Biomedical Ethics

This paper defends and develops Elizabeth Harman’s Actual Future Principle with a concept called Schrödinger’s Fetus. I argue that all early fetuses are Schrödinger’s Fetuses: those early fetuses that survive and become conscious beings have full moral status already as early fetuses, but those fetuses that die as early fetuses lack moral status. With Schrödinger’s Fetus, it becomes possible to accept two widely held but contradictory intuitions to be true, and to avoid certain reductiones ad absurdum that pro-life and pro-choice (...) positions face. It also gives a simple solution to the problem of prenatal harm. (shrink)

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification for current policies of (...) forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries. (shrink)

Review of Margrit Shildrick, Leaky Bodies and Boundaries.

In ‘Moral case for legal age change’, I argue that sometimes people should be allowed to change their age. I refute six immediate objections against the view that age change is permissible. I argue that the objections cannot show that legal age change should always be prohibited. In this paper, I consider some further objections against legal age change raised by Iain Brassington, Toni Saad and William Simkulet. I argue that the objections fail to show that age change should never (...) be allowed. (shrink)

Volume 19, Issue 7, July 2019, Page 16-18.

A new reprogenetic technology, mitochondrial replacement, is making its appearance and, unsurprisingly given its promise to wash off our earthly stains --or at least the scourges of sexual reproduction--, John Harris finds only reasons to celebrate this new scientific feat.1 In fact, he finds mitochondrial replacement techniques (MRTs) so “unreservedly welcome” that he believes those who reject them suffer from “a large degree of desperation and not a little callousness.”2 Believing myself to be neither desperate nor callous, but finding myself (...) also no closer at all – not even after reading his article—to following Harris in welcoming these technologies wholeheartedly, it seems appropriate to respond. (shrink)

The paper discusses some of the implications of regulatory innovation in the area of advanced biological therapies and personalised medicine. Benefits, risks and trade-offs are highlighted.

When are we morally obligated as a society to help the homeless, and is coercive interference justified when help is not asked for, even refused? To answer this question, we propose a comprehensive taxonomy of different types of homelessness and argue that different levels of autonomy allow for interventions with varying degrees of pressure to accept help. There are only two categories, however, where paternalism proper is allowed, be it heavily qualified. The first case is the homeless person with severely (...) diminished autonomy as a result of mental illness, and the second case is the homeless person who runs a risk of serious and imminent harm to self. In the first case, namely, that of soft paternalism, we argue that coercive intervention in the case of a refusal to accept help should be focused on the provision of housing that meets basic needs—needs that we outline in the article. In the case of imminent and severe harm to self, the case of hard paternalism, we argue that forced intervention can only be allowed if it is temporary and local, namely focused on getting someone out of harm’s way. (shrink)

Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: 1) the person genuinely feels his age differs significantly from his chronological age and 2) the person’s biological age is recognized to be significantly different from his chronological age and 3) age change would likely prevent, (...) stop or reduce ageism, discrimination due to age, he would otherwise face. I also consider some objections against the view that people should be allowed to change their legal age and find them lacking. (shrink)

Review of Searching Eyes: Privacy, the State, and Disease Surveillance in America – By Amy L. Fairchild, Ronald Bayer, and James Colgrove.

Published in the American Journal of Bioethics.

In this peer commentary on Maura Priest's "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm", I argue against the "mismatch" model of trans identity. On this model, which is prevalent in institutional and medical contexts, to be trans is to have one's gender identity "mismatch" with one's sexed body.

