BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes (...) both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

Paul applies apocalyptic language not only to the End and Christ's parousia but also to the gospel he proclaims and the faith it creates. The whole of God's saving activity in Jesus Christ, from beginning to end, is apocalyptic.

The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

Aristotle's highly influential work on the soul, entitled De anima, formed part of the core curriculum of medieval universities and was discussed intensively. It covers a range of topics in philosophical psychology, such as the relationship between mind and body and the nature of abstract thought. However, there is a key difference in scope between the so-called "science of the soul," based on Aristotle, and modern philosophical psychology. This book starts from a basic premise accepted by all medieval commentators, namely (...) that the science of the soul studies not just human beings but all living beings. As such, its methodology and approach must also apply to plants and animals. The Science of the Soul discusses how philosophers from Thomas Aquinas to Pierre d'Ailly dealt with the difficult task of giving a unified account of life and traces the various stages in the transformation of the science of the soul between 1260 and 1360. The emerging picture is that of a gradual disruption of the unified approach to the soul, which will ultimately lead to the emergence of psychology as a separate discipline. (shrink)

Hegel is most famous for his view that conflicts between contrary positions are necessarily resolved. Whereas this optimism, inherent in modernity as such, has been challenged from Kierkegaard onward, many critics have misconstrued Hegel's own intentions. Focusing on the Science of Logic, this transformative reading of Hegel on the one hand exposes the immense force of Hegel's conception of tragedy, logic, nature, history, time, language, spirit, politics, and philosophy itself. Drawing out the implications of Hegel's insight into tragic conflicts, on (...) the other hand, De Boer brings into play a form of negativity that allows us to understand why the entanglement of complementary positions always tends to turn into their conflict, but not necessarily into its resolution. (shrink)

Does philosophical critique have a future? What are its possibilities, limits, and presuppositions? Bringing together outstanding scholars from various traditions, this collection of essays is the first to examine the forms of critique that have shaped modern and contemporary continental thought. Through critical analyses of key texts by, among others, Spinoza, Kant, Hegel, Marx, Adorno, Habermas, Foucault, and Rancière, it traces the way critique has time and again geared itself towards new cultural, social, and political problems, shedding those of its (...) assumptions no longer deemed tenable. It is our hope that the many voices of critique that arise from the present volume will produce effects – new doubts, new insights, new challenges, or new resources – that none could have achieved on their own. (shrink)

although mostly known to specialists nowadays, Kenelm Digby was a remarkable figure on the intellectual scene of the early seventeenth century. He has been described as “one of the most influential natural philosophers” of his time,1 and corresponded with many of the great scholars of his days, including Descartes, and the French pioneer of atomism, Pierre Gassendi. In the later years of his life, Digby, alongside men like Robert Boyle, became one of the founding members of the Royal Society.2Digby authored (...) one major work of philosophy: the Two Treatises of 1644. This work consisted of a long First Treatise on bodies, and a shorter, Second Treatise on the human soul. In the First Treatise, Digby argued... (shrink)

While we endorse Heidegger’s effort to reclaim Kant’s Critique of Pure Reason as a work concerned with the possibility of metaphysics, we hold, first, that his reading is less original than is often assumed and, second, that it unduly marginalizes the critical impetus of Kant’s philosophy. This article seeks to shed new light on Kant and the Problem of Metaphysics and related texts by relating Heidegger’s interpretation of Kant to, on the one hand, the epistemological approach represented by Cohen’s Kant’s (...) Theory of Experience and, on the other, the metaphysical readings put forward by Heimsoeth, Wundt and others in the 1920s. On this basis, we argue that Heidegger’s interpretation of Kant remains indebted to the methodological distinction between ground and grounded that informed Cohen’s reading and was transferred to the problem of metaphysics by Wundt. Even if Heidegger resists a ‘foundationalist’ mode of this distinction, we argue that his focus on the notions of ground and grounding does not... (shrink)

