This book offers a discussion of practical as well as theoretical autonomy.

This paper examines the prevalence of the ideal of “independence” in intellectual disability care in the Netherlands. It responds to a number of scholars who have interrogated this ideal through the lens of Michel Foucault’s vocabulary of governmentality. Such analyses hold that the goal of “becoming independent” subjects people with intellectual disabilities to various constraints and limitations that ensure their continued oppression. As a result, these authors contend, the commitment to the ideal of “independence” – the “ethic of autonomy” – (...) actually threatens to become an obstacle to flourishing in the group home. This paper offers an alternative analysis. It does so by drawing on a case study taken from an ethnographic study on group home life in the Netherlands. Briefly put, the disagreement stems from differing conceptualizations of moral life. Put in the vocabulary of moral anthropologist Cheryl Mattingly, the authors propose to approach the group home more from a “first-person” perspective rather than chiefly from a “third-person” perspective. They then draw on Mattingly to cast the group home as a “moral laboratory” in which the ethic of autonomy is not just reproduced but also enacted, and in which the terms of (in)dependence constantly get renegotiated in practice. What emerges is not only a new perspective on the workings of the “ethic of autonomy” in the group home, but also an argument about the possible limitations of the vocabulary of governmentality for analysing care practices. (shrink)

In this article the authors seek to conceptualize a dynamic and inclusive understanding of personal identity within multicultural democracies such as South Africa, which will draw on both the liberal and communitarian traditions' respect for the project of self. A preliminary lay out for such a project emerges from a literature survey of recent, primarily South African publications on identity and culture, and it suggests that selfhood depends on: a) virtues, cultivated within cooperative communities which allow for effective freedom; b) (...) a venture into existential uncertainty, which alleviates that fear of loss of identity that is supposedly central to many multicultural conflicts; c) the hermeneutic construction of identity through narratives that allow for a plurality of voices; and d) the creative transcending and re- interpretation of values and traditions. The authors contend that such an under standing of identity goes some way towards addressing the question of the way that diverse personal and group identities are to be accommodated in South Africa's multicultural democracy, and to re thinking the unity which underlies diversity without resorting to liberalism's reduction of personal identity to rational autonomy. S. Afr. J. Philos. Vol.20(3) 2001: 35-54. (shrink)

Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders (...) who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews. The data were analyzed thematically. Results Perceived benefits of SBDs included increased autonomy, improvement of the therapeutic relationship, possibility of early intervention and prevention of harm, prevention of compulsory care, reduction of the duration of compulsory care and recovery, mitigation of negative experiences around compulsory care, and guidance for professionals in providing compulsory care. Perceived risks included infeasibility of SBD instructions, difficulty in decision-making around SBD activation, limited accessibility of SBDs, disappointment of service users due to non-compliance with SBDs, and limited evaluation and updating of SBD content. Barriers to SBD completion included lack of knowledge of SBDs among professionals, lack of motivation or insight among service users, and lack of professional support for SBD completion. Facilitators of SBD completion and activation included support for SBD completion, involvement of relatives and peer experts, specification of SBD content, and evaluation of compulsory care and SBD content. The new legal framework was regarded as having both positive and negative effects on SBD implementation. Conclusions Stakeholders who have personal or professional experience with legally enforceable SBDs perceive SBDs as having important benefits and tend not to articulate the fundamental ethical concerns about SBDs which can be found in the ethics and legal literature. Instead, they perceive ethical and practical challenges that can be addressed through the implementation of suitable safeguards. (shrink)

Der Begriff der Person wird häufig im Bereich der biomedizinischen Ethik angewandt, wie vor allem in der Abtreibungsdebatte. Es wird immer noch kontrovers darüber diskutiert, ob ein Embryo als Person anzusehen ist.Dieses Buch zeigt einerseits auf, dass der Begriff der Person keinen Beitrag zur Antwort nach dem moralischen Status eines menschlichen Wesens am Lebensbeginn leisten kann. Andererseits wird jedoch deutlich, dass dieser Begriff für den Respekt gegenüber menschlichen Wesen am Lebensende hilfreich ist. Was bedeutet Respekt vor der (...) Autonomie von Personen bei der Sterbehilfe und was bedeutet Respekt gegenüber dementen Personen, die nicht mehr autonom sind? Bei der Beantwortung dieser Fragen spielt der Begriff der Person eine entscheidende Rolle. Dieses Buch soll einen Beitrag zur Verdeutlichung der Grenzen und Gültigkeit des Begriffs der Person in der biomedizinischen Ethik leisten. (shrink)

