In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a (...) generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels. (shrink)

Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on (...) par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals. (shrink)

We are very grateful to Chong-Ming Lim for his thoughtful reply published in this journal on one of our articles, which motivated us to think more carefully about accommodating autistic individuals and treating autism. However we believe there are some confusions in Lim's argument. Lim uses the accommodation thesis, according to which we should accommodate autistic individuals rather than treat autism, as the starting point for his reasoning. He claims that if the accommodation thesis is right, then we should not (...) treat autistic individuals for their autism, not even low-functioning ones, because this would be disrespectful to all autistic individuals. We should instead limit ourselves to accommodate all autistic individuals. However, the opposition between accommodation and treatment is not valid in the case of autism, because of ambiguity in the concepts of accommodation and treatment. Moreover there is confusion in Lim's reasoning caused by omitting important facts about the practice of treating autism. (shrink)

High-functioning individuals with autism spectrum disorder typically lack cognitive empathy, compromising their moral agency from both a Kantian and a Humean perspective. Nevertheless, they are capable of exhibiting moral behavior, and sometimes, they exhibit what may be deemed ‘super-moral’ behavior. The empathy deficit poses, to varying degrees, limitations with respect to their moral motivation and moral agency. To compensate for this deficit, individuals with HF-ASD rely primarily, and justifiably, on the formation and application of moral rules. Educators who focus predominantly (...) on empathy, however, may be less effective in the moral education of individuals with HF-ASD because they neglect the preference for rules of the latter. In this article, I argue that an individualized balance of empathy-based and rule-based strategies in the context of moral education is needed to assist individuals with HF-ASD in their challenges with moral motivation and moral agency. (shrink)

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a (...) hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder. (shrink)

Introduction Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. Background Historically, the nurse’s primary concern is for the person who is ill, which is the core of nurses’ moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. Objective To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. Methods We used Margaret (...) Urban Walker’s framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. Ethical considerations Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). Findings Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19–infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. Discussion Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. Conclusion During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making. (shrink)

Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be ‘attractively morally innocent’ and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to (...) deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing ‘Kantian’ and an empathizing ‘ethics of care’ perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack ‘cognitive empathy’ which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail ‘morally educating’ children and adolescents with autism to become socially skilled empathic ‘liars’. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

Background Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses’ prioritizations in their work to achieve well-being and health for nursing home residents. Aim The aim of this study was to explore nursing home nurses’ priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context We conducted a (...) qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings We identified an overarching theme—nursing home nurses struggling on multiple fronts, “just do it”—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives’ expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions Nurses’ priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses’ priorities. Nursing home nurses need organizational and managerial support to prioritize. (shrink)

This article reconstructs Habermas’ normative program for the successful and mutually beneficial co-existence of the religious and the non-religious, looking especially at his reliance upon a particular translation of Kierkegaard. Kierkegaard himself wrote as a self-described Christian, or at least as someone invested in the possibilities of Christian existence, and so it is instructive to examine how Habermas, an admittedly non-religious thinker, renders Kierkegaard’s project. As I argue below, the specific ways in which Habermas employs Kierkegaard’s thought demonstrates what Habermas (...) himself advocates for others: an appreciative respect for religious insights and simultaneous self-reflection on the limitations of both secular and philosophical thinking. The article concludes by posing several challenges to Habermas's translation of Kierkegaard by looking at the post-secular critiques of liberalism that are found in the work of Asad, Mahmood and others. (shrink)

This book brings Søren Kierkegaard's nineteenth-century existentialist project into our contemporary age, applying his understanding of "freedom" and "despair" to science and science studies, queer, decolonial and critical race theory, and disability studies. The book draws out the materialist dimensions of belief, examining the existential dynamics of phenomena like placebos, epigenetics, pedagogy, and scientific inquiry itself. Each chapter dramatizes the ways in which abstractions like "race" or "genes" and even "belief" are sites of contested practices with pressing political significance. Focusing (...) on the existential dangers posed by neo-liberal and finance capitalist systems, the book brings to life the resources for resistance found within science studies and critical approaches to race, secularity, and disability. Throughout the book, Kierkegaard becomes an ally with ecological and developmental evolutionary theorists, as well as with science studies, critical race, and crip theorists who foreground the relational and impassioned nature of existence. (shrink)

My aim in this chapter is to push back against the tendency to emphasize Mill’s break from Bentham rather than his debt to him. Mill made important advances on Bentham’s views, but I believe there remains a shared core to their thinking—over and above their commitment to the principle of utility itself—that has been underappreciated. Essentially, I believe that the structure of Mill’s utilitarian thought owes a great debt to Bentham even if he filled in that structure with a richer (...) conception of human nature and developed it in more liberal directions. This commonality is revealed, in particular, in Mill’s own institutional designs and practical reform proposals in Considerations on Representative Government and related writings. If this is right, then the tendency of interpreters to highlight their differences rather than their similarities has been to the detriment of both Mill and Bentham scholarship, and so to our understanding of the rise of liberal utilitarianism. (shrink)

Donald Davidson is famous for, among other things, his theory of radical interpretation – an account of how it is that we can attribute meanings to people's words, and contents to their mental states, based on an apparent paucity of evidence. This account is infused with ideas from, and applications of, the general theory of measurement, as well as one specific instance of that theory – decision theory. In addition, however, Davidson also applies measurement theory – in the form of (...) his “measurement theoretic analogy” – from outside the theory of radical interpretation, to yield a novel account of one of its notable features: the indeterminacy of interpretation. I argue that the success of this application is limited, however, in dispelling a worry to which indeterminacy gives rise – namely that if Davidson's account of indeterminacy is correct, we have no mental states. (shrink)