In this paper, we examine the qualitative moral impact of machine learning-based clinical decision support systems in the process of medical diagnosis. To date, discussions about machine learning in this context have focused on problems that can be measured and assessed quantitatively, such as by estimating the extent of potential harm or calculating incurred risks. We maintain that such discussions neglect the qualitative moral impact of these technologies. Drawing on the philosophical approaches of technomoral change and technological mediation theory, which (...) explore the interplay between technologies and morality, we present an analysis of concerns related to the adoption of machine learning-aided medical diagnosis. We analyze anticipated moral issues that machine learning systems pose for different stakeholders, such as bias and opacity in the way that models are trained to produce diagnoses, changes to how health care providers, patients, and developers understand their roles and professions, and challenges to existing forms of medical legislation. Albeit preliminary in nature, the insights offered by the technomoral change and the technological mediation approaches expand and enrich the current discussion about machine learning in diagnostic practices, bringing distinct and currently underexplored areas of concern to the forefront. These insights can contribute to a more encompassing and better informed decision-making process when adapting machine learning techniques to medical diagnosis, while acknowledging the interests of multiple stakeholders and the active role that technologies play in generating, perpetuating, and modifying ethical concerns in health care. (shrink)

During the Corona pandemic, it became clear that people are vulnerable to potentially harmful nonhuman agents, as well as that our own biological existence potentially poses a threat to others, and vice versa. This suggests a certain reciprocity in our relations with both humans and nonhumans. In his The Visible and the Invisible, Merleau-Ponty introduces the notion of the flesh to capture this reciprocity. Building on this idea, he proposes to understand our relationships with other humans, as well as those (...) with nonhuman beings as having a chiasmic structure: to sense, or perceive another entity in a particular way simultaneously implies to be sensed or perceived in a particular way by this other entity. In this paper, we show how a postphenomenological perspective expands on Merleau-Ponty: first, it more radically interprets Merleau-Ponty’s notion of flesh by not only considering it to be a medium that is the condition of possibility for vision but as pointing to the constitution of an intercorporeal field in which entities—both human and nonhuman—mutually sense one another. Second, it augments Merleau-Ponty’s thought by drawing attention to how technologies mediate chiasmic relations. This is clarified through the example of the facemask, which reveals the chiasmic structure of our relation with nonhuman entities, and shows that technologies co-constitute interpersonal relationships by making humans present to one another in a particular way. We suggest that these aspects are not unique to the facemask, but point to a general technologically mediated chiasmic structure of human-world relations. (shrink)

This article challenges the prevailing interpretations of Hegel's account of the concept "contradiction" in the Science of Logic by arguing that it is concerned with the principle of Hegel's method rather than with the classical law of non-contradiction. I first consider Hegel's Doctrine of Essence in view of Kant's discussion of the concepts of reflection in the first Critique. On this basis, I examine Hegel's account of the logical principles based on the concepts "identity," "opposition," and "contradiction." Finally, I point (...) out how the principle Hegel derives from the concept of contradiction actually informs his own method. (shrink)

Numerous studies in the fields of Science and Technology Studies and philosophy of technology have repeatedly stressed that scientific practices are collective practices that crucially depend on the presence of scientific technologies. Postphenomenology is one of the movements that aims to draw philosophical conclusions from these observations through an analysis of human–technology interactions in scientific practice. Two other attempts that try to integrate these insights into philosophy of science are Ronald Giere’s Scientific Perspectivism and Davis Baird’s Thing Knowledge. In this (...) paper, these two approaches will be critically discussed from the perspective of postphenomenology. We will argue that Giere and Baird problematically assume that scientific instruments have a determined function, and that all human members of a scientific collective have immediate access to this function. However, these assumptions also allow them to offer a clear answer to the question how scientists can collectively relate to scientific phenomena. Such an answer is not yet formulated within the postphenomenological perspective. By adding a postphenomenological touch to the semiotic approach in Actor-Network Theory, we offer an account of how different individual human–technology relations are integrated into larger scientific collectives. We do so by showing that scientific instruments not only help constitute scientific phenomena, but also the intersubjectivity within such collectives. (shrink)

By drawing on Jean-Luc Nancy’s philosophy of ontological relationality, this article explores what it means to be a ‘we’ in breast cancer. What are the characteristics—the extent and diversity—of couples’ relationally lived experiences of bodily changes in breast cancer? Through analyzing duo interviews with diagnosed women and their partners, four ways of sharing an embodied life are identified. While ‘being different together’, partners have different, albeit connected kinds of experiences of breast cancer. While ‘being there for you’, partners take care (...) of each other in mutually dependent ways. While ‘being reconnected to you’, partners relate to each other through intimacy and sexuality. While ‘being like you’, partners synchronize their embodied daily lives to one another, sometimes up to the point that the self cannot be distinguished from the other anymore. These ways reveal that being a ‘we’ involves complex affective, bodily encounters in which the many fault lines that both separate partners into individual selves and join them together as a unity are continuously reshaped and negotiated. Being a ‘we’ may be understood as something we have to do. Therefore, in being true to the legacy of Nancy, we argue at the end of this article for a sensible praxis of sharing a life and body, particularly in breast cancer. (shrink)

This paper focuses on a particular method which is used in contemporary empirical happiness studies, namely measuring people’s happiness by scoring their emotions (Kahneman is a prominent scholar). I examine the presupposition in this field that emotion scores can be added or subtracted, that throughout affective space runs a straight axis that plots hedonic tone or pleasure.