In biomedical ethics, the concept of person plays a major role in the discussion of ethically appropriate relationships with early human beings. The debate over abortion is one such case. There is still a heated debate over whether a fetus is already a person. However, because of the structure of the argument, the debate over the moral status of the fetus quickly becomes all-or-nothing. Against this background, I would like to address the question of to what extent the (...) concept of person can be helpful in biomedical ethics. I argue that this concept is not useful for ethically appropriate interactions with early human beings, but it is useful for ethically appropriate interactions with human beings at the end of life. I demonstrate my thesis with reference to the argument about euthanasia. The concept of person plays a crucial role in understanding what it means to respect the autonomy of a person who desires euthanasia. (shrink)

Aktuelle bioethische Debatten werden vor allem von zwei Schwierigkeiten überschattet: zum einen von der Unklarheit des Begriffes menschlicher Autonomie. Hier geht es um individualethische Fragen, vor allem um Beginn und Ende menschlichen Lebens. Zum anderen bedroht die Verschiebung individueller Wissensträgerschaft zum anonymen Kollektivsubjekt angesichts einer zunehmenden Ökonomisierung des Gesundheitswesens das ärztliche Ethos des Helfens und Heilens. Diese und weitere konfliktgeladene Problemstellungen diskutiert Jan P. Beckmann in seinem neuen Buch.

Hat die subjektive Erfahrung, uns selbst und anderen als eine bestimmte Person zu erscheinen, eine ethische Orientierungsfunktion? Und wenn ja, was geschieht, wenn wir uns auf eine Weise verändern, die uns an der Kontinuität dieser Erfahrung zweifeln lässt? Ausgehend von Schilderungen von Nicht-Authentizitäts-Erfahrungen wird in diesem Buch der Versuch unternommen, einen Begriff personaler Authentizität zu rekonstruieren, der für Fragen der angewandten Ethik handhabbar ist. Dabei verbindet das Buch auf innovative Weise zwei Diskussionsstränge aus der Bioethik und der praktischen Philosophie: (...) die bioethische Diskussion um das Neuro-Enhancement und die Debatte um das richtige Verständnis »personaler Autonomie« in der analytischen Philosophie. Dieser Ansatz erlaubt zu zeigen, dass der Begriff der Authentizität nicht im Begriff der Autonomie aufgeht und dass ersterer für die angewandte Ethik am besten als eine Fähigkeit zu rekonstruieren ist. Dadurch kann nicht nur die Bedeutung von Selbstwissen für eine verantwortungsvolle technische Selbstgestaltung thematisiert, sondern auch die in der Enhancement-Debatte häufig stiefmütterlich behandelte Perspektive des guten Lebens hervorgehoben werden. (shrink)

Theorists who support the legalisation of active euthanasia usually base their arguments on the principle of autonomy. In their view the wish of a severely ill person not to continue his or her life must be respected. However, some opponents of the legalisation of active euthanasia refer to the principle of autonomy as well. They are concerned that patients may be held responsible for burdening others with the provision of care. Thus family members, physicians or nurses may exert pressure (...) on patients to opt for active euthanasia. In this article it is argued that these worries are justified; the occurrence of social coercion poses a real danger. However, neither the prohibition nor the permission of active euthanasia enables each individual to make an autonomous choice. Comparing the risks involved in both options, legalisation seems to be preferable to maintaining the status quo. (shrink)

