Thomas Schramme

Der libertäre Paternalismus befürwortet Eingriffe in die Entscheidungsfindung von Bürgern, ohne ihnen Optionen völlig nehmen zu wollen. Vielmehr soll die Lenkung des Willens durch Schubser geschehen. Im folgenden Beitrag möchte ich zeigen, dass der libertäre Paternalismus auf tönernen Füßen steht. Ich bediene mich dabei des polemischen Bilds von Quacksalbern. Dieses Bild passt zu meinem argumentativen Vorgehen, da ich erstens zeigen will, dass der libertäre Paternalismus falsche Diagnosen über vermeintliche Krankheiten der Willensbildung stellt, und zweitens, dass er die falsche Therapie empfiehlt. Im ersten Teil des Artikels kritisiere ich die Diagnose des libertären Paternalismus, wonach Menschen in ihrer Entscheidungsfindung systematisch fehlschlagen. Die Auswirkungen der zugrundeliegenden psychologischen Forschung werden missinterpretiert und damit vielen menschlichen Entscheidungen eine Art Defekt zugeschrieben. Der zweite Teil des Beitrags hinterfragt die Therapie des libertären Paternalismus. Für entsprechende Interventionen in die Wahlarchitektonik muss Wissen erlangt werden über die Richtung, in welche die Menschen jeweils geschubst werden sollten. Die hier genannte epistemische Aufgabe kann mit den theoretischen Mitteln des libertären Paternalismus nicht gelöst werden.

I aim to show that the common idea according to which we can assess how bad death is for the person who dies relies on numerous dubious premises. These premises are intuitive from the point of view of dominant views regarding the badness of death. However, unless these premises have been thoroughly justified, we cannot measure the badness of death for the person who dies. In this paper, I will make explicit assumptions that pertain to the alleged level of badness of death. The most important assumption I will address is the assignment of a quantitative value of zero to death, which leads to the conclusion that there are lives not worth living for the affected person. Such a view interprets the idea of a live worth living in quantitative terms. It is in conflict with actual evaluations of relevant people of their lives.

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.

In 2012, the symposium "Christopher Boorse and the Philosophy of Medicine" was held at the University of Hamburg. The initial ideas presented at this event, which celebrated Chris's contribution to the development of what is now a vibrant area of research, especially to the theory of disease, form the core of the papers published in this issue. Similarly to what Robert Nozick once said about John Rawls's work, it can be demanded that philosophers of medicine must now either work within Boorse's theory or explain why not. It is simply the main contender in the so-called naturalist camp of contributions to the theory of disease. All of the papers in this issue address his approach in some respect, and all of them are friendly toward his theory up to a point. In this brief introduction, I try to extract common threads. In doing so, I focus on three issues that have the capacity to determine future debates. The first is the methodology of developing a theory of disease, especially what conceptual analysis amounts to and what it may achieve. The second is the issue of value-ladenness of the concepts of health and disease, a topic that has been at the forefront of the philosophical debate, but which -- to my mind -- has often been misunderstood. The third issue is the problem of the unity of medical terminology. We can ask whether there is only one core medical concept, be it "disease," "pathology," "disorder," "malady," or something else. Alternatively, we might propose different concepts for different purposes.

ZusammenfassungDer Beitrag beschäftigt sich mit der Frage, ob eine Behinderung immer als Form von Leid betrachtet werden muss. Mit Hilfe einer Unterscheidung zwischen absoluten und komparativen Einschränkungen des Wohls wird aufgezeigt, dass die bloße Tatsache einer vorliegenden medizinischen Schädigung nicht hinreicht, ein Urteil über das absolute Wohl einer Person zu treffen. Es werden verschiedene Argumente geprüft, warum Behinderung dennoch generell negativ bewertet werden sollte. Diese werden zurückgewiesen. Abschließend wird eine Überlegung eingeführt, wonach gleichwohl bestimmte Formen der Behinderung als objektive Beeinträchtigungen des Wohls zu gelten haben, nämlich dann, wenn basale Fähigkeiten betroffen sind.

This essay is concerned with different strategies of justifying a welfare state. I begin with a description of the formal aims of its different versions. I then vindicate the transformation of mutual civic responsibilities into state-controlled institutions. In the main part I develop three accounts that are typically brought forward in order to justify particular institutions of a welfare state. These models focus on freedom, equality, and security. In conclusion, I argue in favour of a higher-level model of justification, which integrates the valid ideas of the other models. It considers inclusion of all citizens into society to be the main goal of welfare institutions.

Michael Slote has long been one of the foremost contributors to discussions in moral theory. Both his work on consequentialism and his particular version of virtue ethics have been highly influential. In recent years, Slote has developed a distinctive and original voice, placing his various theoretical endeavours under the title of “sentimentalism”. His key ethical work in this context is Moral Sentimentalism, which, uniquely, defends versions of both a metaethical and aretaic sentimentalist theory. The present volume is an extended discussion of that work, containing eight original commentaries and a substantial response by Slote, which provide fresh insights into his position. The collection will be of significant value to anyone interested in contemporary debates in meta-ethics or normative ethics.

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not defined as absence of disease but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority

Decision-making capacity or mental competence is one of the most intensively discussed concepts in contemporary bioethics and medical ethics. In this paper I argue that anorexia nervosa, an eating disorder primarily afflicting adolescent girls and young women, seriously challenges what I label the traditional account of decision-making capacity. In light of these results, it may in addition be necessary to rethink a certain popular type of paternalistic argumentation that grounds the justification of compulsory treatment, for example of anorexic persons who refuse treatment, on a lack of decision-making capacity

What is the basis of our capacity to act morally? This is a question that has been discussed for millennia, with philosophical debate typically distinguishing two sources of morality: reason and sentiment. This collection aims to shed light on whether the human capacity to feel for others really is central for morality and, if so, in what way. To tackle these questions, the authors discuss how fellow feeling is to be understood: its structure, content and empirical conditions. Also discussed are the exact roles that relevant psychological features - specifically: empathy, sympathy and concern - may play within morality. The collection is unique in bringing together the key participants in the various discussions of the relation of fellow feeling to moral norms, moral concepts and moral agency. By integrating conceptually sophisticated and empirically informed perspectives, Forms of Fellow Feeling will appeal to readers from philosophy, psychology, sociology and cultural studies.