Immanuel Kant (1724–1804) argued that moral requirements are based on a standard of rationality he dubbed the “Categorical Imperative” (CI). Immorality thus involves a violation of the CI and is thereby irrational. Other philosophers, such as Locke and Hobbes, had also argued that moral requirements are based on standards of rationality. However, these standards were either desirebased instrumental principles of rationality or based on sui generis rational intuitions. Kant agreed with many of his predecessors that an analysis of practical reason (...) will reveal only the requirement that rational agents must conform to instrumental principles. Yet he argued that conformity to the CI (a non-instrumental principle) and hence to moral requirements themselves, can nevertheless be shown to be essential to rational agency. This argument was based on his striking doctrine that a rational will must be regarded as autonomous, or free in the sense of being the author of the law that binds it. The fundamental principle of morality — the CI — is none other than the law of an autonomous will. Thus, at the heart of Kant's moral philosophy is a conception of reason whose reach in practical affairs goes well beyond that of a Humean ‘slave’ to the passions. Moreover, it is the presence of this self-governing reason in each person that Kant thought offered decisive grounds for viewing each as possessed of equal worth and deserving of equal respect. (shrink)

Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that (...) active interference in peoples’ personal lives is justified - if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position. (shrink)

It is within the context of a person’s lifestory, we argue, that the idea of wearing aprosthesis assumes place and meaning. Todevelop this argument, a brightly colored hookprosthesis for children is taken as a startingpoint for reflection. The prosthesis can beseen as fitting this person perfectly, when thebodily difference is understood as positivelyadding to this person’s identity. The choicefor the prosthesis is normative in a moralsense, in that it is grounded in a person’sfundamental convictions with respect to hisbeing and living. (...) This understanding of ‘howto live’ can best be grasped – as is suggested– in contrastive terms of ‘sameness’ and‘otherness’. Striving for conformity andsimilarity would do no justice to theexperiences and ideals of unique persons, andwould come at great cost. Moreover, society isnot benefited by persons who merely conform,who copy and imitate others, but by those whowillfully live up to their own unique standards. (shrink)

There is a long history of interest in ‘strangers’ and ‘strangeness’ in the West. Over the past 100 years, the concept of the stranger has been analysed by philosophers, sociologists and anthropolo...

Arguments against directed altruistic living organ donation are too weak to justify a ban. Potential donors who want to specify the non-related person or group of persons to receive their donated kidney should be accepted. The arguments against, based on considerations of motivation, fairness and (non-)anonymity (e.g. those recently cited by an advisory report of the Dutch Health Council), are presented and discussed, as well as the Dutch Governments response. Whereas the Government argues that individuals have authority with regard to (...) the allocation of their organs, partial considerations have not been sufficiently explored. In addition, it is argued that partial relationships govern human life, are significant and should be valued highly. These relationships are at the core of accepted living kidney donation between relatives (family members, partners, friends). Respecting the particular act of living donation goes beyond respect for autonomy; it touches upon our personal and social identity. Donation, e.g. of a kidney, is not undertaken strictly for the benefit of the recipient, but also to meet the moral standards we wish to set for ourselves. This consideration, rooted in a view of moral identity, provides the basis for many forms of directed donation that are both partial and justified. If the importance of this is not recognized, social policies can be neither adequate nor effective. (shrink)