This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

It is widely assumed that severe mental disabilities prevent relevant deliberative capacities from developing or persisting. Accordingly, excluding many people with mental disabilities from discourse practices seems justified. Against this common assumption I wish to show that the general exclusion is not justified and amounts to a form of epistemic injustice, as theorised by Miranda Fricker. The received norm of capable deliberators is connected to a specific model of deliberation. I introduce an alternative model of deliberation, which I dub the (...) joint effort model. According to this model, people with minority minds (as I call them) add valuable cognitive diversity to the process of deliberation, which is a relevant element of epistemic improvement. In this part of the argument I rely on empirically informed theoretical work by Hélène Landemore. I scrutinise the minimal requirements of capable deliberators from the perspective of a joint effort model of deliberation, and I highlight specific beneficial contributions people with minority minds can make to discourse practices. I will argue that people with minority minds can be presumptively deemed capable deliberators and that therefore their general exclusion is unjustified. (shrink)

This chapter introduces the main findings of the medical research on psychopathy as well as the most significant threads of the philosophical debates surrounding psychopathy. It also introduces the articles collected in this volume. The introduction focuses on issues in moral psychology and metaethics, such as moral motivation, moral responsibility, and moral understanding. It shows the difficulty in conceptualising psychopathy and in using psychopathy as a test case for philosophical theories.

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not defined as absence of disease (...) but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

The interdisciplinary contributions of this edition promote the development of a new "philosophical psychopathology".

In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties (...) to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

ABSTRACT In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of (...) duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

Individualität stellt für Mill eine Quelle und gleichzeitig ein Ziel individuellen und gesellschaftlichen Fortschritts dar. Individualität ist ein Element des Wohlergehens, wie die Überschrift des dritten Kapitels seiner Freiheitsschrift festhält. Individualität ist somit ein vorrangiges Ziel der Erziehung, Bildung und guten Regierung. Zudem kann Individualität, ausgedrückt in verschiedensten Lebensexperimenten, die Entwicklung einer Gesellschaft voranbringen. Es sollte insofern nicht überraschen, dass Individualität ein zentrales Konzept des Mill’schen. Denkens darstellt. Schließlich war sein Denken insgesamt auf die Verbesserung der Menschheit und der Lebensverhältnisse (...) gerichtet. (shrink)

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves (...) the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation. (shrink)

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, (...) the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)

In this paper, I discuss the risks of brain injuries in collision and contact sports and make a proposal to address them without limiting the autonomy of athletes. I aim to analyse the circumstances of profound uncertainty that athletes are facing in terms of the long-term impact of brain injuries. My strategy is to circumvent drastic measures in dealing with such risks, such as banning certain sports or changing their nature by introducing constitutive rule changes, and to scaffold individual autonomy (...) instead. I will focus on two aspects. First, I address the choice whether to take up or continue to play a risky sport given the mentioned profound level of ignorance. I argue that we can scaffold autonomy to make rational choices, particularly by enabling the application of heuristics. Second, I discuss performative skills that can help to prevent brain injuries. It is important to consider collision and contact sports as instances of joint action. The performance of others is an important factor in determining the level of risk in such sports. Hence, supporting athlete’s skills to prevent collisions can reduce the risk of brain injury. I conjecture ways to scaffold players’ skills and performance with this aim in mind. (shrink)

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure (...) of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard. (shrink)

Journal of Social Philosophy, EarlyView.

Misunderstanding other people can be interpreted as the result of an insufficient performance of people’s skills to understand other persons and their experiences. But what does understand mean in these contexts? And what are the relevant skills that need to be engaged to successfully understand other people? I argue that understanding other people is a form of recognition of the epistemic validity of another person’s perspective. I claim that minimal understanding does not require an endorsement of another person’s perspective. This (...) makes the avoidance of lack of understanding a feasible achievement in almost all cases, though it often requires effort in the interactive process of understanding. I specifically analyse the epistemic and normative roles of empathy in this process. In pursuing this aim, I also defend empathy against recent philosophical arguments that point at moral dangers of empathic processes. (shrink)

Ideal for students in the philosophy of medicine, healthcare and public health, this book offers an introduction to the philosophical debates around health justice. It presents clear conceptual definitions of health, disease and illness and the various theories of justice, developing a specific normative argument in the debate on health justice.

