Many arguments have been made against gene editing. This paper addresses the commonly invoked argument that gene editing violates human dignity and is ultimately a subversion of human nature. There are several drawbacks to this argument. Above all, the concept of what human dignity means is unclear. It is not possible to condemn a practice that violates human dignity if we do not know exactly what is being violated. The argument’s entire reasoning is thus undermined. Analyses of the arguments involved (...) in this discussion have often led to the conclusion that gene editing contravenes the principle of genetic identity (genetic immutability) thereby subverting a requisite of human dignity and ultimately threatening human nature. This paper refutes these arguments and shows that any opposition to gene editing cannot rely on the human dignity argument. (shrink)

The principle of respect for human dignity plays a crucial role in the emerging global norms relating to bioethics, in particular in the UNESCO Universal Declaration on Bioethics and Human Rights. This instrument, which is a legal, not merely an ethical document, can be regarded as an extension of international human rights law into the field of biomedicine. Although the Declaration does not explicitly define human dignity, it would be a mistake to see the emphasis put on this notion as (...) a mere rhetorical strategy. Rather, the appeal to dignity reflects a real concern about the need to promote respect both for the intrinsic worth of human beings and for the integrity of the human species. But dignity alone cannot solve most of the dilemmas posed by biomedical practice. This is why international biolaw combines, on the one hand, the appeal to human dignity as an overarching principle with, on the other hand, the recourse to human rights, which provide an effective and practical way forward for dealing with bioethical issues at a global level. (shrink)

The argument of this article is that the dual-nature thesis is not only capable of solving the problem of legal positivism, but also addresses all fundamental questions of law. Examples are the relation between deliberative democracy and democracy qua decision-making procedure along the lines of the majority principle, the connection between human rights as moral rights and constitutional rights as positive rights, the relation between constitutional review qua ideal representation of the people and parliamentary legislation, the commitment of legal argumentation (...) to both authoritative and non-authoritative reasons, and the distinction between rules as expressing a real “ought” and principles as expressing its ideal counterpart. All of this underscores the point that the dual nature of law is the single most essential feature of law. (shrink)

The concept of dignity is pervasive in bioethics. However, some bioethicists have argued that it is useless on three grounds: that it is indeterminate; that it is reactionary; and that it is redundant. In response, a number of defences of dignity have recently emerged. All of these defences claim that when dignity is suitably clarified, it can be of great use in helping us tackle bioethical controversies. This paper rejects such defences of dignity. It outlines the four most plausible conceptions (...) of dignity: dignity as virtuous behaviour; dignity as inherent moral worth; Kantian dignity; and dignity as species integrity. It argues that while each conception is coherent, each is also fundamentally flawed. As such, the paper argues for a bioethics without dignity: an 'undignified bioethics.'. (shrink)

Why should all human beings have certain rights simply by virtue of being human? One justification is an appeal to religious authority. However, in increasingly secular societies this approach has its limits. An alternative answer is that human rights are justified through human dignity. This paper argues that human rights and human dignity are better separated for three reasons. First, the justification paradox: the concept of human dignity does not solve the justification problem for human rights but rather aggravates it (...) in secular societies. Second, the Kantian cul-de-sac: if human rights were based on Kant’s concept of dignity rather than theist grounds, such rights would lose their universal validity. Third, hazard by association: human dignity is nowadays more controversial than the concept of human rights, especially given unresolved tensions between aspirational dignity and inviolable dignity. In conclusion, proponents of universal human rights will fare better with alternative frameworks to justify human rights rather than relying on the concept of dignity. (shrink)

The central argument of this article turns on the dual‐nature thesis. This thesis sets out the claim that law necessarily comprises both a real or factual dimension and an ideal or critical dimension. The dual‐nature thesis is incompatible with both exclusive legal positivism and inclusive legal positivism. It is also incompatible with variants of non‐positivism according to which legal validity is lost in all cases of moral defect or demerit (exclusive legal non‐positivism) or, alternatively, is affected in no way at (...) all by moral defects or demerits (super‐inclusive legal non‐positivism). The dual nature of law is expressed, on the one hand, by the Radbruch formula, which says that extreme injustice is not law, and, on the other, by the correctness argument, which says that law's claim to correctness necessarily includes a claim to moral correctness. Thus, what the law is depends not only on social facts, but also on what the law ought to be. (shrink)