ZusammenfassungDie bei Krebserkrankungen junger Frauen erforderliche Chemo- bzw. Strahlentherapie kann in der Folge bei den betroffenen Patientinnen zur Unfruchtbarkeit führen. Somit werden die Betroffenen oft gleichzeitig mit einer potentiell lebensbedrohlichen Erkrankung und einem potentiell kinderlosen Leben konfrontiert. Die derzeitigen Methoden zum Erhalt der Fertilität sind experimentell, mit therapeutischer Unsicherheit und gesundheitlichen Risiken belastet, dennoch werden sie zunehmend nachgefragt. Die mit dem Angebot fertilitätserhaltender Maßnahmen verbundene derzeitige Beratungspraxis wird in dem hier vorliegenden Beitrag aus ethischer Perspektive hinterfragt. Ausgehend von einer kritischen (...) Würdigung des nach wie vor häufig angewandten Autonomiekonzepts von Beauchamp und Childress wird diskutiert, auf welche Weise die normative Belastbarkeit der Entscheidungsfindung durch die Vulnerabilität der Patientin limitiert sein kann. Als Alternative zum Autonomiekonzept von Beauchamp und Childress wird anschließend eine Entscheidungsfindung auf der Grundlage biographischer Identität in Anlehnung an das Konzept der personalen Autonomie nach Quante erörtert. (shrink)

Irrespective of the short academic history of Christian spirituality, a vast number of academic and popular publications ensued and is still dynamically growing. Many definitions have been proposed to define (Christian) spirituality. Spirituality is also no longer connected only to religion, although in this research the focus will fall on Christian spirituality. This research intends to partake in the continuing academic dialogue to define Christian spirituality. Christian spirituality is interpreted from the perspective of the divine-human conversation. This research consists of (...) three sections. In the first section, a working definition of Christian spirituality is formulated. In the second section, various aspects that constitute spiritualities are distinguished and discussed. In the last section, the constituents of Christian spirituality are pointed out and are reviewed from a conversational perspective. The focus will be on ‘the experience of the divine’ when living a life that resonates with the Christian life. (shrink)

The central thesis of this paper is that, for most issues of multiculturalism, regarding them as a problem of tolerance puts us on the wrong track because there are certain biases inherent in the principle of tolerance. These biases -- individualism, combined with a focus on religion and a focus on beliefs rather than on persons or practices -- can be regarded as distinctly Protestant. Extending the scope of tolerance may seem a solution but if we really want to counter (...) these biases, the principle of tolerance becomes so general that it loses any distinctive meaning. Therefore, we should accept the limited scope of tolerance and its biases. The principle of tolerance can still be useful for some problems where there is a clear and direct link to political or religious beliefs. Moreover, it should be cherished as a more general attitude or practice in Dutch society. For most problems of multiculturalism, however, we should appeal to broader theoretical frameworks that do justice to persons and practices. (shrink)

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial (...) that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship. (shrink)

Personen erz hlen ihr Leben - eine These dieser Art ist vielerorts popul r. Aber es fehlt bislang an ausgearbeiteten Argumenten f r sie, ebenso wie an einer strengen Definition des Begriffs der Narrativit t. Das vorliegende Buch bietet Abhilfe. Zun chst stellt es einen Beitrag zur Theorie personaler Autonomie dar. Eine Analyse des zentralen Begriffs der Identifikation wird vorgeschlagen; ebenso wird eine anspruchsvolle biographische Bedingung der Autonomie formuliert und begr ndet. Ob wir das tun, was wir wirklich (...) wollen, k nnen wir nur vor dem Hintergrund unseres Wissens ber bestimmte biographische Zusammenh nge entscheiden. Weiter wird eine detaillierte Theorie der Syntax, Semantik und Pragmatik narrativer Sprache entwickelt. Narrativit t basiert nicht nur auf der Form und der Bedeutung von S tzen, sondern hat eine essentielle pragmatische Dimension. Erst vor dem Hintergrund der subjektiven Wahrscheinlichkeiten und der empathischen Verm gen von Teilnehmern in Kontexten sind u erungen Geschichten. Vor diesem Hintergrund wird gezeigt, dass die biographischen Zusammenh nge, die relevant f r Autonomie sind, gerade solche sind, von denen wir erz hlen k nnen. Geschichten artikulieren praktische Gr nde, und es zeichnet Personen als autonome Wesen aus, f r diese narrativen Gr nde empf nglich zu sein. Das Buch wurde 2009 mit dem Wolfgang-Stegm ller-Preis der Gesellschaft f r Analytische Philosophie ausgezeichnet. (shrink)

