Henk J. van Gils-Schmidt

We are extremely grateful for the insightful and thought-provoking commentaries on our feature article.1 We have distilled four themes emerging from the commentaries, and we would also like to address one misunderstanding of our argument that has appeared. In our article, we explicitly acknowledge that major decisions relevant for climate protection take place at the mesolevels and macrolevels of healthcare, a point raised again in some of the commentaries.2–4 Climate protection is a societal issue, and we thank these authors for the concrete proposals of potential models to guide action. Yet, to us, it still makes sense to reflect simultaneously on the responsibilities that physicians have themselves. Without wanting to put the main responsibility on them, we argue it is important to start thinking about the scope of action that physicians actually have (or not have). As we have argued the need for climate action comes ever more into focus of society, we wanted to explore whether the professional ethics of the medical professionals needs to be amended. Our argument is that this is the case, based on the reasons that climate change has a big health impact while simultaneously the health system has a strong climate impact. Based on the World Medical Association (WMA) Declaration of Geneva the focus on the individual patient is clear, but this and other important codices do also include a public health perspective. The (model) Professional Code for Physicians in Germany, for example, states in its first article that ‘Physicians serve the health of …

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively.

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas.

Harry G. Frankfurt has put the problem of volitional conflict at the center of philosophical attention. If you care fundamentally about your career and your family, but these cares conflict, this conflict undermines the coherency of your decision standard and thereby your ability to choose and act autonomously. The standard response to this problem is to argue that you can overcome volitional conflict by unifying your foundational motivational states. As Frankfurt puts it, the ‘totality of things that an agent cares about’ plus his ‘ordering of how important to him they are effectively specifies his answer to the question of how to live’ (The Reasons of Love(Princeton: Princeton University Press, 2004), p. 23). In this paper, I critically assess the three main reasons given for such a coherency requirement: 1) we can do only one action at a time; 2) our motivational states come with normative pressure towards coherency; and 3) conflicting motivational states provide us with an incoherent decision-making framework. I conclude that these reasons do not ground a coherency requirement for practical deliberation and argue that we can autonomously express ourselves as volitionally conflicted by acting on our conflicting motivational states over the course of multiple actions.

This paper proposes a framework for understanding and analysing online social resistance movements based on Hilde Lindemann’s concept of counterstories (Damaged Identities, Narrative Repair, 2003). This framework is based on the premise that we shape our identities in shared social spaces, and that such shared spaces are structured according to so-called ‘master narratives’. Master narratives define the ‘realm of possible identities’ that we can assume, and form the basis for either recognizing or denying recognition to various social groups in specific roles that they might occupy. Social oppression occurs when master narratives preclude or forbid a certain form of self-expression, or alternatively force members of a specific social group into a determinate societal role (say, women who receive recognition only in the roles of mother or housewife). Counterstories serve as a corrective to these aspects of oppression by challenging the oppressive facets of master narratives. Based on this framework, I propose an interpretation of the #MeToo movement as a counterstory that aims to change the oppressive aspects of the patriarchal master narrative that (partially) structures many shared social spaces in the modern Western world. I end this paper by applying the framework to consider potential obstacles #MeToo may encounter as a distinctively online movement.