The concept of dignity is notoriously vague. In this paper it is argued that the reason for this is that there are three versions of dignity that are often confused. First we will take a short look at the history of the concept of dignity in order to demonstrate how already from Roman Antiquity two versions of dignity can be distinguished. Subsequently, the third version will be introduced and it will be argued that although the three versions of dignity hang (...) together, they should also be clearly distinguished in order to avoid confusion. The reason for distinguishing the three versions is because all three of them are only partially effective. This will be demonstrated by taking the discussion about voluntary ‘dying with dignity’ as an example. Inspired by both Paul Ricoeur’s concept of ethics and the ethics of care a proposition will be done as to how the three versions of dignity may sustain each other and help achieve what neither one of the versions can do on its own. (shrink)

Does human enhancement threaten our dignity as some prominent commentators have asserted? Or could our dignity perhaps be technologically enhanced? After disentangling several different concepts of dignity, this essay focuses on the idea of dignity as a quality, a kind of excellence admitting of degrees and applicable to entities both within and without the human realm. I argue that dignity in this sense interacts with enhancement in complex ways which bring to light some fundamental issues in value theory, and that (...) the effects of any given enhancement must be evaluated in its appropriate empirical context. Yet it is possible that through enhancement we could become better able to appreciate and secure many forms of dignity that are overlooked or missing under current conditions. I also suggest that in a posthuman world, dignity as a quality could grow in importance as an organizing moral/aesthetic idea. (shrink)

In this review of Leon Kass’s Life, liberty and the defense of dignity and Deryck Beyleveld and Roger Brownsword’s Human dignity in bioethics and biolaw. I consider the prospects for a theory of dignity as a basis for bioethics research. I argue that dignity theories are worth exploring in more detail, but that research needs to consider both “antitheory” accounts of the language of bioethics, and to give more weight to accounts of dignity as an outcome of holding positive liberties (...) and as something that has a psychological dimension. (shrink)

This book offers a unique and insightful analysis of Western and Middle Eastern concepts of dignity and illustrates them with examples of everyday life. Dignity in the 21st Century - Middle East and West is unique and insightful for a range of reasons. First, the book is co-authored by scholars from two different cultures (Middle East and West). As a result, the interpretations of dignity covered are broader than those in most Western publications. Second, the ambition of the book is (...) to use examples from everyday life and fiction to debate a range of dignity interpretations supplemented by philosophical and theological theories. Thus, the book is designed to be accessible to a general readership, which is further facilitated because it is published with full open access. Third, the book does not defend one superior theory of dignity, but instead presents six Western approaches and one based on the Koran and then asks whether a common essence can be detected. -/- The answer to the question whether a common essence can be detected between the Koranic interpretation of dignity and the main Western theories (virtue, Kant) is YES. The essence can be seen in dignity as a sense of self-worth, which persons have a duty to develop and respect in themselves and a duty to protect in others. The book ends with two recommendations. First, given the 7 concepts of dignity introduced in the book, meaningful dialogue can only be achieved if conversation partners clarify which variation they are using. Second, future collaborations between philosophers and psychologists might be helpful in moving theoretical knowledge on dignity as a sense of self-worth into practical action. The “scourges” of a sense of self-worth and dignity are identified by psychologists as violence, humiliation, disregard and embarrassment. To know more about how these can be avoided from psychologists, is helpful when protecting a sense of self-worth in others. (shrink)

MMA fighting in a competition is not necessarily wrong and is often, as far as we can tell, permissible. Our argument has two premises. First, if an act does not infringe on anyone’s moral right or violate another side-constraint, then it is morally permissible. Second, MMA-violence does not infringe on anyone’s moral right or violate another side-constraint. The first premise rested on two assumptions. First, if a person does a wrong act, then he wrongs someone. Second, if one person wrongs (...) a second, then the first infringes on the second’s right. We then looked at Nicholas Dixon’s powerful Kantian argument that MMA fighting is wrong. (shrink)