The concept of autonomy was and still is one of the central notions of practical philosophy. The current discussion often identifies autonomy with free or rational self-determination of a person. But a person must always be seen as being integrated in social and institutional contexts. Therefore the concept of autonomy has to be developed from an integrative perspective which includes both perspectives: the individual and the institutional one. Moreover, this integration cannot be constituted by shared affects and feeling (...) of individuals, but has to refer to the idea of “lawfulness” and guiding norms and orientations. This essay tries to show that Hermann Cohen′s understanding of “autonomy as a task” is a theory worthy of being followed, as it develops the principles as well as the concrete conditions of an integrative concept of autonomy on the basis of a “hypothetical” method which is both: critical and dynamical. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want-to-be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want-to-be parents' child. Want-to-be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want-to-be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence-based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want-to-be parents is morally required and therefore also for want-to-be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk-responsibility analysis. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

Recent findings suggest that multiple event properties contribute to shape the phenomenology of episodic future thoughts, but the specific role of each property is not yet fully understood. This study shows that different phenomenological features are predicted by distinct event properties. The vividness of an episodic future thought largely depends on the familiarity of its constitutive elements , while the visual perspective adopted is instead related to the temporal distance of the imagined event. Cognitive feelings such as the sense of (...) pre-experiencing the future depend on sensory–perceptual qualities, and are further modulated by the personal importance attributed to the event. These findings suggest that the essence of episodic future thought—the sensation of mentally visiting one’s personal future—lies, in part, in the relevance of imagined events with respect to personal goals. (shrink)

This article investigates how companies make sense of CSR. It is based on an explorative comparative case study of 18 companies in the Netherlands using background information, interviews and annual reports. Initially, the sensemaking process of CSR is guided and coordinated by change agents who are specifically appointed to explore the implementation of CSR in their company. These change agents initiate the CSR process within their own organisations. The meaning they develop stems from their personal and organisational values and frames (...) of reference. By attuning the vocabulary of CSR to the language of their colleagues, they aim to gain support for this undertaking in their organisation. This sensemaking procedure can be divided into pragmatic, external, procedural, policy‐oriented and value‐driven processes. The capability of an organisation to embed CSR is the result of trial and error, personal preferences and the use of language by the change agent that fits the (dynamic) situation at hand. Thus, each organisation needs a tailor‐made approach to implement CSR successfully. (shrink)

Can a person’s degree of wellbeing be affected by things that do not enter her experience? Experientialists deny that it can, extra-experientialists affirm it. The debate between these two positions has focused on an argument against experientialism—the experience machine objection—but few arguments exist for it. I present an argument for experientialism. It builds on the claim that theories of wellbeing should not only state what constitutes wellbeing, but also which entities are welfare subjects. Moreover, the claims it makes about (...) these two issues should have a certain coherence with each other. I argue that if we accept a particular plausible answer to the second question—namely that all and only sentient beings are welfare subjects—extra-experientialist theories face a problem of coherence. While this problem can typically be solved, doing so will involve steps that are unattractive. On experientialist theories, on the other hand, the answer to these questions cohere perfectly. (shrink)

Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. (...) We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures. (shrink)

This article asks whether states have a right to close their borders because of their right to self-determination, as proposed recently by Christopher Wellman, Michael Walzer, and others. It asks the fundamental question whether self-determination can, in even its most unrestricted form, support the exclusion of immigrants. I argue that the answer is no. To show this, I construct three different ways in which one might use the idea of self-determination to justify immigration restrictions and show that each of these (...) arguments fails. My conclusion is that the nature and value of self-determination have to do with the conditions of genuine self-government, not membership of political society. Consequently, the demand for open borders is fully consistent with respect to self-determination. (shrink)