A central issue in postphenomenology is how to explain the multistability of technologies: how can it be that specific technologies can be used for a wide variety of purposes (the “multi”), while not for all purposes (the “stability”)? For example, a table can be used for the purpose of sleeping, having dinner at, or even for staging a fencing match, but not for baking a cake. One explanation offered in the literature is that the (material) design of a technology puts (...) constraints on the purposes for which technologies can be used. In this paper, I argue that such an explanation—while partly correct—fails to address the role of the environment in which human beings operate in putting constraints on technology use. I suggest that James Gibson’s affordance theory helps highlighting how stabilities in technology use arise in the interaction between human being and environment. Building on more recent approaches in affordance theory, I suggest that the environment can be conceptualized as a “rich landscape of affordances” that solicits certain actions, which are not just cued by the environment’s material structure, but also by the normativity present in the form of life in which a human being participates. I briefly contrast the approach to affordances developed in this paper with how Klenk (2020) and Tollon (2021) have conceptualized the “affordance character” of technological artifacts, and highlight how a focus on the situated nature of affordances augments these earlier conceptualizations. (shrink)

in a late note, dated 1797, Kant refers to the schematism of the pure understanding as one of the most difficult as well as one of the most important issues treated in the Critique of Pure Reason.1 His treatment of this theme is indeed notorious for its obscurity.2 As I see it, part of the problem is caused by the fact that Kant frames his discussion in terms that he could expect his readers to be familiar with, while he gradually (...) develops ideas that breach any traditional account of cognition. This holds for his references to the power of judgment and the related view that cognition is a matter of subsuming intuitions under concepts3 as well as for the suggestion that there is an initial gap between categories... (shrink)

Given the history of the twentieth century, it is understandable that many contemporary philosophers—in the wake of Kierkegaard, Marx, and Nietzsche—have turned against Hegel’s seemingly unbridled optimism. As I will argue in this chapter, however, Hegel’s account of modern civilizations is much less optimistic than his account of the past. Hegel’s hesitation as to the capacity of modernity to resolve its immanent conflicts preeminently emerges in his account of the oppositions between poverty and wealth and between the state and its (...) citizens. In this chapter I will focus on passages from the Essay on Natural Law, the Lectures on the Philosophy of History, and the Philosophy of Right that express this hesitation and, hence, complicate the prevailing view of Hegel’s philosophy of world history. (shrink)

In current phenomenology of medicine, health is often understood as a state of transparency in which our body refrains from being an object of explicit attention. In this paper, I argue that such an understanding of health unnecessarily presupposes an overly harmonious alignment between subjective and objective body, resulting in the idea that our health remains phenomenologically inaccessible. Alternatively, I suggest that there are many occasions in which one’s body in health does become an object of attention, and that technologies (...) mediate how a relation with one’s body is formed. First, I show prominent accounts in current phenomenology of medicine understand health in terms of a harmonious alignment between objective and subjective body. Second, I argue that there are many occasions in which there is a disharmony between objective and subjective body, and suggest that also in health, we cannot escape being an object that we often relate to. Then, I draw on postphenomenology to show how technologies such as digital self-tracking applications and digital twins can be understood as mediating the relationship with one’s own body in a specific way. In conclusion, I argue that both technologies make present the objective body as a site for hermeneutic inquiry such that it can be interacted with in terms of health parameters. Furthermore, I point to some relevant differences in how different technologies make aspects of our own body phenomenologically present. (shrink)

While Kant in the Critique of Pure Reason maintains that things in themselves cannot be known, he also seems to assert that they affect our senses and produce representations. Following Jacobi, many commentators have considered these claims to be contradictory. Instead of adding another artificial solution to the existing literature on this subject, I maintain that Kant’s use of terms such as thing-in-itself, noumenon, and transcendental object becomes perfectly consistent if we take them to acquire a different meaning in the (...) various parts of the work. Challenging the opposed interpretations of Allison and Langton, I argue that Kant’s account of things in themselves is primarily relevant to the second-order reflection on the possibility and limits of a scientific metaphysics that the Critique undertakes. (shrink)