Shortages in the number of donated organs after death and the growing number of end-stage organ failure patients on waiting lists call for looking at alternatives to increase the number of organs that could be used for transplantation purposes. One option that has led to a legal and ethical debate is to have regulated markets in human organs. Opponents of a market in human organs offer different arguments that are mostly founded on contingent factors that can be adjusted. However, some (...) authors have asked the question whether we still have a reason to believe that there is something wrong with offering human organs for sale for transplantation purposes, even if the circumstances under which the practice takes place are improved. One prominent argument regarding this appeals to the notion of human dignity. It is argued that organ selling violates human dignity. This paper presents a systematic discussion of dignity-based arguments in the organ selling debate, and then develops a social account of dignity. It is argued that allowing the practice of organ selling inherently runs the risk of promoting the notion that some persons have less worth than others and that persons have a price, which is incompatible with dignity. The approach is defended against possible objections and it is shown that it can capture the notion that autonomy is linked to human dignity in important ways, while dignity at the same time can constrain the autonomous choices of persons with regards to certain practices. (shrink)

The main purpose of this paper is to clarify some senses of dignity that are particularly relevant for the treatment and care of the elderly. I make a distinction between two quite different ideas of dignity, on the one hand the basic kind of dignity possessed by every human being, and on the other hand the dignity which is the result of a person's merits, whether these be inherited or achieved. Common to both these ideas is that having a dignity (...) entails having a set of rights, in the case of basic dignity the set of rights which we call human rights, the rights which the United Nations, among others, has tried to determine. The dignities of merit also provide some rights, although normally rights with limited scope covering, for instance, a professional area. This observation gives my preliminary answer to the fundamental question of what distinguishes dignity from other high values that could be attached to humans. I discuss further a kind of value that might be mistaken for a kind of dignity, viz. what I call public status. This status is to be distinguished from social status (the status of e.g. kings, governors, and officials) that I take to be a proper dignity of merit. The public status is the status gained solely via public perception and not directly via any merits on the part of the dignified. Finally, I turn to the topic of the dignity of the elderly and try to determine whether there is some dignity peculiar to the elderly, and which is over and above the basicMenschenwrde. My two preliminary proposals are the following: the elderly have a dignity of wisdom and they have a highly general dignity of merit, which results from their life-long efforts and achievements, and for this they deserve our gratitude. (shrink)

This article examines the nature of human dignity against the background of old age and introduces the novel idea of treating human dignity as a formal principle related to the more foundational notion of indignity. The discussion starts with the objection that the notion of human dignity can be used to justify contrary positions and is therefore inconclusive. This pitfall can be averted by appealing to the notion of indignity rather than dignity in one's moral reasoning and decision‐making. Cases of (...) indignity are more primary and indicate the violation of the very core of a human being. The verifiable property of vulnerability is central to this identification of indignity, as is illustrated by reference to the experiences of elderly people. The article argues for applying the concept of human dignity to reverse the conditions that existed before a particular indignity emerged, rather than trying to define positively the notion of human dignity in the first place. (shrink)

In the debate between positivism and non-positivism the argument from relativism plays a pivotal role. The argument from relativism, as put forward, for instance, by Hans Kelsen, says, first, that a necessary connection between law and morality presupposes the existence of absolute, objective, or necessary moral elements, and, second, that no such absolute, objective, or necessary moral elements exist. My reply to this is that absolute, objective, or necessary moral elements do exist, for human rights exist, and human rights exist (...) because they are justifiable. (shrink)

Alan Gewirth’s claim that agents contradict that they are agents if they do not accept that the principle of generic consistency (PGC) is the supreme principle of practical rationality has been greeted with widespread scepticism. The aim of this article is not to defend this claim but to show that if the first and least controversial of the three stages of Gewirth’s argument for the PGC is sound, then agents must interpret and give effect to human rights in ways consistent (...) with the PGC, or deny that human beings are equal in dignity and rights (which idea defines human rights) or that they are agents (and hence subject to any rules at all). Implications for the interpretation of the international legal system of human rights inspired by the Universal Declaration of Human Rights 1948 are sketched. (shrink)

For some decades, the concept of human dignity has been widely discussed in bioethical literature. Some authors think that this concept is central to questions of respect for human beings, whereas others are very critical of it. It should be noted that, in these debates, dignity is one component of a long-lasting and widespread conceptual construct used to support a stance on the ethical question of the moral status of an action or being. This construct has been used from Modernity (...) onward to condemn slavery and torture as violations of human dignity. In spelling it out, we can come to a better understanding of what “dignity” means and become aware that there exists a quite useful place for this notion in our ethical thought, albeit a modest one. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

