Blaming friends

The aim of this paper is to shed light on the complex relations between friendship and blame. In the first part, I show that to be friends is to have certain evaluative, emotional and behavioral dispositions toward each other, and distinguish between two kinds of norms of friendship, namely friendship-based obligations and friendship-constituting rules. Friendship-based obligations tag actions of friends as obligatory, permissible or wrong, whereas friendship-constituting rules specify conditions that, if met, make it so that two persons stand in a particular type of relationship defined by various friendship-based obligations. I argue that whereas friendship-based obligations apply to actions under direct voluntary control, friendship-constituting rules apply to emotional and evaluative attitudes. The second part develops an account of friendship blame by comparing Scanlon's account of blame with Wallace's Strawsonian account of blame. I demonstrate that Scanlon's account picks out responses that become appropriate when friends' attitudes are not in agreement with friendship-constituting rules, whereas Wallace's account picks out responses that become appropriate when friends violate friendship-based obligations. Arguing that the responses picked out by Scanlon's account do not amount to blame, I show that, when combined, the views give an illuminating picture of possible reactions to friends who fall short of the standards of friendship

Ought implies can, asymmetrical freedom, and the practical irrelevance of transcendental freedom

In this paper, I demonstrate that Kant's commitment to an asymmetry between the control conditions for praise and blame is explained by his endorsement of the principle Ought Implies Can (OIC). I argue that Kant accepts only a relatively weak version of OIC and that he is hence committed only to a relatively weak requirement of alternate possibilities for moral blame. This suggests that whether we are transcendentally free is irrelevant to questions about moral permissibility and moral blameworthiness

Soll die UN-Behindertenrechtskonvention in der psychiatrischen Praxis umgesetzt werden?

In einer kürzlich im $\textit {British Journal of Psychiatry}$ veröffentlichten Debatte wird diskutiert, ob Großbritannien von der UN-Behindertenrechtskonvention (UN-BRK) zurücktreten sollte (Gosney und Bartlett 2020). Die UN-BRK ist eine internationale Konvention, welche die universellen Menschenrechte für Menschen mit Behinderungen spezifiziert und von zahlreichen Ländern, darunter auch Deutschland, ratifiziert wurde. Insbesondere die Allgemeine Bemerkung des UN-Fachausschusses für die Rechte von Menschen mit Behinderungen (United Nations 2014) zum Artikel 12 der Konvention hat eine kontroverse Diskussion angeregt

Assisted suicide and the discrimination argument

According to the "discrimination argument", it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread "joint" approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy-based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence- and autonomy-based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS

"Voluntary in quotation marks"

$\bf Background:$ Psychological pressure refers to communicative strategies used by professionals and informal caregivers to influence the decision-making of service users and improve their adherence to recommended treatment or social rules. This phenomenon is also commonly referred to as informal coercion or treatment pressure. Empirical studies indicated that psychological pressure is common in mental healthcare services. No generally accepted definition of psychological pressure is available to date. A first conceptual analysis of psychological pressure focused on staff communication to promote treatment adherence and distinguished between persuasion, interpersonal leverage, inducements and threats. $\bf Aim:$ The aim of this study was to develop a conceptual model of psychological pressure based on the perspectives of service users. $\bf Methods:$ Data were collected by means of semi-structured interviews. The sample consisted of 14 mental health service users with a self-reported psychiatric diagnosis and prior experience with coercion in mental healthcare. We used theoretical sampling and contacted participants via mental healthcare services and self-help groups to ensure a variety of attitudes toward the mental healthcare system in the sample. The study was conducted in Germany from October 2019 to January 2020. Data were analyzed according to grounded theory methodology. $\bf Results:$ The study indicated that psychological pressure is used not only to improve service users' adherence to recommended treatment but also to improve their adherence to social rules; that it is exerted not only by mental health professionals but also by relatives and friends; and that the extent to which service users perceive communication as involving psychological pressure depends strongly on contextual factors. Relevant contextual factors were the way of communicating, the quality of the personal relationship, the institutional setting, the material surroundings and the level of convergence between the parties' understanding of mental disorder. $\bf Conclusions:$ The results of the study highlight the importance of staff communication training and organizational changes for reducing the use of psychological pressure in mental healthcare services

