Thomas Schramme

TugendethikenTugend, Tugendethik sind normative Theorien des richtigen und guten Handelns, die den zentralen Gesichtspunkt der ethischen Bewertung in der handelnden Person, genauer in ihrer charakterlichen und motivationalen Verfassung sehen. Eine Tugend ist eine charakterlich gefestigte Haltung von Menschen, die sie das Richtige und Gute aus eigener Überzeugung erkennen und erstreben lässt. Als Tugenden gelten dabei nicht nur die im engen Sinne moralischen Tugenden wie Gerechtigkeit oder Aufrichtigkeit,WahrhaftigkeitAufrichtigkeitAufrichtigkeit, sondern sie umfassen beispielsweise auch selbstbezogene und intellektuelle Vortrefflichkeiten wie Besonnenheit oder WeisheitWeisheit, die beide lange Zeit zu den Kardinaltugenden gehörten.

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die.

Philosophy of medicine is thought of today as a distinct discipline with its own set of concerns. This title focuses on all major aspects of the philosophy of medicine and the attempts of philosophers, bioethicists, and physicians to address its unique set of problems and questions. It deals with the various metaphysical, ethical and practical problems and questions facing modern medicine such as human nature and mind; reductionism and holism; causation and etiology; notions of disease, health, illness and disability; ageing, death and suicide; medical theory and models; social determinants of health and the role of factors such as technology and evidence-based medicine in providing valid diagnostic and therapeutic knowledge.

This paper outlines a novel framing of the normative significance of health by considering the idea of ‘health capital’. Health capital is a set of health-related assets of individuals that enable them to pursue their interests and to collaborate with others. The specific contribution of this paper is to establish the notion of health capital beyond a metaphorical idea and to initially explore the repercussions of it for theories of health justice. We propose a sufficientarian approach to health capital justice. Our theory claims that social justice requires enabling people to achieve enough health capital to meet threats to health. This is a dynamic ideal, establishing claims of justice over time. The overarching goal is to avoid disadvantageous tipping points of health depletion.

“Classic,” serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic research. The first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience?

Misunderstanding other people can be interpreted as the result of an insufficient performance of people’s skills to understand other persons and their experiences. But what does understand mean in these contexts? And what are the relevant skills that need to be engaged to successfully understand other people? I argue that understanding other people is a form of recognition of the epistemic validity of another person’s perspective. I claim that minimal understanding does not require an endorsement of another person’s perspective. This makes the avoidance of lack of understanding a feasible achievement in almost all cases, though it often requires effort in the interactive process of understanding. I specifically analyse the epistemic and normative roles of empathy in this process. In pursuing this aim, I also defend empathy against recent philosophical arguments that point at moral dangers of empathic processes.

Individualität stellt für Mill eine Quelle und gleichzeitig ein Ziel individuellen und gesellschaftlichen Fortschritts dar. Individualität ist ein Element des Wohlergehens, wie die Überschrift des dritten Kapitels seiner Freiheitsschrift festhält. Individualität ist somit ein vorrangiges Ziel der Erziehung, Bildung und guten Regierung. Zudem kann Individualität, ausgedrückt in verschiedensten Lebensexperimenten, die Entwicklung einer Gesellschaft voranbringen. Es sollte insofern nicht überraschen, dass Individualität ein zentrales Konzept des Mill’schen. Denkens darstellt. Schließlich war sein Denken insgesamt auf die Verbesserung der Menschheit und der Lebensverhältnisse gerichtet.

Sufficientarianism is a theory of social justice that determines individual entitlements by setting a threshold of what is enough for a decent life. Sufficientarianism therefore seems to be a suitable ally for theories of climate justice, because it restricts claims of justice to a minimum. Furthermore, the notion of sufficiency has been theorized in ecological discourse, so there is pertinent conceptual overlap between the two perspectives. In this paper, I aim to combine sufficientarianism with eco-sufficiency. I will use a framework of needs to highlight different normative urgencies involved in practices that involve carbon emissions. However, as I will argue, the normative urgency of needs might cause problems for restricting emissions to levels that are compatible with planetary limits. In brief, the very aim of achieving sufficientarian justice might clash with the aim of eco-sufficiency. Sufficientarians should therefore critically engage with needs satisfiers as well, which are the means provided to satisfy needs. This step in my argument will be achieved through complementing sufficientarianism with an element of comparative justice, that is, interpersonal and diachronic considerations that help to determine the comparative urgency of claims. The overarching aim of sustainable sufficientarianism is to provide enough for everyone to live a decent life over time.

