The management of patients suffering from chronic disorders of consciousness inevitably raises important ethical questions about the end of life decisions. Some ethical positions claim respect of human life sacredness and the use of good medical practices require allowing DOC patients to live as long as possible, since no one can arbitrarily end either his/her or others’ life. On the other hand, some currents of thought claim respect of human life dignity, patients’ wishes, and the right of free choice entail (...) allowing the withdrawal of life sustaining therapy. This could happen when patients believe their own life to be not worth living, or if therapy is not very beneficial, excessively burdensome, or even futile. Indeed, the decision to withdraw therapies in a DOC patient should be guided by reliable information about DOC diagnosis and prognosis and on how the patient would wish to be treated in such a condition. Taking into account such issues, it would be possible to make the decision that more adequately fits a DOC patient’s best interest. This review aims to overview the range of ethical issues referring to end-of-life decisions in DOC patients, with regard to the thorny debate on the sacredness and dignity of human life. (shrink)

For about five decades the phrase "sanctity-of-life" has been part of the Anglo-American biomedical ethical discussion related to abortion and end-of-life questions. Nevertheless, the concept's origin and meaning are unclear. Much controversy is based on the mistaken assumption that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. In this paper, I offer an analysis of the religious and philosophical history of the idea of "sanctity-of-life." Drawing on biblical texts (...) and interpretation as well as Kant's secularization of the concept, I argue that "sanctity" has been misunderstood as an ontological feature of biological human life, and instead locate the idea within the historical virtue-ethical tradition, which understands sanctification as a personal achievement through one's own actions. (shrink)

For about five decades the phrase “sanctity-of-life“ has been part of the Anglo-American biomedical ethical discussion related to abortion and end-of-life questions. Nevertheless, the concept’s origin and meaning are unclear. Much controversy is based on the mistaken assumption that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. In this paper, I offer an analysis of the religious and philosophical history of the idea of “sanctity-of-life.” Drawing on biblical texts (...) and interpretation as well as Kant’s secularization of the concept, I argue that “sanctity” has been misunderstood as an ontological feature of biological human life, and instead locate the idea within the historical virtue-ethical tradition, which understands sanctification as a personal achievement through one’s own actions. (shrink)

The 1992 incorporation of an article by referendum in the SwissConstitution mandating that the federal government issue regulations onthe use of genetic material that take into account the dignity ofnonhuman organism raises philosophical questions about how we shouldunderstand what is meant by ``the dignity of nonhuman animals,'' andabout what sort of moral demands arise from recognizing this dignitywith respect to their genetic engineering. The first step in determiningwhat is meant is to clarify the difference between dignity when appliedto humans and (...) when applied to nonhumans. Several conceptions of humandignity should be rejected in favor of a fourth conception: the rightnot to be degraded. This right implies that those who have it have thecognitive capacities that are prerequisite for self-respect. In the caseof nonhuman organisms that lack this capacity, respecting their dignityrequires the recognition that their inherent value, which is tied totheir abilities to pursue their own good, be respected. This value isnot absolute, as it is in the case of humans, so it does not prohibitbreeding manipulations that make organisms more useful to humans. But itdoes restrict morally how sentient animals can be used. In regard togenetic engineering, this conception requires that animals be allowedthe uninhibited development of species specific functions, a positionshared by Holland and Attfield, as opposed to the Original Purposeconception proposed by Fox and the Integrity of the Genetic Make-upposition proposed by Rolston. The inherent value conception of dignity,as here defended, is what is meant in the Swiss Constitution article. (shrink)

The COVID-19 pandemic brings up unprecedented challenges. Healthcare practitioners find themselves in an extraordinary, wartime-like situation and are obliged to apply triage on a daily basis. In this context, routine procedures prove insufficient and the redefinition of ethical practice guidelines becomes a necessity – leading not only to a shift in procedures, but also reshaping the very value of human life. This, in turn, triggers an axiological crisis, which exacerbates the tension between paradigms of sanctity and quality of life and (...) the conflicting principles of egalitarianism and utilitarianism. Triage should not be limited to healthcare practice only: the concept can be extended to a macro-level where policymakers decide whether to prioritize human lives over livelihoods and economic health, impacting healthcare system capacity. The complexity of the challenges arising from the pandemic uncovers the urgent need to seek solutions from an integrated approach. In this paper, we offer a transdisciplinary view: we first define technical aspects of triage from the perspective of a healthcare professional. In the second part, we further analyze the problem of medical prioritization in the light of doctrinal findings related to the value of human life, and we show how and to what extent this philosophical debate is reflected in the emerging ethical guidelines in France, Spain, Italy, Belgium, Germany and Austria. Finally, we broaden the concept of triage, adding the “macro-economic” ingredient in our analysis and we present the results for selected European countries with special emphasis on the case of Poland. (shrink)