Interaktives Lernen

Das Gebot des "Social Distancing" während der COVID-19-Pandemie hat eine Revision der bisherigen Lehr-Lern-Settings an Universitäten erforderlich gemacht. Als positiven Nebeneffekt hat die begegnungsarme Kommunikation einen Innovationsschub in puncto digitale Lehre ausgelöst und diente vielen Dozierenden als Anlass, neue Formate zu erproben. Vor diesem Hintergrund hat das Institut für Medizinische Ethik und Geschichte der Medizin der Medizinischen Fakultät der Ruhr-Universität Bochum ein neues Lehrkonzept für den Pflicht-Querschnittsbereich Geschichte, Theorie, Ethik der Medizin (GTE) im Studium der Humanmedizin entwickelt.$^{1}$ Im Folgenden geben wir einen Einblick in die Erwartungen des Teams, die Herausforderungen, die sich bei der Umsetzung gestellt haben, und die Resonanz der Studierenden. $^{1}$Unser Institut ist für die GTE-Lehre an den Medizinischen Fakultäten der Ruhr-Universität Bochum und der Universität Duisburg-Essen verantwortlich. Der neue GTE-Kurs wurde für die Lehre an der Medizinischen Fakultät der Universität Duisburg-Essen entwickelt und dort im Sommersemester 2021 erstmals eingesetzt

Das Verständnis von Wohl im Betreuungsrecht

Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff "Wohl" aus dem Gesetz gestrichen. Hierdurch soll stärker hervorgehoben werden, dass sich der Betreuer an den subjektiven Wünschen des Betreuten statt an einem objektiven Wohlverständnis orientieren soll. In diesem Beitrag wird ermittelt, welches Verständnis von Wohl das reformierte Betreuungsrecht in Abgleich zu gängigen medizinethisch-philosophischen Auffassungen des Wohls implizit enthält. Indem untersucht wird, in welchem Verhältnis das betreuungsrechtliche und das medizinethische bzw. philosophische Verständnis von Wohl zueinanderstehen, soll die interdisziplinäre Verständigung zwischen Recht und Ethik gefördert werden. In der Begründung zur Reform wird betont, dass dem Betreuungsrecht weiterhin ein subjektives Verständnis von Wohl zugrunde liege. Dieses Verständnis deckt sich jedoch nicht mit philosophischen subjektiven Theorien des Wohlergehens, nach denen nur das zum Wohl einer Person beiträgt, was diese sich wünscht. Das Betreuungsrecht nimmt hingegen an, dass die Befolgung bestimmter Wünsche zu objektiven Schädigungen der Person führen und damit ihr Wohl beeinträchtigen kann. Negative Konsequenzen für das objektive Wohl eines Betreuten sind betreuungsrechtlich insofern relevant, als dass sie eine Grenze für die Befolgung aktueller Wünsche aufzeigen, die auf einem natürlichen Willen basieren und nicht Ausdruck von Selbstbestimmung sind. Dies ähnelt einer hybriden Konzeption des Wohls aus medizinethisch-philosophischer Sicht, nach der grundsätzlich angenommen wird, dass die Befolgung der Wünsche einer Person zu ihrem Wohl beiträgt, während aber auch gewisse objektive Kriterien als relevant für ihr Wohl angesehen werden.$\textit {Definition of the problem}$ The reform of German guardianship law coming into force in 2023 will remove the term "well-being" from the law. This is intended to emphasise that the legal guardian should be guided by the subjective wishes of the person rather than by an objective understanding of well-being. This article analyses the understanding of well-being underlying the reformed guardianship law in comparison to common conceptions of well-being in philosophy and medical ethics, aiming to promote interdisciplinary understanding between ethics and law. $\it Arguments$ The justification for the reform emphasises that the law is based on a subjective understanding of well-being. However, this understanding does not correspond to philosophical subjective theories of well-being, according to which only things that a person desires can contribute to her well-being. In contrast, the guardianship law assumes that the fulfilment of certain wishes can lead to objective harm to the person and thus impair her well-being. Negative consequences for the objective well-being of a person are only relevant insofar as they indicate a limit to following current wishes that are based on a natural will and are not an expression of self-determination. $\it Conclusion$ While the term "well-being" is removed from reformed guardianship law, the law implicitly contains an understanding of well-being comparable to a hybrid conception of well-being from a medical ethics perspective. According to this conception, fulfilment of a person's wishes generally contributes to her well-being, although certain objective criteria are also taken into consideration

A german version of the staff attitude to coercion scale

$\textbf {Background:}$ Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion. $\textbf {Aim:}$ The present study aimed to develop and validate a German version of the Staff Attitude to Coercion Scale (SACS). $\textbf {Methods:}$ The original English version of the SACS published was translated into German. Subsequently, it was empirically validated on a sample of $\textit {N = 209}$ mental health professionals by conducting an exploratory factor analysis. $\textbf {Results:}$ The three-factor structure in the original version of the SACS, consisting of critical, pragmatic and positive attitudes toward the use of coercion, could not be replicated. Instead, the German version revealed one factor ranging from rejecting to approving the use of coercion. $\textbf {Conclusion:}$ The SACS is one of the first instruments created to assess staff attitudes toward coercion in a validated way. The version of the instrument developed in this study allows for a validated assessment of those attitudes in German. Our results highlight the ethical importance of using validated measurements in studies on the role of staff factors in the reduction of coercion