In contemporary bioethics, two vocabularies can be distinguished:person-speak andnature-speak. The first is built around the claim that a person's moral decisions are to be respected, while the other stands on the claim that moral decisions should comply with standards for human behaviour conveyed by nature. While most bioethicists have obtained a thorough mastery ofperson-speak, they are considerably less well-versed innature-speak. Apparently, the latter has lost much of its former ability to capture important aspects of moral existence. In this paper I (...) attempt to rehabilitatenature-speak from a hermeneutical perspective. I believe that the task of ethics is to enlarge our range of moral description and to rediscover neglected ways of speaking about human experience. The ethicist should enable individuals in health care settings to become more articulate about their moral experience. He should not content himself with applying those moral vocabularies which happen to be readily available, but should rather proceed by recovering forgotten vocabularies from within the philosophical tradition. Finally, one particular effort at restoringnature-speak is critically reviewed. (shrink)

Bioethical discourse on organ donation and transplantation medicine covers a wide range of topics, from informed consent procedures and scarcity issues up to transplant tourism and organ trade. Over the past decades, this discourse evolved into a stream of documents of bewildering proportions, encompassing thousands of books, papers, conferences, blogs, consensus meetings, policy reports, media debates and other outlets. Beneath the manifest level of discourse, however, a more latent dimension can be discerned, revolving around issues of embodiment, the moral status (...) of the human body and the concept of bodily integrity. This publication aims to bring these “deeper” questions to the fore. What is envisioned is a “depth” ethics (the moral equivalent of a depth psychology) focussing on the tensions, conflicts and ambiguities at work in bioethical deliberations on organ transplantation, fuelling the viewpoints articulated on the more manifest levels of discourse. Organ donation reopens the question of the status of the body as something which we have, but at the same time are, and as something which constitutes a whole, while at the same time being a set of replaceable elements or parts. (shrink)

“Meer dan in enige andere periode in de geschiedenis geniet ‘ethiek’ allerwege belangstelling” (p. 7), zo luidt de openingszin van het Handboek gezondheidsethiek (De Beaufort en Dupuis 1988). Discussies in de media lijken deze indruk te bevestigen. Wanneer de interesse van filosofische lezers door dergelijke mediaberichten worden gewekt, kunnen daar tenminste twee redenen voor zijn. Om te beginnen kunnen zij zich geroepen voelen positie te kiezen in het betreffende debat, door voor een bepaald standpunt te opteren en dat met redenen (...) te omkleden. Dat wil zeggen, zij kunnen het als hun opgave beschouwen om, vanuit hun specifieke ethische deskundigheid, de betrokkenen te assisteren door overwegingen naar voren te brengen, aspecten nader te belichten of op tegenspraken te wijzen. Een andere mogelijkheid is dat zij het debat van een wat grotere afstand volgen, door niet de onderhavige problematiek, maar veeleer het debat als zodanig tot voorwerp van onderzoek te maken. Hun interesse, verwondering of irritatie betreft dan niet zozeer de standpunten die door de betrokkenen worden verwoord, maar veeleer het idioom waarin zij hun morele afwegingen articuleren en de vooronderstellingen die ze daarbij hanteren. In deze studie wordt voor de laatste mogelijkheid gekozen. In de gangbare terminologie wordt de eerste mogelijkheid als ‘ethisch’, de tweede mogelijkheid als ‘meta- ethisch’ aangeduid. In de loop van deze studie zal echter naar voren komen dat dit onderscheid inadequaat is. Mijn meta-ethische reflectie op de problematiek van consensusvorming in de gezondheidsethiek, heeft wel degelijk ook een ethische inzet. Deze zal echter eerder ‘fundamenteel-ethisch’ dan ‘toegepast-ethisch’ van karakter zijn. De studie behelst een fundamenteel-ethische doordenking van een problematiek die naar voren komt in een toegepast- ethisch discours: de gezondheidsethiek. (shrink)

This book examines the central role that language plays in understanding and human flourishing. The book begins by exploring Heidegger's idea that language is an essential element of how we dwell in the world and is, for the most part, ready-to-hand for us. With Gadamer, I then begin to explore phenomena where language is not ready-to-hand but calls for interpretation. The latter half of the book explores distinct ways in which language can become unready-to-hand for individuals (e.g., in cases of (...) trauma, depression, and social subordination) and examines the way that such situations have been analyzed by twentieth-century Continental thinkers (e.g., Blanchot, Kristeva, Derrida). (shrink)

This article aims to develop a Lacanian approach to bioethics. Point of departure is the fact that both psychoanalysis and bioethics are practices of language, combining diagnostics with therapy. Subsequently, I will point out how Lacanian linguistics may help us to elucidate the dynamics of both psychoanalytical and bioethical discourse, using the movie One flew over the Cuckoo’s Nest and Sophocles’ tragedy Antigone as key examples. Next, I will explain the ‘topology’ of the bioethical landscape with the help of Lacan’s (...) three dimensions: the imaginary, the symbolical and the real. This will culminate in an assessment of the dynamics of bioethical discourse with the help of Lacan’s theorem of the four discourses. Bioethics, I will argue, is not a homogeneous discourse. Rather, four modalities of bioethical discourse can be distinguished, all of them displaying specific weaknesses and strengths, opportunities and threats. This will be elucidated with the help of two case studies, namely the debates on human reproductive technologies and on the use of animals as biomedical research models. (shrink)

This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.

