100 Philosophie
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We all know the experience of different demands on ourselves. As a parent, we want to be there for our children, and in pursuit of our career, we want to invest as much time as possible. If we are committed to both being a good parent and pursuing a career, it may be impossible to satisfy the demands stemming from both commitments. It is in such moments in which our, what I call, practical identities are conflicted that our will is in a state of volitional disunity. In this dissertation, I discuss how a person may best cope with volitional disunity.
I define practical identities in line with Christine M. Korsgaard as self-descriptions under which a person finds her life worth living and her actions worth undertaking; examples of such self-descriptions are being a parent, an employee, a hobbyist pianist, the friend of Charlotte, etc. Practical identities provide the person with ideals that form a decision-making framework for her deliberations about what to do. The standard analysis of volitional disunity, is that it causes a person to not know what to do as her identities, as guides, point her in conflicting, even opposite, directions. The solutions proposed in the literature always include, what I call, the Unification Ideal: a person has to prioritize her identities by deciding which is more important to her. By unifying her identities in this way, she constitutes who she is and wants to be thereby providing herself with a clear decision-making framework regarding the question of what to do.
In this dissertation however, I argue that a person does not need to overcome her volitional disunity through unification per se. In order to know what to do, a person could also explore the disunity that defines her will, which includes that she could accept the volitional disunity as hers. I base this Exploration Ideal on two assumptions about human nature: 1) we have inner responses to how we act and 2) we are opaque to ourselves. Since a person cannot always know in advance whether she will be happy with a commitment by turning her attention inwards, she can explore who she wants to be and who she can be through the bodily, psychological, and emotive responses she has to her actions. These responses, however, are not the ultimate authority. This authority stays with her practical identities in light of which she can evaluate these inner responses. Thus, a person exposed to volitional disunity should strive to explore this disunity, how she wants it to define her and whether it is constitutive of who she is (Exploration Ideal) instead of trying to overcome the disunity by striving for unification (Unification Ideal).
Die Dissertation leistet einen Beitrag zur Analyse des intensionalen semantischen Vokabulars von Gebrauchssprachen und formalen Sprachen. Die Frage danach, wann Ausdrücke sinnvoll sind bzw. eine Bedeutung haben, ist eine altehrwürdige. Vor allem in den letzten beiden Jahrhunderten haben Philosophen wie Frege, Russell, Wittgenstein, Carnap und Quine versucht, Antworten auf sie zu finden. In der vorliegenden Schrift wird eine konsistente Menge von Prinzipien des Sinnvollseins herausgearbeitet, die in semantischen Theorien eingesetzt werden könnte. Dafür werden die folgenden Schritte unternommen:
• Bewertung und kritische Abwägung von einschlägigen Intuitionen,
• Präzisierung und Kritik der Vorschläge von logischen Empiristen,
• Würdigung von Vorschlägen jüngeren Datums,
• Begründung aller zentralen Behauptungen in einem formalen Rahmen,
• Untersuchung von Sinnlosigkeitsbehauptungen anhand von Beispielen.
Medical doctors sometimes make diagnoses in persons who are not their patients and who did not ask for their medical opinion, e.g., when an off-duty dermatologist diagnoses melanoma in a stranger, outside of the hospital setting. These diagnoses are referred to as unsolicited medical opinions.
The unsolicited medical opinion raises several ethical questions. Most importantly, it poses a moral challenge for the physician: a possible disease, which may lead to a serious loss of health, is recognised in a person who is not the physician’s patient, outside of the formal medical context. The fundamental ethical question addressed in this dissertation is: Does a medical doctor who makes a clinical diagnosis in a stranger, outside of the formal medical context, have an ethical obligation to offer an unsolicited medical opinion?
This ethical question involves some related questions: If physicians do have an ethical obligation to offer an unsolicited medical opinion, are there any limiting factors to this obligation, which would justify not acting? A more practical question is also raised: How should a physician approach the person in whom an unsolicited diagnosis is made?
The cumulative dissertation is based on three publications addressing the unsolicited medical opinion. Firstly, the unsolicited medical opinion is explored from the perspective of utilitarianism, and a utilitarian argument is made in favour of offering an unsolicited medical opinion. Secondly, the topic is placed in the context of the existing scientific literature and analysed from the perspective of several ethical theories: virtue ethics, care ethics, principlism and contract theory. Lastly, the unsolicited medical opinion is discussed in the context of “medically unknown symptoms”. As in the central argument of this thesis, a utilitarian principle is applied and an argument made in favour of an unsolicited mental health diagnosis.