologies as claimed in the ethics literature, because SQB (a) is fuelled by other and weaker drivers than those addressed in the literature, (b) is at best one amongst many drivers of attitudes towards emergent science and technology, and (c) may not be a particularly prominent driver of irrational decision‐making. While recognizing that SQB can be one driver behind pessimism, this article investigates other and counteracting forces that may be as strong as SQB. Progress bias is suggested as a generic term for the various drivers of unwarranted science and technology optimism. Based on this analysis, a test for avoiding or reducing this progress bias is proposed. Accordingly, we should recognize and avoid a broad range of biases in the assessment of emerging and existing science and technology in order to promote an open and transparent deliberation. (shrink)

This paper will critically engage with Daniel Buckley's argument against “evidential minimalism” (EM), i.e., the claim that necessarily, bits of evidence (are or) provide epistemic reasons for belief. Buckley argues that in some cases, a subject has strong evidence that p (and fulfills further minimal conditions), does not believe p, but nevertheless is not epistemically criticizable and has no epistemic reason to believe p. I will defend EM by pointing out that Buckley's argument trades on an ambiguity between a strong (...) and a weak notion of criticizability. (shrink)

Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to internal processes, obesity is not a disease. Obesity undoubtedly can result (...) in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a “social disease” may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals’ interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese. (shrink)

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

The objective of this article is to investigate whether the concept of techne is fruitful as a framework to analyze some of the pressing challenges inmodernmedicine. To do this, the concept of techne is scrutinized, and it is argued that it is a concept that integrates theoretical, practical and evaluative aspects, and that this makes it particularly suitable to analyze the complex activity of modern medicine. After applying this technical framework in relation to modern medicine, some of its general consequences (...) are elaborated. In particular, it is argued that the concept of techne is appropriate to address the constitutive role of technology in medicine. Techne thus appears to be as fruitful a philosophical concept today as it was in antiquity. (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)

Background:Research integrity has gained attention in the general public as well as in the research community. We wanted to investigate knowledge, attitudes, and practices amongst researchers that...

The paper is an investigation into the prospects of an epistemology of non-conceptual knowledge. According to the orthodox view, knowledge requires concepts and belief. I present several arguments to the effect that there is non-conceptual, non-doxastic knowledge, the obvious candidate for such knowledge being non-conceptual perception. Non-conceptual perception seems to be allowed for by cognitive scientists and it exhibits the central role features of knowledge—it plays the knowledge role: it respects an anti-luck condition, it is an achievement, it enables one (...) to act for a reason, and it provides justification. Furthermore, it makes a straightforward and elegant explanation of perceptual knowledge possible: doxastic perceptual knowledge builds on non-conceptual perception as non-conceptual knowledge. Three objections that might naturally arise will be discussed and answered. Thus, the prospects of an epistemology without belief seem to be much better than the orthodoxy wants to have it. We can extend knowledge into the non-conceptual realm. (shrink)

Building upon Nancy Cartwright's discussion of models in How the Laws of Physics Lie, this paper addresses solid state research in transition metal oxides. Historical analysis reveals that in this domain models function both as the culmination of phenomenology and the commencement of theoretical explanation. Those solid state chemists who concentrate on the description of phenomena pertinent to specific elements or compounds assess models according to different standards than those who seek explanation grounded in approximate applications of the Schroedinger equation. (...) Accurate accounts of scientific debate in this field must include both perspectives. (shrink)

According to the so-called metaphysical conception of analyticity, analytic truths are true in virtue of meaning (or content) alone and independently of (extralinguistic) facts. Quine and Boghossian have tried to present a conclusive argument against the metaphysical conception of analyticity. In effect, they tried to show that the metaphysical conception inevitably leads into a highly implausible view about the truthmakers of analytic truths. We would like to show that their argument fails, since it relies on an ambiguity of the notion (...) of 'independence of (extralinguistic) facts'. If one distinguishes between variation independence and existence independence, the unwelcome view about the truthmakers of analytic truths no longer follows. Thus, there is at best a challenge, but no conclusive argument. The door to the metaphysical conception of analyticity is still open. (shrink)

What is good bioethics? Addressing this question is key for reinforcing and developing the field. In particular, a discussion of potential quality criteria can heighten awareness and contribute to the quality of bioethics publications. Accordingly, the objective of this article is threefold: first, we want to identify a set of criteria for quality in bioethics. Second, we want to illustrate the added value of a novel method: in-depth analysis of a single article with the aim of deriving quality criteria. The (...) third and ultimate goal is to stimulate a broad and vivid debate on goodness in bioethics. An initial literature search reveals a range of diverse quality criteria. In order to expand on the realm of such quality criteria, we perform an in-depth analysis of an article that is acclaimed for being exemplary. The analysis results in eleven specific quality criteria for good bioethics in three categories: argumentative, empirical, and dialectic. Although we do not claim that the identified criteria are universal or absolute, we argue that they are fruitful for fueling a continuous constitutive debate on what is “good bioethics.” Identifying, debating, refining, and applying such criteria is an important part of defining and improving bioethics. (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)

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)

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in (...) the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the "being" of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions. (shrink)

This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and (...) evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)

To develop a method for exposing and elucidating ethical issues with human cognitive enhancement. The intended use of the method is to support and facilitate open and transparent deliberation and decision making with respect to this emerging technology with great potential formative implications for individuals and society. Literature search to identify relevant approaches. Conventional content analysis of the identified papers and methods in order to assess their suitability for assessing HCE according to four selection criteria. Method development. Amendment after pilot (...) testing on smart-glasses. Based on three existing approaches in health technology assessment a method for exposing and elucidating ethical issues in the assessment of HCE technologies was developed. Based on a pilot test for smart-glasses, the method was amended. The method consists of six steps and a guiding list of 43 questions. A method for exposing and elucidating ethical issues in the assessment of HCE was developed. The method provides the ground work for context specific ethical assessment and analysis. Widespread use, amendments, and further developments of the method are encouraged. (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)

Fred Dretske’s account of mental causation, developed in Explaining Behavior and defended in numerous articles, is generally regarded as one of the most interesting and most ambitious approaches in the field. According to Dretske, meaning facts, construed historically as facts about the indicator functions of internal states, are the structuring causes of behavior. In this article, we argue that Dretske’s view is untenable: On closer examination, the real structuring causes of behavior turn out to be markedly different from Dretske’s meaning (...) facts. Our argument proceeds in three steps. First, we set forth the problem of meaning individuation: We argue that the proposal that meaning facts are structuring causes of behavior commits Dretske to a very fine-grained individuation of meanings that is deeply counterintuitive. In a second step, we show that even these finely individuated meaning facts cannot do the job that they are supposed to do, since information facts—which are constitutive of, but distinct from Dretske’s meaning facts—are better candidates for the role of structuring causes. Finally, we argue that it is not even information facts, but facts of co-instantiation which are the real structuring causes of behavior. In concluding, we briefly consider the options that are left for Dretske if our arguments succeed. (shrink)