Mnoge biološke funkcije dopuštaju stupnjevanje. Na primjer, lučenje određenog hormona u organizmu može biti na višoj ili nižoj razini, u usporedbi s istim organizmom drugom prilikom ili u usporedbi s drugim organizmima. Koje razine funkcioniranja predstavljaju slučajeve disfunkcije; gdje da povučemo crtu? To je kvantitativni problem za teorije disfunkcije i bolesti. Cilj mi je braniti verziju bioloških teorija disfunkcije kako bih se uhvatio u koštac s ovim problemom. Međutim, također ću dopustiti da evaluativna razmatranja uđu u teoriju bolesti. Moj argument (...) se temelji na razlikovanju između biološke i kliničke perspektive. Prema mom mišljenju, bolest je ograničena na slučajeve koji spadaju u granice bioloških disfunkcija. Odgovor na kvantitativni problem ne zahtijeva proizvoljne odluke ili društveno vrijednosne sudove. Stoga se zalažem za nearbitrarnu metodu koja se temelji na činjenicama kako bi se riješio kvantitativni problem. Ipak, nisu sve biološke disfunkcije instance bolesti. Dodavanje kliničke perspektive omogućuje nam da spriječimo potencijalnu preveliku uključenost biološke perspektive, zato što postavlja dodatna ograničenja za određivanje granica bolesti. (shrink)

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. -/- The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the (...) lack of empathy, as some philosophers have proposed—but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. -/- As this volume demonstrates, philosophers will be better equipped to determine what they mean by “the moral point of view” when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy. (shrink)

The chapter starts from a specific interpretation of what it means to know the difference between right and wrong, which stems from Gilbert Ryle. To know the difference between right and wrong implies caring about morality. The author links Ryle’s ideas to the notion of being a moral person. Two different ideas found in moral philosophy are delineated, namely, the amoral person, that is, someone who rejects the demands of morality, and the morally incapacitated person, that is, someone who cannot (...) take those demands into account. Psychopaths are not amoral in the philosophers’ sense of the word, but are incapable of, or seriously deficient in, taking the moral point of view. (shrink)

In my commentary on Hempeler et al.’s (2024) important contribution to the ethics of psychiatry I will argue that psychiatric practices are necessarily unruly, and that this fact has important impl...

In this paper, I analyse whether empathy with future generations is feasible and whether it is a potentially useful instrument in effectively providing resources for future generations. I argue that empathy with future generations is possible, that it likely leads to a form of minimal concern, and that it can help in solving the relevant motivational problem. The most significant hurdle is not so much to do with achieving the required normative recognition of future generations, but with epistemic problems regarding (...) the right actions in protecting future interests and needs. Empathy can again be of help in this regard, but it would need to be successfully trained and supported. We need to stretch our empathy to non-existing people and we need to constrain our imagination in adequate ways to achieve a sufficient understanding of the perspectives of future people. (shrink)

TugendethikenTugend, Tugendethik sind normative Theorien des richtigen und guten Handelns, die den zentralen Gesichtspunkt der ethischen Bewertung in der handelnden Person, genauer in ihrer charakterlichen und motivationalen Verfassung sehen. Eine Tugend ist eine charakterlich gefestigte Haltung von Menschen, die sie das Richtige und Gute aus eigener Überzeugung erkennen und erstreben lässt. Als Tugenden gelten dabei nicht nur die im engen Sinne moralischen Tugenden wie Gerechtigkeit oder Aufrichtigkeit,WahrhaftigkeitAufrichtigkeitAufrichtigkeit, sondern sie umfassen beispielsweise auch selbstbezogene und intellektuelle Vortrefflichkeiten wie Besonnenheit oder WeisheitWeisheit, die (...) beide lange Zeit zu den Kardinaltugenden gehörten. (shrink)

Antipsychiatry is famous - and infamous - for its claim that there is no such affliction as mental illness. If this proved to be true, the status of psychiatry would change radically. The field of psychiatry would no longer be accepted by many as an integral part of medicine because the primary task of medicine is to cure the ill. The statement that there is no such thing as mental illness appears so highly radical that many hold doubts as to (...) its plausibility. Indeed, it could well be viewed as a totally absurd assumption, because in some cases we can even "see" the illness with persons who are hearing voices or hallucinate. Nevertheless, the claim appears absurd in the first instance only due to the fact that the existence of the phenomena is not denied, rather reference to the meaningful use of the concept of illness is denied. This would indicate that critics of the concept of mental illness do not contest that there are many people with serious mental problems, but maintain that we should not refer to them as being ill. The first cross-purposes in the debate on the concept of mental illness start at this point. (shrink)

Mit dem Ausdruck ‚sympathy‘ bezeichnet Mill die menschliche Fähigkeit, zu fühlen, was andere fühlen; oder allgemeiner, Zugang zum subjektiven Erleben Anderer zu erlangen. Sowohl Einfühlung als auch Mitfühlen sind in dieser Idee integriert. Für Mill ist ‚sympathy‘ eine wesentliche Voraussetzung der menschlichen Moralität. Allerdings gilt es, ‚sympathy‘ zur Fähigkeit auszubilden, genuin moralische Empfindungen zu zeigen. Erst dann sind stabile Moraldispositionen zu erwarten und damit letztlich die Realisierbarkeit des utilitaristischen Moralprinzips ermöglicht.