Informed consent has become the most obvious instantiation of patient autonomy in contemporary medicine, though as a practice it does not encompass all spheres of medicine. While diagnostic radiological procedures carry some risk due to the use of radiation, there is no standardized practice of informed consent in the United States. The authors describe the ethical justification of informed consent, the legal background surrounding it, and a brief history of radiology and radiological protection. They ultimately argue that informed consent should (...) become a common practice in computed tomography given the risks involved due to radiation exposure, especially considering the overuse of this technology, since it respects patient autonomy. (shrink)

The number of police departments carrying Narcan keeps increasing at a fast pace throughout the U.S., as it is considered an effective measure to fight the opioid epidemic. However, there have been strong oppositions to the idea of the police Narcan use. Still, in 2018, the nation is debating about it. Though not clearly visible to the public, there are important ethical arguments against the police Narcan use which necessarily involve understanding of the ethical roles and responsibilities of police as (...) the law enforcement agency and apprehension of the moral status of a non-therapeutic opioid use. The authors of the paper investigate, primarily, the existing ethical controversies surrounding the police Narcan use while touching upon the issue of the decriminalizing drug policy in the U.S. The authors conclude that the police can carry and administer Narcan without self-contradiction and that the policymakers’ investigation on the drug decriminalization policy should begin with the understanding of the “common morality” of the American public, the ethical view shared and practiced by the greatest number of people. (shrink)

Este trabajo gira en torno al casuismo. Se hace hincapié en su necesidad para la ética biomédica. A través de su carácter analógico, se pone de manifiesto, a su vez, su dependencia de los principios. Sin embargo, ni principios ni casos bastan por sí solos para iluminar completamente las decisiones biomédicas, que presentan un notable componente de incertidumbre. Una decisión no es un objeto preexistente, sino algo que hay que producir, un operable. Aquí se pone de manifiesto que esta realidad (...) no se puede abordar si no es a través de la noción clásica de prudencia, en el sentido de la phrónesis aristotélica. Una vez esbozada ésta en sus líneas generales, dando cuenta de sus aspectos morales e intelectuales, es posible enfocar de nuevo el casuismo con nueva luz, superar las críticas más importantes y comprender que la relación clínica es también una relación jurídica, por lo que el papel del Derecho, y en particular el de la jurisprudencia, se muestra vital. (shrink)

We argue that moral judgment studies currently conducted utilizing virtual reality (VR) devices must confront a dilemma due to how virtual environments are designed and how those environments are experienced. We begin by first describing the contexts present in paradigmatic cases of naturalistic moral judgments. We then compare these contexts to current traditional (vignette-based) and VR-based moral judgment research. We show that, contra to paradigmatic cases, vignette-based and VR-based moral judgment research often fails to accurately model the situational features of (...) paradigmatic moral judgments. In particular, we compare and contrast six recent VR studies to support our view that only simulations high in context-realism and perspectival-fidelity can produce ‘virtually real experiences.’ After analyzing the constituents of a virtually-real experience, we go on to propose guidelines for the creation of VR studies. These guidelines serve two purposes. First, we aim to increase the ecological validity of such studies in order to advance our understanding of moral judgments. Second, we believe that such guidelines should inform how Institutional Review Boards assess VR research. We show that our guidelines are urgently needed given the current lax review standards in place. (shrink)

We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders".

The vast majority of health research resources are used to study conditions that affect a small, advantaged portion of the global population. This distribution has been widely criticized as inequitable and threatens to exacerbate health disparities. However, there has been little systematic work on what individual health research funders ought to do in response. In this article, we analyze the general and special duties of research funders to the different populations that might benefit from health research. We assess how these (...) duties apply to governmental, multilateral, nonprofit, and for-profit organizations. We thereby derive a framework for how different types of funders should take the beneficiaries of research into account when they allocate scarce research resources. (shrink)

Abstract Background The first live birth following the use of a new reproductive technique, maternal spindle transfer (MST), which is a mitochondrial replacement technique (MRT), was accomplished by dividing the execution of the MST procedure between two countries, the USA and Mexico. This was done in order to avoid US legal restrictions on this technique. -/- Sources of data Academic articles, news articles, documents obtained through freedom of information requests, laws, regulations and national reports. -/- Areas of agreement MRTs are (...) new reproductive techniques that present novel ethical and legal challenges, since genetic material from three people is employed to create a child. -/- Areas of controversy Could the first MST procedure that culminated in a live birth negatively impact reproductive medicine in Mexico? -/- Growing points The USA and Mexico need specific and clear legislation on MRTs, in order for such techniques not to be governed by prior existing legislation on assisted reproduction that is inadequate for dealing with the new challenges that these techniques present. -/- Areas timely for developing research There is a pressing need for work to be done on the international governance of new reproductive techniques. (shrink)

