Meeting in the petri dish? -- Screen, test, weed out? -- Prettier, better, stronger? -- Is health a duty? -- The crisis of confidence in organ donation -- On the value of age : beyond the fitness imperative -- Living wills : are forms replacing dialogue? -- Being able to let go : for a new culture of dying -- Epilogue: happiness lies in our attitude toward the world.

The writings of the Scottish physician and philosopher John Gregory play an important role in the modern codification of medical ethics. It is therefore appropriate to use his work as a historical example in approaching the question how elements of aesthetics were incorporated in 18th century medical ethics. The concept of a Gentleman is pivotal to the entire medical ethics of John Gregory as it provides him with the ethical source of the duty to patients. Gregory makes the trustworthiness of (...) the physician a central point of his medical ethics, and it is in this context that Gregory declares good manners as an essential moral quality of a physician. This paper delineates how good manners are ethically justified in Gregory's medical ethics and concludes with an exploration of the importance of Gregory's conception for present day reflection on the inherence of aesthetics in ethical determinations. (shrink)

While many European countries are entering unknown legal terrain where the embryo in vitro is concerned, France can already look back on a long tradition of public discussion and legal codification of ways of dealing with in vitro embryos. In its comprehensive law of 1994, France had still rejected embryo research; however, due to the promising perspectives of stem cell research, the new law now pending implies a clear liberalization of the 1994 provisions. Both the French lawmakers and the National (...) Ethics Commission have repeatedly argued that possible utilization of embryos for research purposes may seem legitimate from the moment that there is no more "parental project." De facto, this concept implies that an embryo can be transformed into an object from the moment that the parents cease to desire it and that the value of protection is solely dependent on the will of third persons. At the same time, France is still speaking of guaranteeing respect for the "dignity of the embryo," which would mean that an embryo must not be reduced to a thing and treated for purposes which are not his own. Therefore, the French solution is not a consistent and honest solution, and in its new legal provisions, France has involved herself in manifold contradictions. France has rejected the conception of pre-embryo, but is de facto following Britain's model without making it explicit. (shrink)

A narrative analysis of a sequence from a documentary on the withholding of treatment in persistent vegetative state allows the discernment of several characteristics of the approach of the media to medical ethical problems: (1) The arrangement of the story units in the film sequence corresponds to established patterns of movie dramaturgy. (2) The documentary ”hollywoodizes” morality; it interprets the arena of the problem in the realm of the movie theatre and not in the realm of ethical discourse. (3) The (...) moral decision occurs in the return to mythical narrative structures which show a tendency to confirm perceived established world interpretation. (4) Morality is reduced to black and white characterizations. (5) The ethical conflict is transmitted through the plane of personal action which tends to blot out complex interdependencies. (6) Private happiness forms the basis for an essential set of criteria for all actions and decisions. The rational weighing of criterion is not easily transmittable by television; instead, television, due to its audiovisual sensory nature, has a great potential to awaken insight into and understanding of specific situations and personal experience. Thus television can supplement the philosophical discipline of hermeneutical bioethics in generating sympathy and deeper understanding. (shrink)

In my recent article, I addressed the question of whether a potential categorical exclusion of decisionally impaired patients from non-therapeutic medical research would be inaccordance with the Principle of Justice as Fairness. I came to the conclusion that a categorical exclusion of decisionally impaired persons from relevant research projects may collide with Rawls’s understanding of Justice as Fairness. Derek Bell has criticized my paper by denying that it is legitimate to apply Rawls to this bioethical problem. In my restatement I (...) try to show that an extrapolation of John Rawls’s thought to such bioethical cases is possible, because Rawls himself has written that his orientation towards decisionally non-impaired persons is an idealized situation that allows extrapolations. In a second part I try to show that Bell hasroughly misunderstood my concept of “presumed consent” which I make a prerequisite for the legitimisation of research on decisionally impaired persons. In using advance consent as a proposal for resolving the problem, Bell has indirectly confirmed my approach because he is using a similar construct of consent, which operates with similar hypotheses and probabilities of error. I see here no categorical difference between Bell’s conclusion and my discussion. Thus, Bell’s reply does not represent a refutation of my thoughts, but rather it is a para phrased confirmation of my central theses. I conclude by showing the relevance of Rawls, pointing out that the discussion between Bell and me illustrates how Rawls’s concept of reflective equilibrium is an appropriate approach to finding a solution to this bioethical problem. (shrink)