Finding meaning in our lives is a central tenet to the human experience and a core contributor to mental health. Individuals tend to actively seek the sources of meaning in their lives or consciously enact efforts to create or “craft” meaning in different life domains. These overall “Life Crafting” behaviors refer to the conscious efforts individuals exert to create meaning in their lives through cognitively framing how they view life, seeking social support systems to manage life challenges, and actively seeking (...) challenges to facilitate personal growth. Specifically, these behaviors are actioned to better align life goals, personal needs, values, and capabilities. However, no psychological assessment instrument currently exists to measure overall life crafting. As such, the purpose of this paper was twofold: to conceptualize life crafting and to develop, validate and evaluate a robust measure of overall life crafting. A mixed-method, multi-study research design was employed. First, nine participants were interviewed to determine the methods or techniques used to craft meaningful life experiences. These methods/techniques were used as indicators to create an initial item pool which was then reviewed by a panel of experts to ensure face validity. Second, in Study 1, the factorial structure of the instrument was explored by gathering data from a convenience sample, with the results showing support for a three-factor structure of life crafting, consisting of cognitive crafting, seeking social support, and seeking challenges. Finally, in Study 2, the aim was to confirm the factorial structure of the Life Crafting scale and to determine its level of internal consistency, partial measurement invariance across genders, and criterion validity [meaning in life, mental health, work engagement, and job burnout ]. The results supported a second-order factorial model of Life Crafting, which comprised of three first-order factors. Therefore, the Life Crafting Scale can be used as a valid and reliable instrument to measure- and track the effectiveness of life crafting interventions. (shrink)

How is Frege able to claim that the notion of judgement is essential to his logic without introducing a form of psychologism? I argue first that Frege’s logical notion of judgement is to be distinguished from an empirical notion of judgement, that it cannot be understood as an abstract, idealized notion, and that there are doubts concerning a transcendental reading of Frege’s writings. Then, I explain that the logical notion of judgement has to be understood from a first-person perspective, (...) to be contrasted with a third-person perspective, in which judgement is understood as an empirical, psychological phenomenon. Frege’s logic is essentially a first-person engagement, as each of us can make use of the ideography as a science of logic only if we ourselves have made the relevant judgements. Finally, I claim that the judging agent as conceived by Frege can, after all, be understood as a transcendental ego. (shrink)

According to Locke, scripture says nothing about the resurrection of the same body. We will be resurrected. But in what sense can resurrected Jane be the “same” as living Jane? Throughout his thinking, Locke holds that sameness of body and/or sameness of soul are not required for the resurrection of “the same Jane.” Sameness of person is required. Locke’s theory of personal identity was ground-breaking in the seventeenth and eighteenth centuries. It was provoking and resulted in a wave of (...) critical responses. His distinction between “man” and “person” is important for his account of personal identity, but the distinction was hard for his contemporaries to understand. The correspondence between Locke and Edward Stillingfleet, for example, shows that for Stillingfleet the distinction between “man” and “person” is artificial. Having read this correspondence, Winch Holdsworth attacks Locke in a sermon in 1719 arguing that Locke denied the resurrection altogether. Catharine Trotter Cockburn tries to defend Locke in her Vindication. Despite her clear understanding of the distinctions applied by Locke, she too struggles with what to make of a person. (shrink)

I here defend historical entitlement theories of property rights against a popular charge. This is the objection that such theories fail because no convincing account of original appropriation exists. I argue that this argument assumes a certain reading of historical entitlement theory and I spell out an alternative reading against which it misfires. On this reading, the role of acts of original appropriation is not to justify but to individuate people’s holdings. I argue that we can identify which acts count (...) as original appropriation against the background of a general justification for a practice of property rights. On this view, what I will call ‘natural’ acts of original appropriation are acts by which a person begins to satisfy the general conditions for justified ownership. Finally, I offer an interpretation of John Locke's theory of appropriation along these lines and argue that it provides an attractive reading of his view. (shrink)

Wellbeing describes how good life is for the person living it. Wellbeing comes in degrees. Subjective theories of wellbeing maintain that for objects or states of affairs to benefit us, we need to have a positive attitude towards these objects or states of affairs: the Resonance Constraint. In this article, we investigate to what extent subjectivism can plausibly account for degrees of wellbeing. There is a vast literature on whether preference-satisfaction theory – one particular subjective theory – can account (...) for degrees of wellbeing. This is generally taken to be problematic. However, other subjective theories – namely, desire-satisfaction, judgment- and value-fulfillment theories – do not suffer from the same difficulties. We introduce two models of degrees of wellbeing a subjectivist can employ: the Relative and the Absolute Model, and defend the claim that both models face difficulties. In particular, we argue that a subjectivist theory should describe instances of depression as instances of low degrees of wellbeing. We also argue that a reduction of desires may sometimes improve one’s degree of wellbeing, an idea we call the Epicurean Intuition. We then argue that the Relative Model fails to account for the disbenefit of certain types of depression, while the Absolute Model fails to meet a central commitment of subjectivism – the Resonance Constraint – and is unable to accommodate the Epicurean Intuition. The upshot of the paper is that subjectivist theories cannot account for degrees of well-being in a plausible way. (shrink)