In this paper, I aim to demonstrate that the consequences of the current United States health insurance scheme on both physician and patient autonomy is dire. So dire, in fact, that the only moral solution is something other than what we have now. The United States healthcare system faces much criticism at present. But my focus is particular: I am interested in the ways in which insurance interferes with physician and patient autonomy. I will argue in favor of an expansion (...) of the traditional conception of what I call “medical autonomy” or “healthcare autonomy” and the usual role it plays in bioethical discussions. More generally, I show that in morally designing or evaluating any healthcare system, serious attention should be paid to how this system helps foster what I call active autonomy. (shrink)

Narrative medicine explores the stories that patients tell; this paper, conversely, looks at some of the stories that patients are told. The paper starts by examining the ‘story’ told by the Shambaa people of Tanzania to explain the bubonic plague and contrasts this with the stories told by Ghanaian communities to explain lymphatic filariasis. By harnessing insights from memory studies, these stories’ memorability is claimed to be due to their use mnemonic devices woven into stories. The paper suggests that stories (...) can be unpatronising, informative, and appropriate vehicles for communicating medical information to all age groups across all cultures. (shrink)

In his paper ‘A libertarian case for mandatory vaccination’, Jason Brennan argues that even libertarians, who are very averse to coercive measures, should support mandatory vaccination to combat the harmful disease outbreaks that can be caused by non-vaccination. He argues that libertarians should accept the clean hands principle, which would justify mandatory vaccination. The principle states that there is a (sometimes enforceable) moral obligation not to participate in collectively harmful activities. Once libertarians accept the principle, they will be compelled to (...) support mandatory vaccination. In my paper, I argue that the cases Brennan uses to justify this principle are disanalogous to the case of non-vaccination and that they are not compelling to libertarians. The cases Brennan offers can be explained by a libertarian using the individual sufficiency principle: which states that if an individual’s action is sufficient to cause harm, then there is a (sometimes enforceable) moral obligation not to carry out that action. I argue that this principle is more appropriate to Brennan’s examples, and more appealing to the libertarian, than the clean hands principle. In order to get libertarians to accept the clean hands principle, I present a modified version of one of Brennan’s cases that is analogous to the case of non-vaccination. Using this case, I argue that whether the clean hands principle will justify mandatory vaccination is dependent on whether the herd immunity rate in a given population is approaching a threshold after which a collective risk of harm will be imposed onto others. (shrink)

We can read about the morality of that time in works by authors who describe or criticize the conduct and activity of the members of those classes taking the lead in the morality of that time. Thus, we can find a lot of information about ancient Greece and its morality in Plato’s presentation of Socrates, Peter Abelard presenting the Middle Ages, Erasmus of Rotterdam, Niccolo Machiavelli, Baldesar Castiglione, but even also Slovak authors such as Martin Rakovský and Juraj Koppay presenting (...) very interesting contemporary facts about the Renaissance. (shrink)

The author studies the role of Christianity in two forms of 9th century political ethics in the history of Great Moravia, represented by the Great Moravian rulers Rastislav and Svatopluk. Rastislav’s conception predominantly uses the pre-Erasmian model of political ethics based on the pursuit of welfare for the country and its inhabitants by achieving the clerical-political independence of Great Moravia from the Frankish kingdom and, moreover, by utilising Christianity for the advancement of culture, education, literature, law and legality, as well (...) as by spreading Christian ethics and morality in the form of the Christian code of ethics expressed in ethicallegal documents. Svatopluk’s political conception was a prototype of Machiavellian political ethics, according to which one is, in the interest of the country and its power and fame, allowed to be a lion and/or a fox. Svatopluk abused Christianity in the name of achieving his power-oriented goals. Great Moravia outlived Rastislav; it did not, however, outlive Svatopluk, as, shortly after his death, it broke up and ceased to exist. The author came to the conclusion that Rastislav’s conception was more viable, as its cultural heritage lives on in the form of works by Constantine and Methodius. (shrink)

