Peter Schröder

Auf den ersten Blick scheint die Religion bei Mill nur eine periphere Rolle zu spielen. Seine ausdrücklich dem Thema der Religion gewidmeten Schriften verfasste er erst spät und sie wurden dann nicht mehr von Mill, sondern von seiner Stieftochter Helen TaylorTaylor, Helen, die eng mit Mill zusammenarbeitete, 1874 publiziert. Aber Religion ist für das Verständnis von Mills Philosophie von grundlegenderer Bedeutung, denn sie wird als moralische Basis für die Gesellschaft von Mill in seiner Theorie des Utilitarismus mitgedacht. Mills Utilitarismus, sein Verständnis von Staat und Gesellschaft, bedarf letztlich eines über die bloße Vernunft des Menschen hinausweisenden Fundaments.

Information is clearly vital to public health, but the acquisition and use of public health data elicit serious privacy concerns. One strategy for navigating this dilemma is to build 'trust' in institutions responsible for health information, thereby reducing privacy concerns and increasing willingness to contribute personal data. This strategy, as currently presented in public health literature, has serious shortcomings. But it can be augmented by appealing to the philosophical analysis of the concept of trust. Philosophers distinguish trust and trustworthiness from cognate attitudes, such as confident reliance. Central to this is value congruence: trust is grounded in the perception of shared values. So, the way to build trust in institutions responsible for health data is for those institutions to develop and display values shared by the public. We defend this approach from objections, such as that trust is an interpersonal attitude inappropriate to the way people relate to organisations. The paper then moves on to the practical application of our strategy. Trust and trustworthiness can reduce privacy concerns and increase willingness to share health data, notably, in the context of internal and external threats to data privacy. We end by appealing for the sort of empirical work our proposal requires.

Das Thema „moralischer Stress / moralische Verletzung“ hat als Gegenstand der sozialwisschenschaftlichen, psychologischen und auch ethischen Forschung in den letzten Jahren an Bedeutung gewonnen. Dieses Kapitel stellt dar, was unter diesen Begriffen zu verstehen ist. Anhand ausgewählter Berufsfelder wird die Problematik und die Praxisrelevanz dieses Forschungsbereichs aus ethischer Perspektive dargestellt. Ansatzweise werden zwei Aspekte angesprochen, die bei der Prävention bzw. Heilung von moralischen Verletzungen hilfreich sein könnten, gleichwohl weiterer Forschung bedürfen: Ein philosophisch fundierter Begriff von „Vertrauen“ und die Relevanz von „Ethiklehre“ in der (akademischen) Berufsausbildung.

Ethik und Seelsorge sind Bereiche, in denen menschliches Sein und Handeln reflektierend begleitet wird, um Orientierung, Unterstützung oder Trost zu geben. Bei Berufen, in denen Menschen auf eine gewaltverstrickte Lebenswelt treffen, ihrerseits staatlich legitimiert Gewalt ausüben und selbst von Gewalt betroffen sind, tauchen dabei besondere Widersprüche und Sinnfragen auf. Diese Herausforderungen in den Blick zu nehmen und an der Schnittstelle von Philosophie und praktischer Theologie zu erörtern, so wie es der Münsteraner Theologe Werner Schiewek richtungsweisend vorgezeichnet hat, ist das Ziel des vorliegenden Bandes.

In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician–patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician–patient relationship in a descriptive heuristic sense. The principal–agent theory can be used to analytically grasp existing action problems in the physician–patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients’ increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician’s necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics

Dieser Beitrag stellt aus ethischer Perspektive Herausforderungen für die polizeiliche Arbeit zur Zeit der „Coronakrise“ in Deutschland dar. Spannungsfelder der konkreten Polizeiarbeit vor dem Hintergrund dieser Pandemie werden ebenso beschrieben wie moralische Normen und Werte sowie ethische Theorien, die berufliches Polizeihandeln und die Setzung staatlicher Rahmenbedingungen für polizeiliches Handeln in dieser Phase leiten können und sollen. Public-health-ethische Ansätze werden dabei mit Perspektiven der polizeilichen Berufsethik kohärent integriert. Die Priorisierung von knappen Ressourcen, darunter auch Vakzinen, wird diskutiert und es wird argumentiert, dass es aus ethischer Sicht gute Gründe gibt, Polizistinnen und Polizisten bei der Verfügbarwerdung sicherer und effektiver Impfstoffe eine hohe Prioritätsstufe zu geben.