The Routledge Handbook of Translation and Philosophy presents the first comprehensive, state of the art overview of the complex relationship between the field of translation studies and the study of philosophy. The book is divided into four sections covering discussions of canonical philosophers, central themes in translation studies from a philosophical perspective, case studies of how philosophy has been translated and illustrations of new developments. With twenty-nine chapters written by international specialists in translation studies and philosophy, it represents a major (...) survey of two fields that have only recently begun to enter into dialogue. The Routledge Handbook of Translation and Philosophy is a pioneering resource for students and scholars in translation studies and philosophy alike. (shrink)

‘Twelve Step' recovery programmes such as Alcoholics Anonymous teach that an alcoholic, or other addict, has a disease, and needs to accept that she is ‘powerless' over her addiction before recovery can begin. However, the disease model of addiction has been criticised on the grounds that some addicts recover without external intervention. This critique is questionable, not because such recovery does not occur, but because many genuine diseases are self-limiting. However, the disease model is better criticised on other grounds. Central (...) here is the idea of powerlessness. This article explores various supposed instances of powerlessness, including that induced by extreme fear, provocation and obsessive-compulsive disorder. It is argued that while addiction is a genuine phenomenon, it is strictly inaccurate to describe it as a lack of power. However, there is a deeper sense in which the autonomy of addicts is compromised, although this does not show that addiction is a disease. (shrink)

This draft entry is a brief overview of John Stuart Mill's moral and political philosophy, with an emphasis on his views on religion, for the Encyclopedia of the Philosophy of Religion (Wiley-Blackwell).

This book provides a rediscovery of one of the most influential philosophical and religious works of Late Antiquity.

Emphasizing imaginaries as an essential tool in deep understanding of social phenomena, the essays in this volume address socio-anthropological environments; collective dynamics of social integration; mass media metamorphosis; politics legitimation processes; symbolic dimension of economics and material culture; and representation of otherness.

This interview, conducted over email, is an exchange between Annemarie Mol, a philosopher and Professor of Anthropology of the Body at the University of Amsterdam, and Ada Jaarsma, associate editor of Symposium. While the questions reflect Jaarsma’s interests in Mol’s account of “empirical philosophy” and its import for contemporary Continental philosophy, Mol’s responses raise questions, in turn, about how phrases like “Continental philosophy” betray geographical and canonical presumptions. Reflecting on the import of wonder, of reading, of intervening in (...) philosophy’s set tropes, and of decentring the subject, Mol draws readers into an array of ways to reconsider the cultural repertoires and social realities by which philosophical activities take place. (shrink)

For over a decade, a small group of scientists and philosophers—members of the Mind and Life Institute—have met regularly to explore the intersection between science and the spirit. At one of these meetings, the themes discussed were both fundamental and profound: can physics, chemistry, and biology explain the mystery of life? How do our philosophical assumptions influence science and the ethics we bring to biotechnology? And how does an ancient spiritual tradition throw new light on these questions? Pier Luigi (...) Luisi not only reproduces this dramatic, cross-cultural dialogue, in which world-class scientists, philosophers, and Buddhist scholars develop a holistic approach to the scientific exploration of reality, but also adds scientific background to their presentations, as well as supplementary discussions with prominent participants and attendees. Interviews with His Holiness the Karmapa, the Buddhist monk Matthieu Ricard, and the actor and longtime human rights advocate Richard Gere take the proceedings into new directions, enriching the material with personal viewpoints and lively conversation about such topics as the origin of matter, the properties of cells, the nature of evolution, the ethics of genetic manipulation, and the question of consciousness and ethics. A keen study of character, Luisi incorporates his own amusing observations into this fascinating dialogue, painting a very human portrait of some of our greatest—and most intimidating—thinkers. Deeply textured and cleverly crafted, _Mind and Life_ is an excellent opportunity for any reader to join in the debate surrounding this cutting-edge field of inquiry. (shrink)

As biological and biomedical research increasingly reference the environmental context of the biological entities under study, the need for formalisation and standardisation of environment descriptors is growing. The Environment Ontology (ENVO) is a community-led, open project which seeks to provide an ontology for specifying a wide range of environments relevant to multiple life science disciplines and, through an open participation model, to accommodate the terminological requirements of all those needing to annotate data using ontology classes. This paper summarises ENVO’s motivation, (...) content, structure, adoption, and governance approach. (shrink)

“Self-transcendence” is proposed as a way in which individuals might find relief and support in the context of COVID-19, as well as other times of uncertainty. However, the authors propose that the multiple definitions of self-transcendence within existing literature lean towards the complex, sometimes obscure, and imprecisely spiritual. A concern is that this creates a circumstance, where the possibility of supporting self-transcendence in a wider population will become excluding in this complexity. In this paper, we have undertaken a critical summary (...) review focused primarily on historical foundations of the concept of self-transcendence, and key theoretical approaches in which self-transcendence and self-transcendent experiences are discussed with the motive of finding a clarity to understanding self-transcendence and the pathways towards it. We argue that this much-needed clarity in our understanding of self-transcendence may serve as an inclusive and democratized resource in which to support well-being and resilience in the context of COVID and beyond. (shrink)

This article addresses the long-standing problem of how to understand Mill’s famous harm principle in light of his failure to specify what counts as “harm” in On Liberty. I argue that standard accounts restricting “harm” to only certain negative consequences fail to do justice to the text, and that this fact forces us to rethink Mill’s defense of individual liberty. I then offer a new account of that defense in which “harm” is understood in an expansive sense, despite apparent problems (...) for such a view. (shrink)