An ethical conflict arises when we must perform research in the interest of future patients, but that this may occasionally injure the interests of today''s patients. In the case of cognitively impaired persons, the question arises whether it is compatible with humane healthcare not only to treat, but also to use these patients for research purposes. Some bioethicists and theologians have formulated a general duty of solidarity, also pertaining to cognitively impaired persons, as a justification for research on these persons. (...) If one examines this thesis from the theory of justice according to John Rawls, it is revealed that such a duty of solidarity cannot necessarily be extrapolated from Rawls' conception of justice. This is at least true of Rawls' difference principle, because accordingto the difference principle only those measures are justifiable which serve the interest of the respective least well off. Those measures which would engender additional injury for the least well off could not be balanced by any utility according to Rawls. However, John Rawls' difference principle is subordinate to the first principle, which is that each person has an equal right to the most extensive basic liberty compatible with the same liberty for others. These primary goods are determined by the freedom and integrity of the person. This integrity of decisionally impaired persons would be in danger if one would abstain from research and thus forego the increase in knowledge related to their disease. Thus one could conclude, at least from Rawls' first principle, that society must take on a duty to guarantee the degrees of freedom for cognitively impaired persons and thus also support the efforts for their healing. (shrink)

The justification of non-therapeutic research on incapacitated persons isastill unsolved problem, because in this situation, both legitimising factors of research - informed consent and therapeutic benefit - are absent and the question arises as to whether such research is morally justifiable at all. The paperwill ask if there could be arguments for such research. One argument could be that under certain circumstances, an institutionally decreed global renunciation of any type of research on this group of persons could also be illegitimate. (...) Not doing research can do injury to the Principles of Justice because in this manner the needs of a particular group may unjustifiably be ignored. This would aggravate the disadvantaged position of this group in a groundless manner and, in particular, would deprive its members of the basis of self respect Precisely in view of this aspect of Justice non-therapeutic studies on decisionally impaired persans must also be permitted in order to ensure the preservation of basic social goods in regard to these persons. (shrink)

In his paper, “The Relevance of Rawls’ Principle of Justice for Research on Cognitively Impaired Patients” (Theoretical Medicine and Bioethics 23 (2002):45–53), Giovanni Maio has developed a thought-provoking argument for the permissibility of non-therapeutic research on cognitively impaired patients. Maio argues that his conclusion follows from the acceptance of John Rawls’s principles of justice, specifically, Rawls’s “liberty principle” Maio has misinterpreted Rawls’s “libertyprinciple” – correctly interpreted it does notsupport non-therapeutic research on cognitivelyimpaired patients. Three other ‘Rawlsian’ (...) arguments are suggested by Maio’s discussion –two “self-respect” arguments and a “presumed consent” argument – but none of them are convincing. However, an alternative argument developed from Rawls’s discussion of “justice in health care” in his most recent book, Justice as Fairness: A Restatement, may justify certain kinds of non-therapeutic research on some cognitively impaired patients in special circumstances. We should not expect anything more permissive from a liberal theory of justice. (shrink)

In the search for a globally binding ethical minimal consensus in dealing with research on human beings the awareness of the cultural specificity of such questions will be of central importance. France provides a good example of such cultural specificities. Three basic structures of French discussion on research ethics can be enumerated: first the particular weight placed on therapeutic benefit, second a particular accentuation on freedom and voluntarism, and third its lesser attention to the aspect of ability to give consent. (...) The weak emphasis on the ability to give consent is rooted as much in the traditionally paternalistically imbued physician-patient relationship as in the French legal system, in which the doctrine of consent is not given the fundamental position of importance found in the Anglo-Saxon countries. As an important Roman country, a different accentuation in the ethical discussion on research on humans can be recognised, a discussion in which for a long time the right of self determination was less of a criterion for decision than the teleology of medical action. It is precisely this aspect of latent cultural influence in ethical convictions which is of decisive importance for future discussion on research on humans. (shrink)

This is the first book to provide a coherent overview over the ethical implications of AI-related technologies in medicine. It explores how these technologies transform practices, relationships, and environments in the clinical field. It provides an introduction into ethical issues such as data security and privacy protection, bias and algorithmic fairness, trust and transparency, challenges to the doctor-patient relationship, and new perspectives for informed consent. The book focuses on the transformative impact that technology is having on medicine, and discusses several (...) strategies for dealing with the resulting challenges. It also introduces innovative methods of ethics research for addressing existing desiderata and future challenges. This book is written to inform health care professionals, policy-makers, and researchers in medicine, health sciences, nursing science, social sciences, and ethics, but may also function as a primary textbook for graduate as well as undergraduate university courses. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and (...) evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