Wilhelm von HumboldtHumboldt, Wilhelm von war ein berühmter preußischer Gelehrter und Bildungsreformer. Sein posthum veröffentlichtes Werk Ideen zu einem Entwurf, die Grenzen der Wirksamkeit des Staates zu beschränken wird in Mills Schrift On Liberty und in seiner Autobiography mehrfach zustimmend erwähnt und zitiert. Selbst das Epigraph, welches Mill als Motto seiner Freiheitsschrift voranstellt, stammt von Humboldt: „The grand, leading principle, towards which every argument unfolded in these pages directly converges, is the absolute and essential importance of human development in its (...) richest diversity“ (CW XVIII, 215). (shrink)

Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention of disease. I point out epistemic and moral problems with these types of nudges, which lead to my conclusion that health-enhancing nudges fail. They fail because we cannot know which choices enhance individual health—properly understood in a holistic way—and because health-enhancing nudges (...) are often themselves bad for our health. They can be bad for our health because they assume inferior agency in their targets and accordingly regularly lead to appropriate resentment and anger—strong emotions which go along with an increased risk of health impairments. Briefly, health-enhancing nudges fail because they are based on persistent ignorance and on a presumptuous attitude. (shrink)

Sufficientarianism is a theory of social justice that determines individual entitlements by setting a threshold of what is enough for a decent life. Sufficientarianism therefore seems to be a suitable ally for theories of climate justice, because it restricts claims of justice to a minimum. Furthermore, the notion of sufficiency has been theorized in ecological discourse, so there is pertinent conceptual overlap between the two perspectives. In this paper, I aim to combine sufficientarianism with eco-sufficiency. I will use a framework (...) of needs to highlight different normative urgencies involved in practices that involve carbon emissions. However, as I will argue, the normative urgency of needs might cause problems for restricting emissions to levels that are compatible with planetary limits. In brief, the very aim of achieving sufficientarian justice might clash with the aim of eco-sufficiency. Sufficientarians should therefore critically engage with needs satisfiers as well, which are the means provided to satisfy needs. This step in my argument will be achieved through complementing sufficientarianism with an element of comparative justice, that is, interpersonal and diachronic considerations that help to determine the comparative urgency of claims. The overarching aim of sustainable sufficientarianism is to provide enough for everyone to live a decent life over time. (shrink)

In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational (...) alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I conclude that Rawlsian Justice as Fairness is bad for the environment. (shrink)

In diesem Artikel wird argumentiert, dass die Philosophie nicht über passende Methoden verfügt, reale politische Probleme angemessen zu analysieren. So sind die tatsächlich vorzufindenden Empfehlungen zur Lösung solcher Fragen meist trivial oder unterkomplex. Es wird geraten, zuerst geeignete Instrumentarien der angewandten bzw. konkreten Ethik zu entwickeln, bevor sich PhilosophInnen zu solch komplexen Fragen wie die der Flüchtlingspolitik äußern.

Der libertäre Paternalismus befürwortet Eingriffe in die Entscheidungsfindung von Bürgern, ohne ihnen Optionen völlig nehmen zu wollen. Vielmehr soll die Lenkung des Willens durch Schubser geschehen. Im folgenden Beitrag möchte ich zeigen, dass der libertäre Paternalismus auf tönernen Füßen steht. Ich bediene mich dabei des polemischen Bilds von Quacksalbern. Dieses Bild passt zu meinem argumentativen Vorgehen, da ich erstens zeigen will, dass der libertäre Paternalismus falsche Diagnosen über vermeintliche Krankheiten der Willensbildung stellt, und zweitens, dass er die falsche Therapie empfiehlt. (...) Im ersten Teil des Artikels kritisiere ich die Diagnose des libertären Paternalismus, wonach Menschen in ihrer Entscheidungsfindung systematisch fehlschlagen. Die Auswirkungen der zugrundeliegenden psychologischen Forschung werden missinterpretiert und damit vielen menschlichen Entscheidungen eine Art Defekt zugeschrieben. Der zweite Teil des Beitrags hinterfragt die Therapie des libertären Paternalismus. Für entsprechende Interventionen in die Wahlarchitektonik muss Wissen erlangt werden über die Richtung, in welche die Menschen jeweils geschubst werden sollten. Die hier genannte epistemische Aufgabe kann mit den theoretischen Mitteln des libertären Paternalismus nicht gelöst werden. (shrink)