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Institute of Biomedical Ethics and History of Medicine (IBME)

Dissertation Tobias Zürcher

«Towards a better understanding of the relevance of free will, authentic decision-making and the self in medical ethics»


This research project takes as its theme fundamental philosophical concepts and their relevance to questions of medical ethics. In the best case, it might contribute to transfer thoughts and arguments from one field (philosophy) to another field (medical ethics) and help to better understand the issues at stake. At the center of this inquiry are the concepts of free will, competent decision-making, and the self. I argue that these three topics overlap in a number of ways and help to illuminate one another. Free will can and should be understood as a part or prerequisite for decision-making competence. Terminological demarcations that arise (quasi-naturally) due to specializations of individual scientific domains should not obscure the fact that the individual disciplines ultimately address common questions. In the first contribution, the connection between decision-making competence and a compatibilist understanding of free will is established. In the second contribution, the significance of free will for psychotherapy is discussed on this basis. Finally in this context, the third contribution argues that in the case of assisted suicide, mental illness does not necessarily undermine a person's decision-making competence, even if the desire to die has been brought about by the mental illness. In the context of these three contributions, parallel to the work with the concepts of free will and decision-making competence, the notion of the person or the personal self will be explored as well. In the fourth contribution, the notion of the self becomes the focus of consideration when, with critical intent, the narrative understanding of the self is examined in light of the problem of personal identity.

In addition to individual (fine-grained) insights in the respective themes of the four contributions, the aim is to show performatively, in view of all contributions combined, that philosophical voices can be profitably brought into medical ethics and that the fields of medicine, psychiatry, and psychology - the stories of persons in health and illness, in living and dying - offer important phenomena to be reflected upon in philosophy.