The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before (...) we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively. (shrink)

We are extremely grateful for the insightful and thought-provoking commentaries on our feature article.1 We have distilled four themes emerging from the commentaries, and we would also like to address one misunderstanding of our argument that has appeared. In our article, we explicitly acknowledge that major decisions relevant for climate protection take place at the mesolevels and macrolevels of healthcare, a point raised again in some of the commentaries.2–4 Climate protection is a societal issue, and we thank these authors for (...) the concrete proposals of potential models to guide action. Yet, to us, it still makes sense to reflect simultaneously on the responsibilities that physicians have themselves. Without wanting to put the main responsibility on them, we argue it is important to start thinking about the scope of action that physicians actually have (or not have). As we have argued the need for climate action comes ever more into focus of society, we wanted to explore whether the professional ethics of the medical professionals needs to be amended. Our argument is that this is the case, based on the reasons that climate change has a big health impact while simultaneously the health system has a strong climate impact. Based on the World Medical Association (WMA) Declaration of Geneva the focus on the individual patient is clear, but this and other important codices do also include a public health perspective. The (model) Professional Code for Physicians in Germany, for example, states in its first article that ‘Physicians serve the health of …. (shrink)

Language’s intentional nature has been highlighted as a crucial feature distinguishing it from other communication systems. Specifically, language is often thought to depend on highly structured intentional action and mutual mindreading by a communicator and recipient. Whilst similar abilities in animals can shed light on the evolution of intentionality, they remain challenging to detect unambiguously. We revisit animal intentional communication and suggest that progress in identifying analogous capacities has been complicated by (i) the assumption that intentional (that is, voluntary) production (...) of communicative acts requires mental-state attribution, and (ii) variation in approaches investigating communication across sensory modalities. To move forward, we argue that a framework fusing research across modalities and species is required. We structure intentional communication into a series of requirements, each of which can be operationalised, investigated empirically, and must be met for purposive, intentionally communicative acts to be demonstrated. Our unified approach helps elucidate the distribution of animal intentional communication and subsequently serves to clarify what is meant by attributions of intentional communication in animals and humans. (shrink)

Mit der Vielzahl von Daten aus genetischen Untersuchungsverfahren wächst das Problem von „Zufallsbefunden“, d. h. von zufällig erhobenen Nebenbefunden, die mit der ursprünglichen Fragestellung nicht in Verbindung stehen und dennoch eine Bedeutung für Gesundheit und Reproduktionsverhalten der untersuchten Person selbst oder ihrer Anverwandten haben. In Ermangelung nationaler oder internationaler Richtlinien greifen die Autoren die aktuelle Diskussion um den Umgang mit genetischen Zufallsbefunden in Behandlungs- und Forschungskontext auf. Dabei nehmen sie auf die für Deutschland relevanten rechtlichen und ethischen Rahmenbedingungen Bezug. Nach (...) Gendiagnostikgesetz (GenDG) muss in Deutschland im Rahmen eines Behandlungsvertrages auf die Möglichkeit von Zufallsbefunden hingewiesen werden. Es ist Bestandteil der Aufklärung und Einwilligung, inwieweit Zufallsbefunde mitgeteilt werden, wobei das Recht auf Nichtwissen und der Schutz nicht-einwilligungsfähiger Personen berücksichtigt werden müssen. Im Forschungskontext greift das GenDG nicht, aber auch hier sollte über mögliche Zufallsbefunde aufgeklärt werden, wenngleich eine Rückmeldung nicht zwingend, aber bei Befunden mit hohem klinischen Nutzen ethisch geboten sein kann. Folgende Aspekte sind im Umgang mit Zufallsbefunden zu berücksichtigen: 1) Art und Umfang der Aufklärung und Einwilligung bei einer unüberschaubaren Zahl von möglichen Befunden. 2) Einordnung der klinischen Bedeutung einer genetischen Veränderung im Sinne von gesichertem, wahrscheinlichem, möglichem oder fraglichem/unbekanntem klinischen Nutzen. 3) Prozessierung des Informationsrückflusses für Gegenwart und Zukunft. 4) Ressourcenplanung im Hinblick auf die klinische Validierung, die Erläuterung von Befunden und den Transfer in die klinische Praxis. Im Umgang mit genetischen Zufallsbefunden besteht erheblicher empirisch-ethischer Forschungs- und politischer Regelungsbedarf. Zeitgleich ist es unabdingbar, die Wahrnehmung und das Verständnis der untersuchten Personen sowie die Grundhaltung gegenüber Zufallsbefunden im Rahmen von Studien zu beleuchten und entsprechende Bildungs- und Kommunikationswerkzeuge zu entwickeln. (shrink)