In this commentary on Yashar Saghai's article "Salvaging the Concept of Nudge" (JME 2013) I discuss his distinction between a 'prod' (which is 'substantially controlling') and a 'nudge' (which is ‘substantially non-controlling’).

The prospect of cognitive enhancement well beyond current human capacities raises worries that the fundamental equality in moral status of human beings could be undermined. Cognitive enhancement might create beings with moral status higher than persons. Yet, there is an expressibility problem of spelling out what the higher threshold in cognitive capacity would be like. Nicholas Agar has put forward the bold claim that we can show by means of inductive reasoning that indefinite cognitive enhancement will probably mark a difference (...) in moral status. The hope is that induction can determine the plausibility of post‐personhood existence in the absence of an account of what the higher status would be like. In this article, we argue that Agar's argument fails and, more generally, that inductive reasoning has little bearing on assessing the likelihood of post‐personhood in the absence of an account of higher status. We conclude that induction cannot bypass the expressibility problem about post‐persons. (shrink)

After 41 years from the approval of the first living will law in 1976 in California, on December 22nd 2017 the bill on “Rules on in- formed consent and advance directives” has been approved in Italy. The applicability of the law highlights a lack of a univocal methodol- ogy regarding the recovery process of the patient’s subjective dimension under a testamentary will; so, it seemed useful to highlight the passages that occur between the drafting and the use of an advance (...) directive in an existential phenomenological prospective. Is the individual who freely drafts an A.D., choosing to decide now for the future, the same per- son for which the provisions were outlined? The goal of this paper is to offer an ethical reading of the ontological issue that illness can raises. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

Responding to Danaher et al. on self-tracking technologies, I argue that human lived experience is becoming increasingly mediated by generalized, statistical information, which I term our "infotality." Drawing on the work of Foucault, I argue that infotality is historically novel and best understood as the product of biopolitics, healthism, and informatics. I then critique the authors' "stance of cautious openness,” which misunderstands the aims of the technology in question and the fundamental ambiguity of the role information plays in the achievement (...) of human wellbeing. Self-tracking technologies are not primarily designed to change behavior; they are designed to create and sustain the desire for their use. I conclude by suggesting that infotality names a new way to fall for an old ruse: the promise that more information means more wellbeing. (shrink)

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis (...) of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies. (shrink)

Ce dossier traite du concept de responsabilité en tant qu‘il constitue l‘une des bases d‘une réflexion éclairée en ce qui concerne les enjeux éthiques engen- drés par les biotechnologies. Qu‘entend-on par le concept de responsabilité ? L‘être humain est-il responsable des artéfacts qu‘il crée ? Si oui, de quel type de responsabilité s‘agit-il ? N‘est-elle que d‘ordre juridique ? Ou également d‘ordre éthique ou morale ? Comment et qui détermine l‘acceptation ou le re- fus des possibilités que nous offrent les (...) biotechnologies ? Qui est respon- sable des innovations produites par les découvertes des scientifiques, et à l‘égard de qui ? (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

G. E. Moore’s critical analysis of right action in utilitarian ethics and his consequentialist concept of right action is a starting point for a theory of moral/right action in ethics of social consequences. The terms right and wrong have different meanings in these theories. The author explores different aspects of right and wrong actions in ethics of social consequences and compares them with Moore’s ideas. He positively evaluates Moore’s contributions to the development his theory of moral/right action.