The next World Congress of Bioethics will be held in Doha, Qatar. Although this location provides opportunities to interact with a more culturally diverse audience, to advance dialogue between cultures and religions, offer opportunities for mutual learning, there are also huge moral concerns. Qatar is known for violations of human rights ‐ including the treatment of migrant workers and the rights of women ‐ corruption, criminalization of LGBTQI+ persons, and climate impact. Since these concerns are also key (bio)ethical concern we (...) call for a broad debate within the bioethics community whether organizing and attending the World Congress in Qatar is ethically problematic and how ethical concerns should be dealt with. (shrink)

The concepts of autonomy and subjectivity are crucial not only for modern philosophy of law but also for its practice. Nevertheless, postmodern philosophy and postmodern theory of law claim to suspend these concepts, interpreting them as hypostatized narratives. The article argues that contrary to the postmodern reading, already the early modern concept of subjectivity is very fragile: It has no reality outside of a historical process in which the principle of subjectivity is connected to its external objective conditions of existence. (...) These conditions are both theoretical and practical; the former are acquired by science, the latter by social, political, and legal history. This history has not been the pure realization of rationality. The development of the state of law from the state of nature, including the original appropriation and legalization of private property, has been a history of violence. This violence has not simply been overcome but is preserved in modern legal systems, too. It takes a materialistic social theory to tell this story in opposition to the narrative of modern law as a pure triumph of human freedom. This also entails that the subjectivity that stands at the end of this story is not only fragile but also fragmented. (shrink)

The central thesis of this paper is that, for most issues of multiculturalism, regarding them as a problem of tolerance puts us on the wrong track because there are certain biases inherent in the principle of tolerance. These biases – individualism, combined with a focus on religion and a focus on beliefs rather than on persons or practices – can be regarded as distinctly Protestant. Extending the scope of tolerance may seem a solution but if we really want to counter (...) these biases, the principle of tolerance becomes so general that it loses any distinctive meaning. Therefore, we should accept the limited scope of tolerance and its biases. The principle of tolerance can still be useful for some problems where there is a clear and direct link to political or religious beliefs. Moreover, it should be cherished as a more general attitude or practice in Dutch society. For most problems of multiculturalism, however, we should appeal to broader theoretical frameworks that do justice to persons and practices. (shrink)

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a (...) severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be. (shrink)

This article investigates how companies make sense of CSR. It is based on an explorative comparative case study of 18 companies in the Netherlands using background information, interviews and annual reports. Initially, the sensemaking process of CSR is guided and coordinated by change agents who are specifically appointed to explore the implementation of CSR in their company. These change agents initiate the CSR process within their own organisations. The meaning they develop stems from their personal and organisational values and frames (...) of reference. By attuning the vocabulary of CSR to the language of their colleagues, they aim to gain support for this undertaking in their organisation. This sensemaking procedure can be divided into pragmatic, external, procedural, policy‐oriented and value‐driven processes. The capability of an organisation to embed CSR is the result of trial and error, personal preferences and the use of language by the change agent that fits the (dynamic) situation at hand. Thus, each organisation needs a tailor‐made approach to implement CSR successfully. (shrink)

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

This article describes compassion as perceived within the relationship between nurses and older persons with a chronic disease. The aim of the study is to understand the benefit of compassion for nursing practice within the context of long-term care. The design of the study involves a qualitative analysis of in-depth interviews with nurses and patients in three different care-settings. Results show the nature of compassion in seven dimensions: attentiveness, listening, confronting, involvement, helping, presence and understanding. Analysis of the data also (...) shows in what way opinions of participants relate to issues raised in a previous literature study, for example the difference between pity and compassion. The conclusion states that compassion is a valuable process which motivates patients as well as nurses to cooperate in achieving relevant outcomes of care. The discussion involves some methodological issues. For one thing, further confirmation of the dimensions found is recommended. (shrink)

