This paper asks how to account for vulnerable integrity in the temporal dynamism of human lives without relying on a subtractive vision of integral human nature, borrowing from presumed past or future rationality and maturity, or depending on an external attribution of dignity. Illustrating the challenges with vignettes from the author’s life, it argues inductively that human integrity includes morally inviolable vulnerability to others with whom we are in interdependent relationship and without whom we cannot develop or maintain our selves. (...) Others reside at the core of our integrity, for better and for worse, and we reside at theirs. Augustine’s accounts of memory, time, and the narrative self; Whiteheadian process thought’s understanding of continuity through change; and feminist theories of narrative all provide theological and philosophical justifications for this vision of integrity. John Wall’s and Johan Brännmark’s non-foundational approaches to integrity and human rights lead us to the same conclusion without entailing theological anthropological claims, ensuring its relevance in a pluralist culture. (shrink)

In everyday conversations, professional codes, policy debates, and academic literature, the concept of respect is referred to frequently. Bioethical arguments in recent decades equate the idea of respect for persons with individuals who are capable of autonomous decision-making, with the focus being explicitly on ‘autonomy,’ ‘capacity,’ or ‘capability.’ In much of bioethics literature, respect for persons is replaced by respect for autonomy. Though the unconditional respect for persons and their autonomy (irrespective of actual decision-making capacity) is established in Kantian bioethics, (...) current argument and debates often revolve around a thin concept of autonomy, focusing on capacity and capability: persons are owed respect because they are ‘rational beings’ or with a focus on ‘agency’ and ‘decision-making abilities.’ However, these aspects alone are insufficient while engaging the concept of respect for persons, particularly in healthcare settings. This paper sets out to explore if the concept of respect for persons—as opposed to a thin concept of autonomy—could help us engage better in healthcare practices. We shall probe the practical value of the experiential aspect of respect—understood as the recognition of persons as respect-worthy through certain dispositions and deliberative acts—by reflecting on instances in clinical practice that tend to be dismissed as negligible or even unavoidable in a stressful environment such as a busy hospital. We shall argue that these instances are far from trivial but carry moral significance and express an unacceptable—disrespectful—attitude that can compromise the moral habitus in hospital settings. In our conclusion, we call for practicing recognition respect in the health professional–patient encounter by focussing on manners, attitudes, and behaviors. Furthermore, we call for continuous medical ethics education programs to address the moral significance of disrespectful behaviors and their manifestations in particular socio-cultural contexts. (shrink)

In the wake of two recent high-profile, controversial cases involving the prosecution and conviction of Drs Bramhall and Bawa-Garba, this article considers when it is socially desirable to criminalise doctors’ behaviour, exploring how the matters of harm, public wrongs and the public interest can play out to justify—or not, as the case may be—the criminal law’s intervention. Dr Bramhall branded his initials on patients’ livers during transplant surgery, behaviour acknowledged not to have caused his patients any harm by way of (...) injury to their organs. Dr Bawa-Garba misdiagnosed and failed to properly assess a 6-year-old boy with pneumonia and sepsis under her care, who subsequently died. Taking account of contextual and public interest concerns, can and should there be exceptions to imposing criminal liability where a doctor’s behaviour is deemed grossly negligent and a significant contribution to a patient’s death? And is it really appropriate to subject a doctor to penal sanction where he may have committed a private wrong against a patient, but does not set back their interests? (shrink)

The concept of dignity is widely debated as to its efficacy as a ground upon which to base respect particularly in relation to human rights. Traditional concepts of inherent dignity associate dignity with the possession of rationality and autonomy, which consequently excludes non-rational humans from being viewed as possessing inherent dignity and therefore equal and inherent worth. This paper offers a theory of inherent dignity based on an account of a common humanity within which all humans might be seen as (...) possessing inherent worth and, therefore, deserving of being recognized and respected equally as ends in themselves. The theory is based on the communal practice and expectation of moral accountability, a practice that can be viewed as taking place universally both between and within human communities. (shrink)

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of medicine is (...) secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)