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)

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)

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)

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)

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)

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)

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)

Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded (...) in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing. (shrink)

The area of biomedicine is one of the fastest developing areas of science and technology. The perception of its possible and expected positive or negative impacts results in the growing number of bioethical discussions in scientific community, politics and public. Their intensity, focus and used methods differ from country to country. Th e authors of the prologue have tried to map the state of the art and expected development of bioethical discussion in the countries of Middle and Eastern Europe. In (...) the beginning, they addressed the bioethical experts with short questionnaire from 7 “new” European countries and two “old” European countries. In the end, seven experts have responded their questions and expressed their expectations and difficulties of the development of bioethical discussions and institutionalisations in their countries. The authors summarize in the prologue the most interesting results. (shrink)

Children and adolescents with an intellectual disability and autistic traits often attend special needs schools where they are surrounded by peers with diverse characteristics. Given the role that peers can play in social development, we examined whether autistic traits development in students with ID and high levels of such characteristics are influenced by the level of autistic traits among the schoolmates they like most. Furthermore, we investigated the degree to which this peer influence susceptibility depends on students’ gender. A longitudinal (...) design, with data collection points at the beginning and the end of a school year, was used. Staff reported on 330 students with high levels of autistic traits who attended 142 classrooms in 16 Swiss special needs schools. Results showed that students’ future individual level of autistic traits was not predicted by the autistic traits level of preferred peers, controlling for individual autistic traits at T1, level of general functioning, gender, and age. However, the peer effect was significantly moderated by students’ gender, indicating that girls but not boys were susceptible to peer influence. These findings are discussed in terms of implications for understanding autistic traits development and directions of support for children and adolescents in their peer context. (shrink)

Human actions have diverse consequences. Some consequences are intended, others are considered side effects, although they too, such as climate-damaging CO2 emissions, can be ethically relevant. Ethically speaking, considering consequences in a differentiated way is therefore clearly unavoidable. After discussing the influential concepts of utilitarianism and moral theology, the author presents his own approach to considering consequences.

According to a classical causal account of perception, to perceive that object x is F is to fulfill the following conditions: (i) one has an experience as of x's being F, (ii) x is F, and (iii) one's experience of x's being F depends causally on x's being F. This is the core of Grice's causal theory of perception, and it is initially quite plausible (Grice 1961).

Constructive technology assessment aims at anticipating societal impacts of technological innovations and suggests incorporating reflexivity and social learning into technology development. Social learning involves fostering the ability of diverse social actors to cultivate sociotechnical critical skills, thus allowing technological and social change to be governed with consideration for social values and diverging interests. Based on this demand, our paper presents a discourse-theoretical, interventionist approach to software design introducing deconstruction and (un-)learning as reflective practices to guide development processes. Inspired by Donna (...) Haraway’s focus on power relations in technoscience culture, our approach—called ‘deconstructive design’—traces how structures such as in/formal hierarchies and discursive hegemonies affect the development processes and design decisions of teams or communities of practices. The underlying deconstructivist methodology refers to practice-based concepts of situated learning. Thus, it locates a potential for value-based intervention at the micro/meso-level of everyday work practices. (shrink)

Hugh Mellor has proposed what appears to be a new solution to the problem of intrinsic change (Mellor 1998). Assuming endurantism and a B‐theoretic, nonpresentist view of time, facts are supposed to have only enduring things and atemporal properties (or relations) as constituents, but no times. The having of properties and relations is not relativised to times. Instead, the whole of a fact is conceived of as temporally localised. It will be argued that this interesting and novel proposal does not (...) succeed as an account of change in the intrinsic properties of things. The basic difficulty is that the view still leads into contradiction, since it makes it incomprehensible how one and the same thing can have both a property and some incompatible property. The having of these incompatible properties is treated as two facts. But to add that these facts have certain temporal locations is of no help for avoiding the contradiction. (shrink)

The science/non-science distinction has become increasingly blurred. This paper investigates whether recent cases of fraud in science can shed light on the distinction. First, it investigates whether there is an absolute distinction between science and non-science with respect to fraud, and in particular with regards to manipulation and fabrication of data. Finding that it is very hard to make such a distinction leads to the second step: scrutinizing whether there is a normative distinction between science and non-science. This is done (...) by investigating one of the recent internationally famous frauds in science, the Sudbø case. This case demonstrates that moral norms are not only needed to regulate science because of its special characteristics, such as its potential for harm, but moral norms give science its special characteristics. Hence, moral norms are crucial in differentiating science from non-science. Although this does not mean that ethics can save the life of science, it can play a significant role in its resuscitation. (shrink)

Auf der Suche nach dem „Urdrama“ entwickelt Hauptmann eine Dramaturgie, die der attischen Tragödie und ihrem mythischen Menschenbild folgt. Im Mittelpunkt seiner Dramatik und Prosa steht das Problem menschlichen Scheiterns. Er formuliert es als Anfrage an den neuzeitlichen Freiheitsbegriff.

This paper argues that critical realism is one of the main theoretical orientations of the social sciences in the twentieth and twenty-first centuries. Critical realism aims to study the transcende...

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)

This article focuses stakeholder theory on that critical juncture where stakeholder relationships and corporate policy decisions converge. A case study methodology is described that permits detailed analyses of multiple stakeholders’ objectives; it is suitable for studies of major corporate strategic decisions that are complex, controversial, involve multiple stakeholders, and require strategic trade-offs. The methodology is applied here to the dramatic decision by a Pacific Northwest forest company to phase out traditional clear-cut harvesting methods of old-growth forests. The study’s findings point (...) to new research questions and have theoretical implications for a finer grained conceptualization of stakeholder groups, stakeholder objectives, and stakeholder issues. (shrink)