In this chapter, the focus is on robotics development and its ethical implications, especially on some particular applications or interaction principles. In recent years, such developments have happened very quickly, based on the advances achieved in the last few decades in industrial robotics. The technological developments in manufacturing, with the implementation of Industry 4.0 strategies in most industrialized countries, and the dissemination of production strategies into services and health sectors, enabled robotics to develop in a variety of new directions. Policy (...) making and ethical awareness addressed these issues using socio-economic knowledge and also in an effort to solve some of the application problems raised in a range of different circumstances and sectoral environments. (shrink)

Human dignity is one of the key concepts of our ethical evaluations, in politics, in biomedicine, as well as in everyday life. In moral philosophy, however, human dignity is a source of intractable trouble. It has a number of characteristic features which apparently do not fit into one coherent ethical concept. Hence, philosophers tend to ignore or circumvent the concept. There is hope for a philosophically attractive conception of human dignity, however, given that one takes three crucial turns. The negative (...) turn: to start the inquiry with violations of human dignity. The inductive turn: to consider the whole range of applications of the concept of human dignity in different areas of ethics. And finally, the historical turn: to take into account the historical bonds between human dignity and traditional conceptions of dignity. Taken together they point in the direction of an understanding of human dignity as universal nobility. (shrink)

The concept of dignity has occasioned a robust conversation in recent healthcare scholarship. When viewed as a whole, research on dignity in healthcare has engaged each of the four bioethical principles popularized by Beauchamp and Childress, but has paid the least attention to beneficence. In this paper, we look at dignity and beneficence. We focus on the dignity promotion component of a model of dignity derived from a grounded theory study. After describing the study and presenting a précis of the (...) resulting model, we review the principle of beneficence and look at the ways in which the notion of dignity promotion can be used to complement our understanding of this principle. Specifically, we explore what we can learn from dignity promotion about the relational nature of beneficence in healthcare and how dignity promotion can be marshaled to help address the epistemological quandary of soft paternalism. (shrink)

Two claims lay the foundation for Beyleveld and Brownsword’s legal theory. The first says that immoral laws cannot be law, the second that rights to freedom and welfare can be proven to be logically necessary given merely the phenomenon of agency. The author argues that both claims are too strong. The first is an overidealization of law, which fails to do justice to its double nature as a real as well as an ideal phenomenon. The second must fail, for a (...) moral “ought” cannot be deduced from a merely instrumental “ought.”. (shrink)

It is tempting to argue that Kantian moral philosophy justifies prohibiting both human germ-line genetic engineering and non-therapeutic genetic engineering because they fail to respect human dignity. There are, however, good reasons for resisting this temptation. In fact, Kant’s moral philosophy provides reasons that support genetic engineering—even germ-line and non-therapeutic. This is true of Kant’s imperfect duties to seek one’s own perfection and the happiness of others. It is also true of the categorical imperative. Kant’s moral philosophy does, however, provide (...) limits to justifiable genetic engineering. (shrink)

Ethical principles are fundamental for the exercise of any profession. Portuguese psychologists have waited for 30 years for professional validation. This paper will define the Portuguese psychologists’ ethical principles, with a universal view as a starting point and then an adaptation to the cultural and professional reality in Portugal. The level of acceptability of these principles will be ascertained in a later paper.

This paper targets an orphan topic in research ethics, namely the so called principle of the primacy of the human being, which states that the interests of the human subject should always take precedence over the interests of science and society. Although the principle occupies the central position in the majority of international ethical and legal standards for biomedical research, it has been commented in the literature mainly in passing. With a few notable exceptions, there is little in-depth discussion about (...) the meaning and role of the principle. Several authors note that the principle is vogue, ambiguous and apparently conflicting with the accepted practice of conducting non-beneficial research on individuals unable to give consent. There are opinions that it is just “a vacuous figure of speech” and should be abandoned. This paper argues that the primacy principle is far from being “a vacuous figure of speech”, rather it should be seen as a threefold concept: a fundamental interpretative rule, a procedural rule, and a substantive rule aimed at protecting research subjects from instrumental treatment and unacceptable risks. This interpretation tracks back to the principle regulatory and normative origins in the Declaration of Helsinki of 1975, but also acknowledges changes in research ethics and practice, which took place at the turn on the twentieth and twenty-first centuries. Thus, the proposed reading of the principle is not only original, but also historically grounded and normatively fruitful. It provides a fresh and ethically rich perspective on extensively debated, but still controversial problem of an upper limit of permissible risks in non-beneficial studies. (shrink)

Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons in minimally conscious state (...) remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity. (shrink)

