Claudia Wiesemann

Families occupy a problematic position within the liberal society. They are networks of intimate, trusting relationships often devoted to the care of dependent human beings; promoting the liberty of their members is not their most important aim. I will emphasize the moral role of the child as truster and of the family as a moral sphere for trusting relationships. I will discuss why and how the family's moral role has been criticized from liberal as well as feminist points of view and suggest a revised conception.

In this chapter, I delineate some of the problems of classical approaches to parenthood. It will become clear how moral adultism has seeped into much of what has been written about childhood ethics. I examine different approaches, including child rights and welfare rights approaches, that attempt to realize the equal moral consideration of the child and show why, in a significant aspect, they fail to achieve this goal. A moral-equality approach should avoid developmentalism and moral adultism, and focus on the child’s agency and moral self-respect.

Under the new heading “Philosophie aktuell” topics which are relevant in terms of public, moral, and political discourse will be discussed from a philosophical vantage point. By way of example, the explanatory capacity of philosophical reflection and critique will be demonstrated. The present issue puts the reform of the Transplantation Law under philosophical investigation. Concepts of life and death, in particular that of cerebral death, will be scrutinized. It will be asked whether these concepts are descriptive in nature or prescriptive, normatively charged ones. Are cerebrally dead persons still alive or already dead?

Definition of the problemThe article addresses the relationship between reproduction, time and the good life. Services offered by reproductive medicine and conceptions of the good life in time influence each other reciprocally. This interaction is characterised by implicit and explicit normative settings and expectations of appropriate temporality.ArgumentsWe first discuss the significance of time for the life course and for parenthood from a sociological and social psychological perspective. Reproductive medicine can increase the options for becoming a parent and thus for life-time autonomy. However, in the context of societal imperatives for optimisation and efficiency, it can also have opposite effects and increase heteronomy. Overall, this leads to changed forms of adaptation and self-determination, new dilemmas and ambivalences in the temporal optimisation of parenthood.ConclusionsAgainst this background, we explain how the ethics of reproductive medicine could benefit from interdisciplinary research that focuses on life in its temporal course.

Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.

Es ist ein intuitiv einleuchtender Gedanke, dass Kinder über Menschenwürde verfügen. In der Ethik wird aber ganz überwiegend entweder die Menschenwürde erwachsener Personen oder die von Embryonen thematisiert. Die Menschenwürde geborener Kinder wird so gut wie nie diskutiert. Viele Autoren und Autorinnen, die sich um die Präzisierung des Menschenwürde-Begriffs im Rahmen von personhood accounts bemühen, scheinen zu unterstellen, der von ihnen jeweils entwickelte Begriff sei im Prinzip auf Erwachsene wie auf Kinder anwendbar. Im Beitrag werden unterschiedliche Menschenwürde-Interpretationen daraufhin untersucht, ob sie tatsächlich geeignet sind, die Situation von Kindern angemessen zu erfassen. Ziel ist eine Analyse geläufiger Menschenwürde-Konzeptionen aus der Perspektive des Kindes. Dies soll einerseits theoretisch-analytisch und andererseits mit Bezug auf zwei praktische Beispiele geschehen.

Definition of the problem Few concepts in recent ethical debates have enjoyed as much popularity as the concept of discrimination. However, a comparative discussion of the concept, including its conceptual nuances and its ethical significance for health care, has so far been lacking. The aim of this paper is to develop a nuanced understanding of discrimination based on the philosophical and sociological literature against the background of ethically relevant medical and nursing scenarios. Methods Using practical examples from health care, we discuss direct, indirect, and statistical discrimination; we examine the importance of intentions and the role of collective actors. In addition, we analyze which social groups may experience discrimination and the respective importance of forms of epistemic injustice. Conclusions We argue that despite its complexity, the concept offers significant added value because it allows us to highlight forms of disadvantage that go beyond the violation of individual specific rights or interests. As a knowledge-based system of great societal influence, health care exhibits some characteristics that can foster discrimination. Acknowledging this fact is essential in order to effectively address discrimination.

Presenting real life cases from clinical practice, this book claims that children can be conceived of as moral equals without ignoring the fact that they still are children and in need of strong family relationships. Drawing upon recent advances in childhood studies and its key feature, the ‘agentic child’, it uncovers the ideology of adultism which has seeped into much what has been written about childhood ethics. However, this book also critically examines those positions that do accord moral equality to children but on grounds not strong enough to support their claim. It lays the groundwork for a theory of moral equality by assessing the concepts of parenthood, family, best interest, paternalism, and, above all, autonomy and trust which are so important in envisioning what we owe the child. It does not only show how children – like adults – should be considered moral agents from infancy but also how ethical theories addressing adults can significantly profit from recognizing this. The analysis takes into account contributions from European as well as American scholars and makes use of a wide range of ethical, psychological, cultural, and social-scientific research.

ZusammenfassungDer vorliegende Beitrag untersucht, wie angesichts eines Interessenpluralismus ethische Diskurse über innovative und hochriskante Forschungsvorhaben angemessen geführt werden können. Dazu rekonstruieren wir erstens den Begriff des Stakeholders im Kontext seiner Entstehung in der Unternehmensethik und Anwendung in der Medizinethik und legen dessen implizite normative Prämissen frei. Wir entwickeln zweitens eine Klassifizierung von Stakeholdern und illustrieren diese am Beispiel der klinischen Forschung. Besonderes Augenmerk wird dabei auf das Kriterium der Betroffenheit gelegt. Drittens werden für unterschiedliche Formen der Betroffenheit von Stakeholdern angemessene Beteiligungsverfahren vorgestellt, die von Information bis Empowerment reichen können. Wir zeigen, warum es für ethische Diskurse in der Medizin- und Bioethik wichtig ist, Betroffenheit und Beteiligungsverfahren auf transparente und nachvollziehbare Weise in ein reflektiertes Verhältnis zu setzen und wie das praktisch zu bewerkstelligen ist.