With dying increasingly becoming a medicalised experience in old age, we are witnessing a shift from concern over death itself to an interest in dying ‘well’. Fierce discussions about end-of-life decision making and the permissibility of medical intervention in dying, discursively structured around the notion of a ‘good’ death, are evidence of this shift. This article focuses on ‘autonomy’ and ‘dignity’ as key signifiers in these discussions. Rather than being fully fixed and stable, both signifiers are contingent and carry a (...) variety of meanings within different discursive projects. The article aims to distinguish the varieties of these signifiers by elaborating existing theoretical perspectives on autonomy and dignity, and also, starting from a perspective on mass media as sites of meaning production and contestation, to study the contingency of autonomy and dignity in Belgian newspaper coverage of four prominent euthanasia cases. By means of a discourse-theoretical textual analysis, this study exposes a dominant—yet contested—articulation of rational-personal autonomy and of dignity in external terms as something that can be obtained, retained or lost, rather than in terms of intrinsic human integrity. These logics of representation reflect a more general late modern dominance of liberal autonomy and of dignity as being closely connected to self-identity, but at the same time result in limited visibility of alternative ways of experiencing an autonomous and dignified death. (shrink)

With dying increasingly becoming a medicalised experience in old age, we are witnessing a shift from concern over death itself to an interest in dying ‘well’. Fierce discussions about end-of-life decision making and the permissibility of medical intervention in dying, discursively structured around the notion of a ‘good’ death, are evidence of this shift. This article focuses on ‘autonomy’ and ‘dignity’ as key signifiers in these discussions. Rather than being fully fixed and stable, both signifiers are contingent and carry a (...) variety of meanings within different discursive projects. The article aims to distinguish the varieties of these signifiers by elaborating existing theoretical perspectives on autonomy and dignity, and also, starting from a perspective on mass media as sites of meaning production and contestation, to study the contingency of autonomy and dignity in Belgian newspaper coverage of four prominent euthanasia cases. By means of a discourse-theoretical textual analysis, this study exposes a dominant—yet contested—articulation of rational-personal autonomy and of dignity in external terms as something that can be obtained, retained or lost, rather than in terms of intrinsic human integrity. These logics of representation reflect a more general late modern dominance of liberal autonomy and of dignity as being closely connected to self-identity, but at the same time result in limited visibility of alternative ways of experiencing an autonomous and dignified death. (shrink)

Zusammenfassung. In der Auseinandersetzung um die Frage, ob aktive Sterbehilfe mit dem ärztlichen Ethos vereinbar ist, werden häufig deskriptive Unterscheidungen wie Tun vs. Unterlassen, aktiv vs. passiv oder auch intendieren vs. in Kauf nehmen benutzt, um eine kategorische moralische Differenz zwischen Töten und Sterbenlassen auszuweisen. Als zusätzliche Schwierigkeit erweist sich dabei zum einen, daß zentrale Begriffe zwischen einer deskriptiven und einer ethischen Bedeutung changieren, und zum anderen, daß die Kennzeichnung des Problems (z.B. Sterbehilfe) selbst ethisch nicht neutral ist. Nach der (...) Entwicklung einer ethisch neutralen Problemstellung werden kategorische Argumente gegen die ethische Zulässigkeit aktiver Sterbehilfe diskutiert und verworfen. Anschließend werden Begründungen diskutiert, die mittels intrinsischer oder extrinsischer Situationsmerkmale eine ethische Unzulässigkeit aktiver Sterbehilfe aufzuweisen versuchen. Dabei zeigt sich, daß graduelle ethische Unterschiede zwischen passiver, indirekt und direkt aktiver Sterbehilfe begründbar sind, die ein jeweils höheres Maß an Rechtfertigungsgründen erfordern. (shrink)

This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account (...) of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics. (shrink)