This contribution addresses the anthropocenic challenge from a dialectical perspective, combining a diagnostics of the present with a prognostic of the emerging future. It builds on the oeuvres of two prominent dialectical thinkers, namely Georg Wilhelm Friedrich Hegel and Pierre Teilhard de Chardin. Hegel himself was a pre-anthropocenic thinker who did not yet thematise the anthropocenic challenge as such, but whose work allows us to emphasise the unprecedented newness of the current crisis. I will especially focus on his views on (...) Earth as a planetary process, emphasising that the “spirit” of technoscience is basically monitoring the impacts of its own activities on geochemistry and evolution. Subsequently, I will turn attention to Teilhard de Chardin, a palaeontologist and philosopher rightfully acknowledged as one of the first thinkers of the Anthropocene whose oeuvre provides a mediating middle term between Hegel’s conceptual groundwork and the anthropocenic present. Notably, I will discuss his views on self-directed evolution, on the on-going absorption of the biosphere by the noosphere, and on emerging options for “sublating” the current crisis into a synthetic convergence towards the Omega point. I will conclude that, after disclosing the biomolecular essence of life, biotechnology must now take a radical biomimetic turn ; that reflection itself must become distributed and collective; and, that the anthropocenic crisis must be sublated into the noocene. (shrink)

: In 1927, Fritz Jahr, a Protestant pastor, philosopher, and educator in Halle an der Saale, published an article entitled "Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants" and proposed a "Bioethical Imperative," extending Kant's moral imperative to all forms of life. Reviewing new physiological knowledge of his times and moral challenges associated with the development of secular and pluralistic societies, Jahr redefines moral obligations towards human and nonhuman forms of life, outlining the concept of (...) bioethics as an academic discipline, principle, and virtue. Although he had no immediate long-lasting influence during politically and morally turbulent times, his argument that new science and technology requires new ethical and philosophical reflection and resolve may contribute toward clarification of terminology and of normative and practical visions of bioethics, including understanding of the geoethical dimensions of bioethics. (shrink)

Heidegger’s oeuvre (> 100 volumes) contains a plethora of comments on contemporary science, or rathertechnosciencebecause, according to Heidegger, science is inherently technical. What insights can be derived from such comments for philosophers questioning technoscience as it is practiced today? Can Heidegger’s thoughts become a source of inspiration for contemporary scholars who are confronted with automated sequencing machines, magnetic resonance imaging machines and other technoscientific contrivances? This is closely related to the question of method, I will argue. Although Heidegger himself was (...) notoriously ambivalent when it came to method, especially in his later writings, his oeuvre nonetheless contains important hints for how a philosophical questioning of technoscience could be practiced, such as: paying attention to language (to the words that we use) or taking a step backwards (towards the moment of commencement of the type of rationality at work). For Heidegger, method means: being underway, and a philosophical method must be developed along the way. After discussing Heidegger’s views on method, both in his earlier and in his later writings, three dimensions of contemporary technoscience will be addressed, namely: technoscientific objects (research artefacts), technoscientific sites (laboratories as unworldly environments) and technoscience as a global enterprise. In the final section, the question will be addressed whether and how a critical encounter between philosophy and technoscience is possible. (shrink)

This review essay examines H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics, a contemporary nonfeminist text in mainstream biomedical ethics. It focuses upon a central concept, Engelhardt's idea of the moral community and argues that the most serious problem in the book is its failure to take account of the political and social structures of moral communities, structures which deeply affect issues in biomedical ethics.

