Bert Heinrichs

Recent advances in genomic research have led to the development of new diagnostic tools, including tests which make it possible to predict the future occurrence of monogenetic diseases (e.g. Chorea Huntington) or to determine increased susceptibilities to the future development of more complex diseases (e.g. breast cancer). The use of such tests raises a number of ethical, legal and social issues which are usually discussed in terms of rights. However, in the context of predictive genetic tests a key question arises which lies beyond the concept of rights, namely, What should we want to know about our future? In the following I shall discuss this question against the background of Kant’s Doctrine of Virtue. It will be demonstrated that the system of duties of virtue that Kant elaborates in the second part of his Metaphysics of Morals offers a theoretical framework for addressing the question of a proper scope of future knowledge as provided by genetic tests. This approach can serve as a source of moral guidance complementary to a justice perspective. It does, however, not rest on the – rather problematic – claim to be able to define what the “good life” is

In this paper I propose to examine the concept of discrimination from an ethical viewpoint. In a preliminary part, I will point out which aspects of the subject matter I will focus on and which I will leave aside (II). On the basis of the Aristotelian principle “treat like cases alike”, I will continue with a very formal definition, according to which discrimination can be understood as acting in a way that implies that like cases are not treated alike. This leads to the difficult question of which cases are to be considered as “alike”, or which traits can serve as morally valid reasons for identifying cases as “unlike” (III). I will argue that this question cannot be answered independently from the specific circumstances and the normative premises referred to for describing these circumstances. My conclusion is that the concept of discrimination derives its “moral strength” solely from these normative premises. As a consequence, the use of the con- cept of discrimination can often be misleading since it falsely presupposes that there is agreement about the underlying normative premises (IV). Finally, I will illustrate the argumentation using “genetic discrimination” in connection with insurance contracts as an example (V).

Definition of the problem Case studies, both with a view to didactical and argumentative purposes, are widely used in applied ethics. However, case studies are often used without methodological considerations concerning the premises and limi- tations of these kind of studies as methodologi- cal tools within ethics. Conclusion The present paper critically examines the recourse to – real or fictitious – case studies. Important suggesti- ons will be taken from Kant’s philosophy. Kant himself occasionally uses case studies in his ethical writings. Yet, he also discusses the relevance as well as the limitations of case studies in ethics. Arguments Against the background of this analysis, the opinion that ethics can be taught or developed in concreto, or that ethics might eventually be resolved into compilations of case studies must be rejected.

The so-called Principlism of Beauchamp and Childress is one of the most prominent approaches in bioethics. It has, nevertheless, given rise to an ongoing debate on methodology in bioethics. At the bottom of this debate lies the question whether a multi-principles approach or a single-principle approach is more convincing in bioethics. In this paper I shall propose a 'third way' of bioethical reasoning that is committed neither to a multi-principles nor to a single-principle approach. In contrast, I will take up the Kantian differentiation of formal and material principles. This differentiation permits combining the strengths of multi-principles as well as of single-principle approaches.

It has become evident that neuroimaging raises new normative questions that cannot be addressed adequately within the (in this regard unspecific) frameworks of existing research ethics. Questions that are especially troubling are, among others, provoked by incidental findings. Two questions are particularly intricate in view of incidental findings: (1) How can the research subject’s right not to know be guaranteed? And (2) should a diagnostic check of scans by a neuroradiologist become an obligatory part of neuroscientific research protocols? The present paper examines these question against the background of two recent recommendations. The differentiation between difference position and similarity position serves as an analytic tool to further investigate the issue and to develop a distinct proposal for answering the questions

For a couple of years, “Aristotelian Naturalism” has been the subject of intensive debates. Among the most prominent proponents of this type of ethical theory are Philippa Foot and John McDowell. At first sight, these approaches are quite attractive for they seem to combine a number of advantages. The central thesis of the present paper is, however, that they do not succeed in developing a convincing ethical theory. To substantiate this claim, Foot’s approach will be presented in a first step. In a second step, McDowell’s critique on Foot will be out- lined. Foot’s attempt to provide an external foundation for morality takes centre stage here. In a third step, McDowell’s own version of Aristotelian Naturalism, which has an explicitly anti-foundational shape, will be delineated. Although McDowell’s critique on Foot proves to be valid, it leads him to the wrong con- clusions. He ignores that a reason-internal foundation of morality is available which resists his legitimate critique while being superior to his own anti-foun- dational theory. At the core of such an approach lies a non-reductive concept of person, which stands in clear contrast to Foot’s concept of “life form” as well as to McDowell’s concept of “second nature”.

Unter Off-Label-Use versteht man den zulassungsüberschreitenden Einsatz eines Arzneimittels außerhalb der von Zulassungsbehörden genehmigten Anwendungsgebiete. Er ist in der medizinischen Praxis weit verbreitet und fächerübergreifend zu beobachten. Der Beitrag gibt eine Einschätzung der Off-Label-Anwendung aus ethischer Sicht. Dazu wird die Off- Label-Anwendung zunächst von anderen, sachlich verwandten Anwendungsweisen abgegrenzt. Danach wird über die aktuelle Verbreitung des Off-Label- Use informiert. Sodann wird gezeigt, dass sich bekannte Problemlagen aus der Medizinethik bei der Off-Label-Anwendung in spezifischer Weise verschärfen. Schließlich wird diskutiert, wie eine ethisch akzeptable Off-Label-Anwendung von Arzneimitteln ausgestaltet werden könnte und auf welchen Ebenen sie ansetzen müsste.