Die Beiträge des vorliegenden Bandes behandeln grundlegende Lebensbereiche der Eisenzeit aus kulturwissenschaftlicher Perspektive, u.a. Sozialordnungen, die Rolle der Frauen, Waffen und Kriegerordnungen, Werkzeug, Grabbau, Religion und Rituale, Kunst.

Mit seiner Sportwetten-Grundsatzentscheidung vom 28. Marz 2006 hat das Bundesverfassungsgericht die verfassungsrechtlichen Rahmenbedingungen fur das Glucksspielwesen in Deutschland prazisiert und den Gesetzgeber mit dessen Neuregelung beauftragt. Zum 1. Januar 2008 ist ein neues Glucksspielrecht in Deutschland in Kraft getreten. Allein die Ziele der Suchtvermeidung und Suchtbekampfung rechtfertigen Glucksspielmonopole, durch die private Glucksspielanbieter vom deutschen Glucksspielmarkt ausgeschlossen werden. Damit rucken neben okonomischen und rechtlichen Fragengerade auchdie Erkenntnisse der Glucksspielsucht-Forschung in den Mittelpunkt des Interesses. Dem versucht dieses interdisziplinar angelegte Buch Rechnung zu (...) tragen, indem namhafte Wissenschaftler und Praktiker - Okonomen, Juristen, Suchtfachleute - das Glucksspielwesen umfassend analysieren. Die Autoren beziehen Position und verdeutlichen die unterschiedlichen Sichtweisen und Interessenlagen zum Thema. Das Buch gibt dem Leser zugleich eine Idee von der geschichtlichen Dimension und der Bedeutung des Glucksspiels fur den Einzelnen und die Gesellschaft insgesamt.". (shrink)

Over the last two decades foundationalism has been severely criticized. In response to this various alternatives to it have been advanced, notably coherentism. At the same time new versions of foundationalism were crafted, that were claimed to be immune to the earlier criticisms. This volume contains 12 papers in which various aspects of this dialectic are covered. A number of papers continue the trend to defend foundationalism, and foundationalism's commitment to basic beliefs and basic knowledge, against various attacks. Others aim (...) to show that one important objection against coherentism, viz. that the notion of 'coherence' is too vague to be useful, can be countered. (shrink)

First, we explain the conception of trustworthiness that we employ. We model trustworthiness as a relation among a trustor, a trustee, and a field of trust defined and delimited by its scope. In addition, both potential trustors and potential trustees are modeled as being more or less reliable in signaling either their willingness to trust or their willingness to prove trustworthy in various fields in relation to various other agents. Second, following Alfano (forthcoming) we argue that the social scale of (...) a potential trust relationship partly determines both explanatory and normative aspects of the relation. Most of the philosophical literature focuses on dyadic trust between a pair of agents (Baier 1986, Jones 1996, Jones 2012, McGeer 2008, Pettit 1995), but there are also small communities of trust (Alfano forthcoming) and trust in large institutions (Potter 2002, Govier 1997, Townley & Garfield 2013, Hardin 2002). The mechanisms that induce people to extend their trust vary depending on the size of the community in question, and the ways in which trustworthiness can be established and trusting warranted vary with these mechanisms. Mechanisms that work in dyads and small communities are often unavailable in the context of trusting an institution or branch of government. Establishing trust on this larger social scale therefore requires new or modified mechanisms. In the third section of the paper, we recommend three policies that – we argue – tend to make institutions more trustworthy and to reliably signal that trustworthiness to the public. First, they should ensure that their decision-making processes are as open and transparent as possible. Second, they should make efforts to engage stakeholders in dialogue with decision-makers such as managers, members of the C-Suite, and highly-placed policy-makers. Third, they should foster diversity – gender, ethnicity, age, socioeconomic background, disability, etc. – in their workforce at all levels, but especially in management and positions of power. We conclude by discussing the warrant for distrust in institutions that do not adopt these policies, which we contend is especially pertinent for people who belong to groups that have historically faced (and in many cases still do face) oppression. (shrink)