Online research in philosophy

During the 1980s, empirical social sciences and normative theory seemingly converged within ethical debates. This tendency kindled new debates about the limits and possibilities of empirical-normative collaboration. The article asks for adequate ways of collaboration by taking a closer look at the philosophy of science of empirical social sciences as well as normative theory development and its logical groundings. As a result, three possible modes of cooperation are characterized: first, the empirical assessment of conditions that actually necessitate the translation of normatively derived basic principles into practice rules; second, the empirical assessment of conditions for application of a moral norm which are formulated by bridging principles; third, the empirical assessment of social practice which allows (a) to measure whether adopted norms actually are implemented in practice or not and (b) to encounter new moral problems which are in need of ethical guidance. Finally, the article defends a symbiotic position in Weaver’s and Trevino's triad of possible approaches to empirical-normative collaboration in ethics.

This paper explores the usefulness of the 'ethical matrix', proposed by Ben Mepham, as a tool in technology assessment, specifically in food ethics. We consider what the matrix is, how it might be useful as a tool in ethical decision-making, and what drawbacks might be associated with it. We suggest that it is helpful for fact-finding in ethical debates relating to food ethics; but that it is much less helpful in terms of weighing the different ethical problems that it uncovers. Despite this drawback, we maintain that, with some modifications, the ethical matrix can be a useful tool in debates in food ethics. We argue that useful modifications might be to include future generations amongst the stakeholders in the matrix, and to substitute the principle of solidarity for the principle of justice.

This paper explores the relevance of the debate about ethical expertise for the practice of clinical ethics. We present definitions, explain three theories of ethical expertise, and identify arguments that have been brought up to either support the concept of ethical expertise or call it into question. Finally, we discuss four theses: the debate is relevant for the practice of clinical ethics in that it (1) improves and specifies clinical ethicists' perception of their expertise; (2) contributes to improving the perception of moral competence of non-ethicists; (3) gives insight into complementary styles of argumentation of ethicists and non-ethicists; and (4) contributes to the awareness of the problem of profession-building of (clinical) ethicists.

Health technology assessment (HTA) consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results of such evaluations.Still, the examples of cochlear inplants (CI) and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer.

In recent years there has been growing attention paid to a kind of human action or activity which does not issue from a process of reflection and deliberation and which is described as, e.g., ‘engaged coping’, ‘unreflective action’, and ‘flow’. Hubert Dreyfus, one of its key proponents, has developed a phenomenology of expertise which he has applied to ethics in order to account for ‘everyday ongoing ethical coping’ or ‘ethical expertise’. This article addresses the shortcomings of this approach by examining the pre-reflective ethical know-how individuals first develop and on which all later forms of ethical expertise are dependent. In the first section an account is given of the ‘ethical second nature’ which every individual develops from childhood onwards and which forms the basis of pre-reflective ethical know-how. The acquisition of an ethical second nature early on opens up the very domain of ‘the ethical’ for us in the first place and is constitutive of our sensitivity to it. The second section turns to pre-reflective ethical know-how and whether it is conceptual in nature. Just as sensorimotor understanding forms the basis of our reflective perceptual concepts, pre-reflective ethical know-how is similarly proto-conceptual and is the source of our reflective ethical and moral concepts. Finally, the third section examines the process whereby ethical second nature and pre-reflective ethical know-how are actually acquired, namely, through immersion in an ‘ethical world’. This world consists of both the web of ethical meanings and significances which has evolved in a particular society or community as well as its members whose actions and interactions continually reproduce that web.

Technology Assessment (TA) is a problem oriented endeavour dealing with political, societal, ecological, etc. problems. Only in rare cases is one individual scientific discipline sufficient to assess these problems. Usually the perspectives of different scientific disciplines have to be combined in order to develop interdisciplinary based recommendations to act. In this paper a quality controlled interdisciplinary discussion process is described which encourages an expert group to generate argumentation chains cross-cutting the disciplinary boundaries. The role of ethical reflection in this procedure depends on the problem situation. Whenever a technical application is on the agenda which cannot be allocated to a so-called “business-as-usual” case, one would ask for ethical reflection. This contribution argues that this ethical reflection has to take place together with the interdisciplinary discussion due to two reasons. Firstly, the technical, economical, legal and social aspects are deeply cross-correlated with the ethical reflection. And secondly, participating in such interdisciplinary discussions enables an ethical reflection which keeps in touch with the real world. Two case studies dealing with robotics applications in health care are mentioned as examples for problem settings, in which interdisciplinary TA succeed in developing discipline-crossing argumentation chains.

In a recent article, Steinkamp, Gordijn, and ten Have discussed a new way of thinking about the ethics consultant's ethical expertise. After critiquing their model of ethical expertise, along with the notion that discourse can and will enable ethicists to consult without over-reaching, this essay suggests that the debate about ethical expertise is intractable because it constitutes a 'tragic choice'.

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect.

The role of ethics in technology development has been often questioned, especially in the early days of societal reflection of technology. However, the situation has changed dramatically. Ethical consideration now is generally declared to be indispensable in shaping technology in a socially acceptable and sustainable way. The expectations of ethics are large; often even a kind of “New Ethics” is postulated. In the present paper an over-estimation of the role of ethics for technology development is rejected. It is argued that ethical reflection is, indeed, indispensable in certain problem areas and situation types; but there is, on the other hand, space for technology development free from the requirement for ethical reflection. The absence of a requirement for ethical reflection, however, always has to be considered relative to some “morale provisoire” (provisional morality) as an accepted normative framework within which technology development may occur without explicit ethical reflection. If this framework, however, is doubted or is shown to be insufficient the situation changes completely. Ethical reflection in this case becomes necessary, to consider this normative framework in order to offer modifications or supplements.

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.