Swiss-born Emer de Vattel was one of the last eminent thinkers of natural law. He shaped the later part of early-modern natural jurisprudence. At the time, the subject had become a fashionable academic sub-discipline in both jurisprudence and philosophy. Vattel's considerable impact on statesmen, political thinkers, diplomats and lawyers during his lifetime and after rested primarily on the fact that his The Law of Nations transformed natural law into the basis of a more comprehensive and practicable theory of interstate relations. His ideas served to promote reform programmes whose comprehensive natures spanned the domains of economic reform, constitutionalism and international diplomacy and foreign trade policy. Vattel's conception centred round the principle that defined all sovereign states as nations composed of societies of free men and profoundly influenced legal and political debates in the eighteenth and nineteenth centuries.

International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman’s central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria.

International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman’s central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria.

ZusammenfassungPatientenmobilität und grenzüberschreitende Gesundheitsversorgung sind alltägliche Phänomene in der Europäischen Union. Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien über ethische Aspekte grenzübergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzübergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwähnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Möglichkeit der Patientenmobilität und die damit vor allem verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings können wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil können sogar negative Konsequenzen für einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Überlegungen kritisch zu sehen ist.

Developments in Non-Invasive Prenatal Testing (NIPT) and cell-free fetal DNA analysis raise the possibility that antenatal services may soon be able to support couples in non-invasively testing for, and diagnosing, an unprecedented range of genetic disorders and traits coded within their unborn child’s genome. Inevitably, this has prompted debate within the bioethics literature about what screening options should be offered to couples for the purpose of reproductive choice. In relation to this problem, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) tentatively recommend that any expansion of this type of screening, as facilitated by NIPT, should be limited to serious congenital and childhood disorders. In support of this recommendation, the ESHG and ASHG cite considerations of distribution justice. Notably, however, an account of justice in the organization and provision of this type of screening which might substantiate this recommendation has yet to be developed. This paper attempts to redress this oversight through an investigation of Norman Daniels’ theory of Just health: meeting health needs fairly. In line with this aim, the paper examines what special moral importance (for Just health) screening for the purpose of reproductive choice might have where concerning serious congenital and childhood disorders in particular. The paper concludes that screening for reproductive choice where concerning serious congenital and childhood disorders may be important for providing women with fair opportunity to protect their health (by either having or not having an affected child).

The four-principles-approach of Tom Beauchamp and Jim Childress has been very influential in bioethics in the last decades. It has proven well although mid-level principles in general and this approach in particular are highly contested by ethicists who would prefer approaches rather based on rules, virtues or personal relations. The author of this study systematically discusses the origin, method and criticism of the Beauchamp and Childress approach. Finally he argues that the applicability of this approach for ethical challenges in the biomedical setting should stimulate a principled approach for ethical challenges of public health as well. Such an approach can utilize the method from Beauchamp and Childress. Principles for public health ethics, as presented in a concise set by the author, however, must be different in scope and content to meet the ethical challenges of public health

The study of natural law theories is presently one of the most fruitful areas of research in the studies of early modern intellectual history, and moral and political theory. Likewise the historical significance of the Enlightenment for the development of `modernisation' in many different forms continues to be the subject of controversy. This collection therefore offers a timely opportunity to re-examine both the coherence of the concept of an `early Enlightenment', and the specific contribution of natural law theories to its formation. The works of major thinkers such as Grotius, Hobbes, Locke, Malebranche, Pufendorf and Thomasius are reassessed, and the appeal and importance of the discourse of natural jurisprudence both to those working inside conventional educational and political structures and to those outside - such as in the Huguenot diaspora - is evaluated. This volume will therefore be of importance to all those readers concerned to study the character of the debates in the period 1650-1750 surrounding moral and political agency, sovereignty and obligation, and the legitimation of religious toleration in the divergent states and patriotic contexts of Europe.