Elite sport is both worshipped disparaged. It is adored because athletes embody an ethical act of courage, self-sacrifice and fair play; it is criticized for too many scandals that plague and discredit it. Too often, athletes seem trapped in and crushed by a system much bigger than they are, a system that also compels them to do wrong, in a way that seems to instrumentalize them. But what is the real status of elite athletes? Does the system treat them with (...) dignity in a manner that allows them to accept freely and voluntarily the end purpose of the record to be beaten that demands enormous sacrifices? This article considers how an analysis of the concept of human dignity can help us better understand the place of the athlete in this complex reality of elite sport. (shrink)

This paper contends that the conventional ethical and legal ways of analysing the wrong involved in the misuse of human body parts are inadequate, and should be replaced with an analysis based on human dignity. It examines the various ways in which dignity has been understood, outlines many of the criticisms made of those ways , and proposes a new way of seeing dignity which is exegetically consonant with the way in which dignity has been historically understood, and yet avoids (...) the pitfalls which have led to dignity being dismissed by many as hopelessly amorphous or incurably theological. The account of dignity proposed is broadly Aristotelian. It defines dignity in terms of human thriving, and presupposes that it is possible, at least in principle, to determine empirically what makes humans thrive. It contends that humans are quintessentially relational animals, and that it is not possible to define humans as atomistic entities. One important corollary of this is that when using dignity/thriving as a criterion for determining the ethical acceptability of a proposed action or inaction, one should ask not merely how the dignity interests of the patient would be affected, but how the dignity interests of all stakeholders would be affected. The business of ethics is then the business of auditing all those interests, and determining the course of action which would maximise the amount of thriving in the world. (shrink)

In this paper we advance inquiry into human dignity in relation to the theory and practice of social entrepreneurship and innovation in a two-fold manner. First, we explore how concepts from the literatures of human dignity and humanistic management can inform and enrich social entrepreneurship and innovation. Second, we examine case studies of social entrepreneurship and innovation to refine how we think about and operationalize notions of human dignity. In this way, we connect human dignity research more closely to alternative (...) life-conducive forms of organizing. Our goals are to advance an understanding of human dignity and to make this concept more accessible and relevant in business and management, as well as to explore how the practice of social entrepreneurship and innovation can both enrich and be enriched by the notion of human dignity. Third, we draw on the emerging literature of humanistic management to generate a classification system in the context of social innovation that specifies how organizing can contribute to dignity restoration, dignity protection, and dignity promotion. We elaborate and showcase paradigmatic cases, probe the limits of these cases for future research, and consider how to extend this dignity organizing model to other modes of business practice, such as the notion of value creation. Fourth, we outline an emerging research agenda for those interested in connecting innovation and organizing practices writ large with the notion of human dignity. (shrink)

This paper presents a sketch of the way in which an ideal-typical community of rights, Gewirthia, responds to the so-called “internal problem of authority.” Notwithstanding the deep moral consensus in Gewirthia, where citizens are fully committed to the Principle of Generic Consistency (requiring that agents respect one another’s freedom and basic well-being), Gewirthians make no claim to “know all the answers.” In consequence, public governance in Gewirthia needs a strategy for dealing with the many kinds of disputes—disputes that relate to (...) matters of both principle and practice—that require authoritative settlement. In this context, having outlined the nature of (and justification for) the procedural strategy that Gewirthia adopts in order to resolve such disputes, we discuss the range of regulatory questions that are potentially moot in Gewirthia, and focus on three hard cases in which the State might argue for a precautionary licence—namely, where there is a dispute about indirect and speculative harm to rights-holders, about harm to arguable rights-holders, and about the possible corrosion of the conditions that are essential for the sustainability of a moral community. (shrink)