The use of genetic testing has prompted the question of whether insurance companies should be able to use predictive genetic test results (GTRs) in their risk classification of clients. While some jurisdictions have passed legislation to prohibit this practice, the UK has instead adopted a voluntary code of practice that merely restricts the ways in which insurance companies may use GTRs. Critics have invoked various theories of justice to argue that this approach is unfair. However, as well as sometimes relying (...) on somewhat idealised assumptions, these analyses have tended to invoke theories that have wide-ranging and highly revisionary implications for insurance. Moreover, they fail to adequately engage with a conception of justice that plausibly undergirds the status quo approach to insurance in the UK. I argue that it is a mistake to simply invoke a single contestable theory in seeking to develop sound policy on the use of GTRs in insurance. To that end, in this paper, I outline three plausible principles of justice that policy on this issue ought to balance: A principle of equity, a principle of equal access and a principle of need. In doing so, I shall offer a pluralist justice-based argument in support of the spirit, if not the precise letter, of the UK approach. (shrink)

Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not (...) now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. (shrink)

Truth and knowledge are conceptually related and there is a way of construing both that implies that they cannot be solely derived from a description that restricts itself to a set of scientific facts. In the first section of this essay, I analyse truth as a relation between a praxis, ways of knowing, and the world. In the second section, I invoke the third thing—the objective reality on which we triangulate as knowing subjects for the purpose of complex scientific endeavours (...) like medical science and clinical care. Such praxes develop robust methods of “keeping in touch” with disease and illness (like biomarkers). An analysis drawing on philosophical semantics motivates the needed (anti-scientistic) account of meaning and truth (and therefore knowledge) and underpins the following argument: (i) the formulation and dissemination of knowledge rests on language; (ii) language is selective in what it represents in any given situation; (iii) the praxes of a given (sub)culture are based on this selectivity; but (iv) human health and illness involve whole human beings in a human life-world; therefore, (v) medical knowledge should reflectively transcend, where required, biomedical science towards a more inclusive view. Parts three and four argue that a post-structuralist (Lacanian) account of the human subject can avoid both scientism and idealism or unconstrained relativism. (shrink)

Euripides’ Alcestis (1959) raises the issue of ethical duties within families and exposes the romantic postures and rhetoric that can dominate such discussions. Should anybody be asked to sacrifice themselves or even undergo significant health risks for members of their own family? (An issue that is also relevant in considering our duties to future generations in terms of the earth we leave to them.) The issue that is dramatized to a heroic level in Alcestis arises in live organ and tissue (...) donation within a family and challenges the idea that families should be trusted to sort out solutions that they can all live with. Alcestis intensifies the debate because the sacrifice of one life for another is its topic but, in doing so, it exposes many traps lying in wait for ethicists and medical jurists who boldly enter such debates (where emotions create shifting ground on which angels fear to tread). (shrink)

Three metaphors appear to guide contemporary thinking about organ transplantation. Although the gift is the sanctioned metaphor for donating organs, the underlying perspective from the side of the state, authorities and the medical establishment often seems to be that the body shall rather be understood as a resource . The acute scarcity of organs, which generates a desperate demand in relation to a group of potential suppliers who are desperate to an equal extent, leads easily to the gift’s becoming, in (...) reality, not only a resource, but also a commodity . In this paper, the claim is made that a successful explication of the gift metaphor in the case of organ transplantation and a complementary defence of the ethical primacy of the giving of organs need to be grounded in a philosophical anthropology which considers the implications of embodiment in a different and more substantial way than is generally the case in contemporary bioethics. I show that Heidegger’s phenomenology offers such an alternative, with the help of which we can understand why body parts could and, indeed, under certain circumstances, should be given to others in need, but yet are neither resources nor properties to be sold. The phenomenological exploration in question is tied to fundamental questions about what kind of relationship we have to our own bodies, as well as about what kind of relationship we have to each other as human beings sharing the same being-in-the-world as embodied creatures. (shrink)

Die im Wintersemester 1929/30 an der Freiburger Universität vierstündig gehaltene Vorlesung ist in zweierlei Hinsicht erregend. Zum einen enthält sie eine breit durchgeführte Analyse der in der Freiburger Antrittsvorlesung 'Was ist Metaphysik?' nur gestreiften Langeweile, zum anderen bietet sie eine ebenso ausführliche Wesensbestimmung des Organismus und des Lebens - eine Thematik, die Heidegger in 'Sein und Zeit', § 12, nur benennt. 'Diese Vorlesung ist wohl die bedeutendste, die Heidegger gehalten hat, und schon fast ein zweites Hauptwerk.' Rüdiger Safranski.

The General Medical Council’s (GMC) Outcome for Graduates, published in 2018,1 is the latest guidance for medical schools on the GMC’s expectations of the undergraduate medical curriculum. One of its three top level outcomes—Professional Values and Behaviours—refers to medical ethics and law, professionalism and patient safety competencies. Furthermore, the recent proliferation of patient safety inquiries in the UK2–4 has elevated the emphasis on ethical medical practice5 and critical medical ethics and law competencies for future doctors. In response to these developments (...) and to ensure an up to date offering, the Institute of Medical Ethics Education Committee has updated the consensus statement on the core curriculum for medical ethics and law for doctors of tomorrow.6 This refined curriculum is the result of a national consultation process. We asked for the views of all lead teachers of medical ethics and law in all UK medical schools, the UK’s chief medical officers, the GMC, and delegates at our annual education conference in 2017 who …. (shrink)