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  • 1.
    Jaarsma, Pier
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Cultivation of empathy in individuals with high-functioning autism spectrum disorder2013In: Ethics and Education, ISSN 1744-9642, E-ISSN 1744-9650, Vol. 8, no 3, p. 290-300Article in journal (Refereed)
    Abstract [en]

    High-functioning individuals with autism spectrum disorder (HF-ASD) typically lack cognitive empathy, compromising their moral agency from both a Kantian and a Humean perspective. Nevertheless, they are capable of exhibiting moral behavior, and sometimes, they exhibit what may be deemed ‘super-moral’ behavior. The empathy deficit poses, to varying degrees, limitations with respect to their moral motivation and moral agency. To compensate for this deficit, individuals with HF-ASD rely primarily, and justifiably, on the formation and application of moral rules. Educators who focus predominantly on empathy, however, may be less effective in the moral education of individuals with HF-ASD because they neglect the preference for rules of the latter. In this article, I argue that an individualized balance of empathy-based and rule-based strategies in the context of moral education is needed to assist individuals with HF-ASD in their challenges with moral motivation and moral agency.

  • 2. Order onlineBuy this publication >>
    Jaarsma, Pier
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Reflections on Autism: Ethical Perspectives on Autism Spectrum Disorder in Health Care and Education2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the four papers presented in this dissertation I analyze and discuss various value statements and moral stances, which I regard as unjustifiably harmful for persons with Autism and obstacles for the creation of an Autism-friendly society. In the papers I try to show that the positions underpinning the Autism-phobic moral stances are not warranted and cannot be defended in a good way. In doing so, I hope to transform the harmful moral intuitions underlying these positions into autism-friendly ones. The first paper investigates the Neurodiversity claim that ‘Autism is a natural variation’. The claim is interpreted and investigated and an argument is given that, contrary to Low-Functioning Autism, High-Functioning Autism can indeed be seen as a natural variation, without necessarily being seen as a disability. The second paper focuses on the problem for persons with Autism to adapt to prosocial lying, which is saying something not true but socially acceptable in a situation. By comparing a Kantian approach and a care ethics approach, the paper ends up recommending teaching persons with Autism to lie in a rule based and empathic way. The third paper deals with the morality of embryo selection in IVF. Based on a widely shared intuition of natural capabilities, arguments are given that it is morally legitimate to choose an Autistic embryo instead of a ‘normal’ one, contrary to arguments given by proponents of ‘every child should have the best chance of the best life’. The fourth paper deals with moral education. An argument is given that due to problems with cognitive empathy children with Autism should be taught pro-social behavior in a rule based way.

    List of papers
    1. Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement
    Open this publication in new window or tab >>Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement
    2012 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 1, p. 20-30Article in journal (Refereed) Published
    Abstract [en]

    Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.

    Place, publisher, year, edition, pages
    Dordrecht: Springer, 2012
    Keywords
    Autism, Disability, DSM-V, Equality, Neurodiversity, Vulnerability
    National Category
    Ethics
    Identifiers
    urn:nbn:se:liu:diva-72172 (URN)10.1007/s10728-011-0169-9 (DOI)000300252300002 ()
    Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08
    2. Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics
    Open this publication in new window or tab >>Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics
    2012 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 3, p. 271-277Article in journal (Refereed) Published
    Abstract [en]

    Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be 'attractively morally innocent' and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing 'Kantian' and an empathizing 'ethics of care' perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack 'cognitive empathy' which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail 'morally educating' children and adolescents with autism to become socially skilled empathic 'liars'.

    Place, publisher, year, edition, pages
    Dordrecht: Springer, 2012
    Keywords
    High-functioning autism, Autobiographies, Truthfulness, Moral responsibilities, Moral education, Kant, Ethics of care
    National Category
    Ethics
    Identifiers
    urn:nbn:se:liu:diva-72173 (URN)10.1007/s11019-011-9363-7 (DOI)
    Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08Bibliographically approved
    3. Human capabilities, mild autism, deafness and the morality of embryo selection
    Open this publication in new window or tab >>Human capabilities, mild autism, deafness and the morality of embryo selection
    2013 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, no 4, p. 817-824Article in journal (Refereed) Published
    Abstract [en]

