Thomas Schramme

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters.

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.

In this essay, I exploit an ambiguity in the concept of self-determination. Self-de Green termination can mean to determine oneself in choices and actions or to determine one’s self. The second kind of self-determination leads to our capacity to imagine alternative selves of ourselves, which are to be actualized. This creates the basis for a normative conception of self-determination, i.e. a conception that incorporates the aspect of a right or good way to determine oneself. I defend a normative interpretation of self-determination, which is illustrated by reference to three theorists: Harry Frankfurt, Thomas Hill Green and John Stuart Mill.

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.

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.

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.

Der Artikel befasst sich zunächst mit Ralf Stoeckers Analyse des Krankheitsbegriffs, speziell mit der Auffassung, dass es sich um einen Bündelbegriff handelt, der verschiedene Dimensionen des Phänomens Krankheit verbindet. Im Anschluss wird ein mögliches Szenario entworfen, in dem es gar keinen Krankheitsbegriff mehr gibt und damit die steuernde Funktion beim Zugang zu Gesundheitsressourcen wegfiele. Wäre es gut, wenn der gebrechliche Begriff der Krankheit, wie Stoecker ihn ebenfalls bezeichnet, das Zeitliche segnete?

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.

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.

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.

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.

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.

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).