[Excerpt]: Bioethics has an uneasy relationship with embodiment. Only with vigilance does knowledge of the body as it is lived counterbalance the momentous inertia of knowledge of the body as an object brought about by modern medical sciences. As a field tethered to detached, technical ways of knowing the world, bioethics must toil to treat the body as more than mere material and machine. To be more is, among other things, to be social—to live in the thickets of interdependence and (...) the institutions and practices we build, hone, and defend to facilitate it. I take this tension to define the ultimate stakes of Melinda Hall's The Bioethics of Enhancement: Transhumanism, Disability, and Biopolitics. Hall homes in on transhumanism, the idea that we should embrace technology to vault beyond current human limitations. Yet the work serves as a reminder for all bioethicists and philosophers of how easily one can be led astray by otherwise irreproachable values when they are disconnected from the conditions and realities of human life, including being irremediably interdependent embodied beings. Put more acerbically, the book is a reminder of how thinking goes wrong when divorced from the principal sources out of which human appraisals emerge: our fleshy, messy, social bodies. (shrink)

A number of health care professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone; nor should they suffer any undesirable consequences of such refusal. Those who claim this right err by blurring or conflating three (...) issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true: a conscientious professional should not do her professional duty AND others need not permit or excuse her refusal. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt for that failure. Finally, there are compelling reasons why we could not implement a consistent moral policy giving advocates what they want, likely not even in qualified form. (shrink)

This article engages with debates concerning the moral worth of human beings with profound intellectual and multiple disabilities (PIMDs). Some argue that those with such disabilities are morally less valuable than so-called normal human beings, whereas others argue that all human beings have equal moral value and so each group of humans ought to be treated with equal concern. We will argue in favor of a reconciliatory view that takes points from opposing camps in the debates about the moral worth (...) of humans with PIMDs. The view in question, roughly, is this: most humans with PIMDs are persons in the morally significant sense and so deserve equal moral consideration to so-called normal human beings. Some humans with PIMD may not, however, be persons, but nevertheless deserve equal moral consideration to persons because they stand in a special relation to persons. (shrink)

This paper explores the position that moral enhancement interventions could be medically indicated in cases where they provide a remedy for a lack of empathy, when such a deficit is considered pathological. In order to argue this claim, the question as to whether a deficit of empathy could be considered to be pathological is examined, taking into account the difficulty of defining illness and disorder generally, and especially in the case of mental health. Following this, Psychopathy and a fictionalised mental (...) disorder are explored with a view to consider moral enhancement techniques as possible treatments for both conditions. At this juncture, having asserted and defended the position that moral enhancement interventions could, under certain circumstances, be considered medically indicated, this paper then goes on to briefly explore some of the consequences of this assertion. First, it is acknowledged that this broadening of diagnostic criteria in light of new interventions could fall foul of claims of medicalisation. It is then briefly noted that considering moral enhancement technologies to be akin to therapies in certain circumstances could lead to ethical and legal consequences and questions, such as those regarding regulation, access, and even consent. (shrink)

En este artículo expondré un análisis de la valoración negativa de las consecuencias que suelen atribuirse al fenómeno de la medicalización y, partiendo de aquí, mi objetivo básico será mostrar que la medicalización no es en sí mismo un fenómeno negativo. Sólo lo será cuando se obtenga un valor negativo del cálculo entre, por un lado, la efectividad de la propuesta médica para solucionar el problema y, por otro lado, el balance entre los beneficios de dicha propuesta médica y sus (...) posibles efectos secundarios; o bien, cuando se dé un contexto en el que el individuo, ya sea por desinformación o por una restricción externa (paternalismo médico), no tiene la libertad suficiente de escoger entre una propuesta médica y una propuesta no-médica. (shrink)

In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient (...) weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally. (shrink)

Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such “population engineering” proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it (...) fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty. (shrink)

In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that do not (...) allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility. (shrink)

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that must be observed in (...) an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

The once animated efforts in medical phenomenology to integrate the art and science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based medicine (...) has refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine. (shrink)