The aim of this paper is to provide a preliminary defence of the use of the concept of dignity in legal and ethical discourse. This will involve the application of three philosophical insights: (1) Ludwig Wittgenstein’s notion of language-games; (2) his related approach to understanding the meanings of words (sometimes summarised as ‘meaning is use’); and (3) Jeremy Waldron’s layered understanding of property wherein ‘property’ consists in an abstract concept fleshed out in numerous particular conceptions. These three insights will be (...) applied, in the first place, to the concept of ‘dignity’, which is chosen here as a good example of a concept which is both vague and contested in legal and ethical discourse, but which can nevertheless be rendered workable by the application of the aforementioned insights. Later, the analysis will be extended briefly to some other troublesome concepts in order to demonstrate its general application. This paper is concerned primarily with formal, rather than substantive questions about dignity. Matters of content will be touched on only insofar as is necessary to illustrate and illuminate my argument about how we ought to approach (rather than answer) questions about dignity. It should be emphasised that because there is no intention of exploring substantive questions in any depth, the discussion here will not delve into the criticisms of ‘speciesism’ often levelled against the idea of ‘human dignity’. ‘Speciesist’ theories are those that claim that the status, value, or rights of human beings can be regarded as being higher than that of other animals, purely on the basis of their membership of the human species, and without justifying the distinction by pointing to any relevant capacity or characteristic possessed by all and only human beings. For a critical description of speciesism see, e.g., Singer [18] Chapter Three passim; for present purposes, the term ‘dignity’ will be used synonymously with ‘human dignity’, and concerns about speciesism will not be considered. (shrink)

This paper is focused on the analysis of two documents (the Council of Europe's Bioethics Convention and the Additional Cloning Protocol) inasmuch as they refer to the relationship between human dignity and human genetic engineering. After presenting the stipulations of the abovementioned documents, I will review various proposed meanings of human dignity and will try to identify which of these seem to be at the core of their underlying assumptions. Is the concept of dignity proposed in the two documents coherent? (...) Is it morally legitimate? Is it, as some might assume, of Kantian origin? Does it have any philosophical roots? (shrink)

While “dignity” plays an increasingly important role in contemporary moral and political debates, there is profound dispute over its definition, meaning, and normative function. Instead of concluding that dignity’s elusiveness renders it useless, or that it signals its fundamental character, this paper focuses on illuminating one particular strand of meritocratic dignity. It introduces a number of examples and conceptual distinctions and argues that there is a specific strand of “expressive” meritocratic dignity that is not connected to holding a special office (...) or rank, but that is ascribed to individuals who are able to engage in autonomous self-expression. (shrink)

This paper, guided by the UNESCO Universal Declaration on Bioethics and Human Rights, assumes that regulators should aim to support the development of nanomedicine while, at the same time, putting in place whatever limits or safeguards are indicated by ethical considerations. Relative to this regulatory objective, it is argued that, notwithstanding the importance of precaution (characteristically, concerning health, safety, and the environment), ethical reflection needs to go both broader and deeper. It is suggested that, by attending to the basic matrix (...) of ethical debate and the “bioethical triangle” through which the matrix is currently articulated, the breadth, depth, and conflictual plurality of ethical concerns about nanomedicine will be clarified. In this light, the conventional thinking about precaution is revisited and concerns about human dignity and informed consent (under conditions of extreme uncertainty) are analysed. The paper concludes that, once the range of ethical pluralism is grasped, the extent of the challenge facing regulators will be more clearly appreciated. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

A ‘Ulysses arrangement’ (UA) is an agreement where a patient may arrange for psychiatric treatment or non-treatment to occur at a later stage when she expects to change her mind. In this article, I focus on ‘competence-insensitive’ UAs, which raise the question of the permissibility of overriding the patient’s subsequent decisionally competent change of mind on the authority of the patient’s own prior agreement. In “The Ethical Justification for Ulysses Arrangements”, I consider sceptical and supportive arguments concerning competence-insensitive UAs, and (...) argue that there are compelling reasons to give such UAs serious consideration. In “Decisional Competence and Legal Capacity in UAs”, I examine the nature of decisional competence and legal capacity as they arise in UAs, an issue neglected by previous research. Using the distinctions which emerge, I then identify the legal structure of a competence-insensitive UA in terms of the types of legal capacity it embodies and go on to explain how types of legal capacity might be shared between the patient and a trusted other to offer support to the patient in the creation and implementation of a competence-insensitive UA. This is significant because it suggests possibilities for building patient support mechanisms into models of legal UAs, which has not addressed in the literature to date. Drawing on this, in “Using Insights from the Competence/Capacity Distinction to Enhance Patient Support in UAs”, I offer two possible models to operationalize competence-insensitive UAs in law that allow for varying degrees of patient support through the involvement of a trusted other. Finally, I outline some potential obstacles implementing these models would face and highlight areas for further research. (shrink)

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is (...) argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life. (shrink)