    A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

    Place, publisher, year, edition, pages
    Springer Netherlands, 2013
    Keywords
    autism, reproduction, genetic selection, ethics, human capabilities, procreative beneficence, quality of life
    National Category
    Ethics
    Identifiers
    urn:nbn:se:liu:diva-89704 (URN)10.1007/s11019-013-9464-6 (DOI)000327128500021 ()
    Available from: 2013-03-04 Created: 2013-03-04 Last updated: 2017-12-06
    4. Cultivation of empathy in individuals with high-functioning autism spectrum disorder
    Open this publication in new window or tab >>Cultivation of empathy in individuals with high-functioning autism spectrum disorder
    2013 (English)In: Ethics and Education, ISSN 1744-9642, E-ISSN 1744-9650, Vol. 8, no 3, p. 290-300Article in journal (Refereed) Published
    Abstract [en]

    High-functioning individuals with autism spectrum disorder (HF-ASD) typically lack cognitive empathy, compromising their moral agency from both a Kantian and a Humean perspective. Nevertheless, they are capable of exhibiting moral behavior, and sometimes, they exhibit what may be deemed ‘super-moral’ behavior. The empathy deficit poses, to varying degrees, limitations with respect to their moral motivation and moral agency. To compensate for this deficit, individuals with HF-ASD rely primarily, and justifiably, on the formation and application of moral rules. Educators who focus predominantly on empathy, however, may be less effective in the moral education of individuals with HF-ASD because they neglect the preference for rules of the latter. In this article, I argue that an individualized balance of empathy-based and rule-based strategies in the context of moral education is needed to assist individuals with HF-ASD in their challenges with moral motivation and moral agency.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2013
    Keywords
    Autism spectrum disorder, empathy, rules, education, Kant, Hume
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-104417 (URN)10.1080/17449642.2013.878514 (DOI)
    Available from: 2014-02-17 Created: 2014-02-17 Last updated: 2017-12-06Bibliographically approved
  • 3.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gelhaus, Petra
    Region Östergötland. Institute for Ethics, History and Philosophy of Medicine, University of Muenster, Muenster, Germany.
    Medium-Range Narratives as a Complementary Tool to Principle-Based Prioritization in Sweden: Test Case "ADHD"2019In: Journal of Bioethical Inquiry, ISSN 1176-7529, E-ISSN 1872-4353, Vol. 16, no 1, p. 113-125Article in journal (Refereed)
    Abstract [en]

    In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels.

  • 4.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Gelhaus, Petra
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Psychiatry and Habilitation.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics2012In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 3, p. 271-277Article in journal (Refereed)
    Abstract [en]

    Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be 'attractively morally innocent' and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing 'Kantian' and an empathizing 'ethics of care' perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack 'cognitive empathy' which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail 'morally educating' children and adolescents with autism to become socially skilled empathic 'liars'.

  • 5.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Welin, Stellan
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences.
    Autism, Accommodation and Treatment: A Rejoinder to Chong-Ming Lims Critique2015In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 29, no 9, p. 684-685Article in journal (Other academic)
    Abstract [en]

    We are very grateful to Chong-Ming Lim for his thoughtful reply published in this journal on one of our articles, which motivated us to think more carefully about accommodating autistic individuals and treating autism. However we believe there are some confusions in Lims argument. Lim uses the accommodation thesis, according to which we should accommodate autistic individuals rather than treat autism, as the starting point for his reasoning. He claims that if the accommodation thesis is right, then we should not treat autistic individuals for their autism, not even low-functioning (i.e. intellectually disabled) ones, because this would be disrespectful to all autistic individuals. We should instead limit ourselves to accommodate all autistic individuals. However, the opposition between accommodation and treatment is not valid in the case of autism, because of ambiguity in the concepts of accommodation and treatment. Moreover there is confusion in Lims reasoning caused by omitting important facts about the practice of treating autism.

  • 6.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement2012In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 1, p. 20-30Article in journal (Refereed)
    Abstract [en]

    Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.

  • 7.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Human capabilities, mild autism, deafness and the morality of embryo selection2013In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, no 4, p. 817-824Article in journal (Refereed)
    Abstract [en]

    A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

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