Health authorities increasingly request that general practitioners use information and communication technologies such as electronic patient records for accountability purposes. This article deals with the use of EPRs among general practitioners in Britain. It examines two ways in which GPs use the EPR for accountability purposes. One way is to generate audit reports on the basis of the information that has been entered into the record. The other is to let the computer intervene in the clinical process through prompts. The (...) article argues that GPs' ambivalence toward using the EPR makes them active in finding ways that turn the EPR into a meaningful tool for them, that is, a tool that helps them provide what they see as good care. The article's main contribution is to show how accountability and autonomy are coproduced; less professional autonomy does not follow from more requests to document one's work. Instead, new forms of autonomy are produced in the sociotechnical network that is made up by health policy and local engagements with patients and technology. (shrink)

Hoewel in de laatste jaren sterk de nadruk is gelegd op de “autonomie” van het geschrevene ten opzichte van de schrijver en diens belevingswereld, wil deze auteur graag beginnen met een persoonlijke betuiging van erkentelijkheid. Een mens is toch wel zodanig verbonden met een geesteskind dat hij lang bij zich gedragen heeft, dat hij de aandacht en de grondigheid die uit de hiervoor geplaatste reacties spreekt, alleen maar in hoge mate kan waarderen. Hij heeft ze ervaren als toonbeelden van (...) “ontmoeting”. De verschillen tussen de drie reacties laten nog eens zien dat ontmoeting verre van monotoon is. Juist ook die verschillen vond ik leerzaam. Bij de opzet van mijn repliek wil ik aan de diversiteit zo goed mogelijk recht doen door de reacties stuk voor stuk te bespreken. Af en toe zal een “intertekstuele” opmerking wenselijk of onvermijdelijk zijn. Overigens vrees ik dat binnen het bestek van deze repliek niet voldoende ingegaan kan worden op alle vragen en tegenwerpingen. (shrink)

Job’s body is ‘portrayed’ in a text that can be nothing more than audible. Compared with the eyes of Job (mentioned 49 times explicitly), his ears (mentioned 13 times, i.e., four times less than his eyes, perhaps because his ears are less visible) play a much more subtle role, underlying even his final confession in 42:5-6, where it seems/sounds that his eyes gave him (only) his final in-‘sight’. That leaves the impression that his ears give him access to the second-hand (...) testimony of tradition but his eyes to his own, personal experience. The hypothesis of this study is that a psychoanalytical perspective can give additional meaning to this polarity and cooperation of the senses for both the main character and recipient of the book of Job in that Job’s (in)sight depends on the foundation of the aural experience, even the musical experience.Contribution: A psychoanalytical perspective adds to the breadth and depth of insight gained from studying the role of the sensory experience in the narrative about the psychic and spiritual development of the protagonist in the Book of Job. (shrink)

Recent research suggests that one can have the feeling of being the cause of an action’s outcome, even in the absence of a prior intention to act. That is, experienced self-agency over behavior increases when outcome representations are primed outside of awareness, prior to executing the action and observing the resulting outcome. Based on the notion that behavior can be represented at different levels, we propose that priming outcome representations is more likely to augment self-agency experiences when the primed representation (...) corresponds with a person’s behavior representation level. Three experiments, using different priming and self-agency tasks, both measuring and manipulating the level of behavior representation, confirmed this idea. Priming high level outcome representations enhanced experienced self-agency over behavior more strongly when behavior was represented at a higher level, rather than a lower level. Thus, priming effects on self-agency experiences critically depend on behavior representation level. (shrink)

The Shapley value is the unique value defined on the class of cooperative games in characteristic function form which satisfies certain intuitively reasonable axioms. Alternatively, the Banzhaf value is the unique value satisfying a different set of axioms. The main drawback of the latter value is that it does not satisfy the efficiency axiom, so that the sum of the values assigned to the players does not need to be equal to the worth of the grand coalition. By definition, the (...) normalized Banzhaf value satisfies the efficiency axiom, but not the usual axiom of additivity. (shrink)