El artículo destaca la importancia de distinguir entre dos roles diversos que la noción de dignidad humana juega en bioética: uno, como principio de orden jurídico-político, y otro, como estándar moral del trato debido al paciente. Cuando la dignidad es entendida en el primer sentido, nos encontramos con un concepto muy general, que cumple un rol fundacional y de orientación de las normas relacionadas con las prácticas biomédicas. En cambio, cuando es utilizada en el segundo sentido, intenta captar la exigencia (...) moral de tratar siempre al paciente como “persona”, es decir, con el mayor cuidado y respeto. Para clarificar el significado de la dignidad como principio, se apela a la distinción entre principios y normas elaborada en el campo de la filosofía jurídica. La dignidad como estándar moral de la relación médico-paciente se ilustra en base a una serie de estudios empíricos. (shrink)

On a reproché au modèle perceptuel de la connaissance morale d'être inadéquat en ce qu'il serait incapable d'expliquer le signe distinctif et fondamental de l'éthique, à savoir son caractère normatif. Je tente de montrer que la critique n'est pas pertinente, car le normatif n'a en réalité qu'une place dérivée en morale : l'éthique est d'abord une question de valeurs, entités dont il est tout à fait plausible de dire que nous les percevons. Pour justifier la place dérivée du normatif, je (...) m'appuie sur les études de Max Scheler et sur l'examen de certains traits de la psychologie morale, qui tendent à montrer que le normatif n'est qu'un cas particulier de l'axiologique, mettant en évidence les caractères de force des valeurs, de risques de transgression et de contrainte.The perceptual model of moral knowledge has been the target of criticisms: it could be unable to explain the basic character of ethics, namely its normative character. I try to show that this criticism is misguided: in fact normativity is not central but lateral to ethics. What matters in ethics first and foremost are values, and it is quite appropriate to say we perceive values. To justify the lateral character of normativity, I rely on some analysis of Max Scheler and turn to some traits of moral psychology. It suggests that the normativity is a province of the axiological, characterized by strength of values, risks of transgression and constraint. (shrink)

South Africa’s groundbreaking constitution explicitly confers a right of access to sufficient water. But the country is officially ‘water-stressed’ and around 10 % of the population still has no access to on-site or off-site piped or tap water. It is evident that a disconnect exists between this right and the reality for many; however the reasons for the continuation of such discrepancies are not always clear. While barriers to sufficient water are myriad, one significant factor contributing to insufficient and unpredictable (...) access to water is the high percentage of broken water pumps. Previous studies have reported that between 20 and 50 % of all hand operated water pumps installed on the African continent are broken, or out of use. Monitoring and maintenance of pumps, which in South Africa is the responsibility of local municipalities is often ineffective, in part due to the distances between municipal centres and rural communities and the consequent costs of site visits, as well as breakdowns within the local bureaucratic system. The emergence of new telemetry tools that can remotely monitor water applications constitutes a novel and cost-efficient alternative to undertaking regular sites visits. Sustainable, appropriate, low-cost telemetry systems are emerging that could be used to monitor the operational performance of water pumps, or a wide range of other field parameters, and to communicate this information swiftly and cheaply to water service providers, using SMS messages. Data on the performance of water pumps could also be made available to the public online. This is an example of how ICT can be used for water resources management and environmental regulation, as well as in the governance of socio-economic rights: helping to optimize water allocation by improving communication and strengthening accountability. (shrink)

Biobanking policy needs to take into account the concept of human dignity, because this concept is enshrined in both international and South African law. The accepted understanding of informed consent, which is also required by law, is inadequate for biobanking because it is often not possible to inform people of possible uses of their stored tissue. If human dignity is understood as a multidimensional concept that corresponds to the multidimensionality of the human person, then human dignity can be said to (...) be both (i) something that all people already have, as an inviolable worth that inheres in their potential to live meaningful lives; and (ii) something that people seek to realize through morally good behavior in historically-situated relationships. This understanding of human dignity can be used as both an interpretive lens and a normative vision. It is interpretive because it reveals how various attitudes to biobanking and the various proposed consent regimes--presumed, broad, and specific--might all be underpinned by appeals to human dignity. It is a normative vision because, given that all of these positions can be underpinned as morally meaningful with respect to human dignity, provision should be made for all of the possible consent regimes in law and in biobanking practice. Nonetheless, where compromise cannot be avoided, then, at the very least, human dignity understood as the human potential to live a meaningful moral life must be protected. (shrink)