Thomas Schramme

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.

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.

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.

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.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

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.

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?

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. -/- The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the lack of empathy, as some philosophers have proposed—but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. -/- As this volume demonstrates, philosophers will be better equipped to determine what they mean by “the moral point of view” when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy.

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.

Alternative approaches in the discussion of distributive justice differ in their answers to the question „equality of what“? In this essay I intend to ask instead,why equality?" The article rejects several arguments in favour of distributive equality, mainly on the grounds that they confuse two different kinds of justice, namely,formal’ justice (equal respect) and distributive justice. The ideal of distributive equality is based on comparisons but equal respect does not necessarily involve relational considerations. Subsequently I will consider equality of opportunity which appears on first sight to be the most promising account. However, I will point out that this approach is not convincing as an attempt to give everyone the chance to live a good life. Finally I will submit that only a theory of absolute needs is adequate.

ABSTRACT In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations.

Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem. The capabilities approach puts forward a particular solution to this problem. In this article I will discuss some issues of such an approach in relation to Sridhar Venkatapuram's well-known theory. Another problem I examine is how to determine a threshold of provision within a theory of justice. What is enough in terms of health justice? I argue that we need such a threshold to avoid healthism, the expansion of the pursuit of health over and above the treatment and prevention of disease. This is an especially pertinent problem in public health, which is also the context of Venkatapuram's theory

In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations.

Mnoge biološke funkcije dopuštaju stupnjevanje. Na primjer, lučenje određenog hormona u organizmu može biti na višoj ili nižoj razini, u usporedbi s istim organizmom drugom prilikom ili u usporedbi s drugim organizmima. Koje razine funkcioniranja predstavljaju slučajeve disfunkcije; gdje da povučemo crtu? To je kvantitativni problem za teorije disfunkcije i bolesti. Cilj mi je braniti verziju bioloških teorija disfunkcije kako bih se uhvatio u koštac s ovim problemom. Međutim, također ću dopustiti da evaluativna razmatranja uđu u teoriju bolesti. Moj argument se temelji na razlikovanju između biološke i kliničke perspektive. Prema mom mišljenju, bolest je ograničena na slučajeve koji spadaju u granice bioloških disfunkcija. Odgovor na kvantitativni problem ne zahtijeva proizvoljne odluke ili društveno vrijednosne sudove. Stoga se zalažem za nearbitrarnu metodu koja se temelji na činjenicama kako bi se riješio kvantitativni problem. Ipak, nisu sve biološke disfunkcije instance bolesti. Dodavanje kliničke perspektive omogućuje nam da spriječimo potencijalnu preveliku uključenost biološke perspektive, zato što postavlja dodatna ograničenja za određivanje granica bolesti.