Individuals who deviate from social norms by committing crimes may have reduced facial emotion recognition abilities. Nevertheless, a specific category of offenders – i.e. organised crime (OC) members – is characterised by hierarchically organised social networks and a tendency to manipulate others to reach their illicit goals. Since recognising emotions is crucial to building social networks, OC members may be more skilled in recognising the facial emotion expressions of others to use this information for their criminal purposes. Evidence of a (...) difference between OC and non-organised crime (NOC) offenders in terms of facial emotion recognition is still lacking. To fill this gap in the literature, we tested 50 OC, 50 NOC offenders, and 50 non-offender controls for their ability to identify six basic emotions (happiness, sadness, fear, anger, disgust, and surprise). All participants underwent a cognitive and psychological evaluation to avoid alternative explanations. Results show that OC members were more able to detect the expression of fear in others as compared to NOC. We interpreted this finding in light of the social context and the behavioural criminal attitude of OC members. (shrink)

This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook, however the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note that the online publication date for this handbook is the date that the first article in the title was published online.

Emotions and personhood are important notions within the field of mental health care. How they are related is less evident. This book provides a framework for understanding the important and complex relationship between our emotional wellbeing and our sense of self, drawing on psychopathology, philosophy, and phenomenology.

How can we better understand and treat those suffering from schizophrenia and manic-depressive illnesses? This important new book takes us into the world of those suffering from such disorders. Using self descriptions, its emphasis is not on how mental health professionals view sufferers, but on how the patients themselves experience their disorder. A new volume in the International Perspectives in Philosophy and Psychiatry series, this book will be of great interest to all those working with sufferers from such disorders - (...) helping them to better understand their mental lives, and providing important insights into how best to treat them. (shrink)

The semantical structures called T×W frames were introduced in (Thomason, 1984) for the Ockhamist temporal-modal language, ℒO, which consists of the usual propositional language augmented with the Priorean operators P and F and with a possibility operator ⋄. However, these structures are also suitable for interpreting an extended language, ℒSO, containing a further possibility operator ⋄s which expresses synchronism among possibly incompatible histories and which can thus be thought of as a cross-history ‘simultaneity’ operator. In the present paper we provide (...) an infinite set of axioms in ℒSO, which is shown to be strongly complete forT ×W-validity. Von Kutschera (1997) contains a finite axiomatization of T×W-validity which however makes use of the Gabbay Irreflexivity Rule (Gabbay, 1981). In order to avoid using this rule, the proof presented here develops a new technique to deal with reflexive maximal consistent sets in Henkin-style constructions. (shrink)

The semantical structures called T x W frames were introduced in (Thomason, 1984) for the Ockhamist temporal-modal language, $[Unrepresented Character]_{o}$ , which consists of the usual propositional language augmented with the Priorean operators P and F and with a possibility operator ◇. However, these structures are also suitable for interpreting an extended language, $[Unrepresented Character]_{so}$ , containing a further possibility operator $\lozenge^{s}$ which expresses synchronism among possibly incompatible histories and which can thus be thought of as a cross-history 'simultaneity' operator. (...) In the present paper we provide an infinite set of axioms in $[Unrepresented Character]_{so}$ , which is shown to be strongly complete for T x W-validity. Von Kutschera (1997) contains a finite axiomatization of T x W-validity which however makes use of the Gabbay Irreflexivity Rule (Gabbay, 1981). In order to avoid using this rule, the proof presented here develops a new technique to deal with reflexive maximal consistent sets in Henkin-style constructions. (shrink)

The λ-continuum of inductive methods was derived from an assumption, called λ-condition, which says that the probability of finding an individual having property $x_{j}$ depends only on the number of observed individuals having property $x_{j}$ and on the total number of observed individuals. So, according to that assumption, all individuals with properties which are different from $x_{j}$ have equal weight with respect to that probability and, in particular, it does not matter whether any individual was observed having some property similar (...) to $x_{j}$ (the most complete proof of this result is presented in Carnap, 1980). The problem thus remained open to find some general condition, weaker than the λ-condition, which would allow for the derivation of probability functions which might be sensitive to similarity. Carnap himself suggested a weakening of the λ-condition which might allow for similarity sensitive probability functions (Carnap, 1980, p. 45) but he did not find the family of probability functions derivable from that principle. The aim of this paper is to present the family of probability functions derivable from Carnap's suggestion and to show how it is derived. In Section 1 the general problem of analogy by similarity in inductive logic is presented, Section 2 outlines the notation and the conceptual background involved in the proof, Section 3 gives the proof, Section 4 discusses Carnap's principle and the result, Section 5 is a brief review of the solutions which have previously been proposed. (shrink)