Mit dem Ausdruck ‚sympathy‘ bezeichnet Mill die menschliche Fähigkeit, zu fühlen, was andere fühlen; oder allgemeiner, Zugang zum subjektiven Erleben Anderer zu erlangen. Sowohl Einfühlung als auch Mitfühlen sind in dieser Idee integriert. Für Mill ist ‚sympathy‘ eine wesentliche Voraussetzung der menschlichen Moralität. Allerdings gilt es, ‚sympathy‘ zur Fähigkeit auszubilden, genuin moralische Empfindungen zu zeigen. Erst dann sind stabile Moraldispositionen zu erwarten und damit letztlich die Realisierbarkeit des utilitaristischen Moralprinzips ermöglicht.

Wilhelm von HumboldtHumboldt, Wilhelm von war ein berühmter preußischer Gelehrter und Bildungsreformer. Sein posthum veröffentlichtes Werk Ideen zu einem Entwurf, die Grenzen der Wirksamkeit des Staates zu beschränken wird in Mills Schrift On Liberty und in seiner Autobiography mehrfach zustimmend erwähnt und zitiert. Selbst das Epigraph, welches Mill als Motto seiner Freiheitsschrift voranstellt, stammt von Humboldt: „The grand, leading principle, towards which every argument unfolded in these pages directly converges, is the absolute and essential importance of human development in its richest diversity“ (CW XVIII, 215).

In this paper, I analyse whether empathy with future generations is feasible and whether it is a potentially useful instrument in effectively providing resources for future generations. I argue that empathy with future generations is possible, that it likely leads to a form of minimal concern, and that it can help in solving the relevant motivational problem. The most significant hurdle is not so much to do with achieving the required normative recognition of future generations, but with epistemic problems regarding the right actions in protecting future interests and needs. Empathy can again be of help in this regard, but it would need to be successfully trained and supported. We need to stretch our empathy to non-existing people and we need to constrain our imagination in adequate ways to achieve a sufficient understanding of the perspectives of future people.

In this paper, I discuss the risks of brain injuries in collision and contact sports and make a proposal to address them without limiting the autonomy of athletes. I aim to analyse the circumstances of profound uncertainty that athletes are facing in terms of the long-term impact of brain injuries. My strategy is to circumvent drastic measures in dealing with such risks, such as banning certain sports or changing their nature by introducing constitutive rule changes, and to scaffold individual autonomy instead. I will focus on two aspects. First, I address the choice whether to take up or continue to play a risky sport given the mentioned profound level of ignorance. I argue that we can scaffold autonomy to make rational choices, particularly by enabling the application of heuristics. Second, I discuss performative skills that can help to prevent brain injuries. It is important to consider collision and contact sports as instances of joint action. The performance of others is an important factor in determining the level of risk in such sports. Hence, supporting athlete’s skills to prevent collisions can reduce the risk of brain injury. I conjecture ways to scaffold players’ skills and performance with this aim in mind.

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims.

Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention of disease. I point out epistemic and moral problems with these types of nudges, which lead to my conclusion that health-enhancing nudges fail. They fail because we cannot know which choices enhance individual health—properly understood in a holistic way—and because health-enhancing nudges are often themselves bad for our health. They can be bad for our health because they assume inferior agency in their targets and accordingly regularly lead to appropriate resentment and anger—strong emotions which go along with an increased risk of health impairments. Briefly, health-enhancing nudges fail because they are based on persistent ignorance and on a presumptuous attitude.

Antipsychiatry is famous - and infamous - for its claim that there is no such affliction as mental illness. If this proved to be true, the status of psychiatry would change radically. The field of psychiatry would no longer be accepted by many as an integral part of medicine because the primary task of medicine is to cure the ill. The statement that there is no such thing as mental illness appears so highly radical that many hold doubts as to its plausibility. Indeed, it could well be viewed as a totally absurd assumption, because in some cases we can even "see" the illness with persons who are hearing voices or hallucinate. Nevertheless, the claim appears absurd in the first instance only due to the fact that the existence of the phenomena is not denied, rather reference to the meaningful use of the concept of illness is denied. This would indicate that critics of the concept of mental illness do not contest that there are many people with serious mental problems, but maintain that we should not refer to them as being ill. The first cross-purposes in the debate on the concept of mental illness start at this point.