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)

In dieser Arbeit werden drei Gedankenexperimente geprüft, die im Diskurs zur Moralität der Abtreibung vorgebracht wurden: der Geiger von Judith J. Thomson und zwei Erwiderungen darauf von Kenneth Himma und Christopher H. Conn. Sie sind dadurch charakterisiert, dass sie von Rechten sprechen, eine besondere Betonung auf Verkörperung legen und an die moralische Intuition appellieren. Ich behaupte, dass nur menschliche Individuen Menschenrechte haben können und dass Individuation nicht auf der Verletzung der moralischen Rechte anderer basieren kann. Deshalb kann der Fetus weder (...) Träger von moralischen Rechten noch ein Aggressor gegen die Rechte seiner Mutter sein. Die Paradigmen der Umweltethik scheinen für moralische Überlegungen über Abtreibung besser geeignet zu sein als das Paradigma der Rechte. Im Zentrum der Umweltethik stehen eher Fürsorge und Achtung vor dem Leben als Rechte; sie ist auf Verkörperung und natürliche Prozesse abgestimmt und beruft sich mehr auf Gefühle der Fürsorge und Tugend als auf ein Gerechtigkeitsgefühl. (shrink)

As space travel and intentions to colonise other planets are becoming the norm in public debate and scholarship, we must also confront the technical and survival challenges that emerge from these hostile environments. This paper aims to evaluate the various arguments proposed to meet the challenges of human space travel and extraterrestrial planetary colonisation. In particular, two primary solutions have been present in the literature as the most straightforward solutions to the rigours of extraterrestrial survival and flourishing: (1) geoengineering, where (...) the environment is modified to become hospitable to its inhabitants, and (2) human (bio)enhancement where the genetic heritage of humans is modified to make them more resilient to the difficulties they may encounter as well as to permit them to thrive in non-terrestrial environments. Both positions have strong arguments supporting them but also severe philosophical and practical drawbacks when exposed to different circumstances. This paper aims to show that a principled stance where one position is accepted wholesale necessarily comes at the opportunity cost of the other where the other might be better suited, practically and morally. This paper concludes that case-by-case evaluations of the solutions to space travel and extraterrestrial colonisation are necessary to ensure moral congruency and the survival and flourishing of astronauts now and into the future. (shrink)

Justice requires that public policy improve the lives of disadvantaged members of society. Dementia is a source of disadvantage, and a growing global public health challenge. This article examines the theoretical and ethical connections between theories of justice and public dementia policy. Disability in general, and dementia in particular, poses important challenges for theories of justice, especially social contract theories. First, the article argues that non-contractarian accounts of justice such as the Capabilities and Disadvantage approaches are better equipped than their (...) contractarian counterparts to analyse issues of justice and dementia. Secondly, using a capabilities framework, I analyse original empirical data from qualitative interviews and discussion groups with health and social care professionals. The article concludes that social connection is a ‘fertile functioning’—a multiplier of advantage that enables people to live well with dementia together—and should therefore be a priority for public dementia policy. (shrink)

Over the last decade, several European countries and the Council of Europe itself have strongly supported the use of advance directives as a means of protecting patients’ autonomy, and adopted specific norms to regulate this matter. However, it remains unclear under which conditions those regulations should apply to people who are placed in correctional settings. The issue is becoming more significant due to the increasing numbers of inmates of old age or at risk of suffering from mental disorders, all of (...) whom might benefit from using advance directives. At the same time, the closed nature of prisons and the disparate power relationships that characterise them mean that great caution must be exercised to prevent care being withdrawn or withheld from inmates who actually want to receive it. This paper explores the issue of prisoners’ advance directives in the European context, starting with the position enshrined in international and European law that prisoners retain all their human rights, except the right to liberty, and are therefore entitled to self-determination regarding health care decisions. (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)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 257-259 [Access article in PDF] Atrocity, Banality, Self-Deception Adam Morton Keywords evil, self-deception, banality, atrocity, motivation When talking about evil we must make a fundamental choice about how we are to use the term. We may use it as half of the contrast "good versus evil," in which case it covers everything that is not good. That includes moral incompetence, lack of imagination, (...) willingness to follow orders, overreactions, and a host of other reasons why people who do not have personalities that we would call evil do things that are wrong, often very wrong. Call this the weak reading of evil: evil as wrongdoing. Or we may use it with the meaning suggested by "evil person," "really evil act," "the evil lurking in all of us," and other such idioms. If we do this, we focus on a particular class of actions, and the motives and people that produce them, that arouse a particular moral revulsion in us. Call this the strong reading of evil: evil as atrocity (for more on this contrast see Morton [2004] and Card [2002]).Kubarych, following Peck, thinks of evil in the strong way. Most of the time at any rate: Some of the philosophers, such as Kant, that he draws on are thinking of evil in the weak way, and some of his quotations are from the German, where good/bad/evil distinctions are not drawn in the same way as in English. He explores a general explanation of evil that seems to be targeted at the psychology of extremely abhorrent actions. But, I argue, his account is in danger of collapse in either of two directions. Depending on how we interpret Kubarych's account, it could turn out that it describes all wrongdoing as evil, or, making some different choices, it could turn out that there are no really evil people.The strong reading of evil is definitely the most interesting and potentially fruitful. After all, we have no shortage of satisfying explanations of why people lie to get out of unwelcome appointments, steal to support their children or their drug habits, or defraud investors to become rich. But we do feel deeply puzzled by those who commit torture, serial murder, or genocide. We ask of these people not so much "Why did he do it?" as "How could he do it?" We feel the need of a philosophical or psychological theory that can give us even a slight handle of these people and their deeds. There are two risks associated with the project of explaining atrocity, though. The first is the risk of accepting unsatisfactory accounts, just because they purport to explain what we desperately want to understand. The second is the risk of supposing that there is a single explanation when the causes of the phenomenon are in fact too varied. On other topics these two risks have often combined to make people believe what seem to us now to be evident falsehoods. Humans have often for example wanted to know the causes of disease, and as a result have accepted blanket explanations, in terms of [End Page 257] evil spirits or lack of faith, that seem ludicrous to us now that we have a better grasp of the variety of factors that can cause our bodies to misfunction. So before asking naively "Why and how can people do these awful things?" we should ask "Is there a deeper causal unity here, beyond the fact that we react to these acts with horror?"My suspicion is that there is not much unity, that it is asking too much to want a common profile to the psychology of serial killers, or of proponents of genocide, let alone a profile that applies across these and other categories. What we can do, I believe, is describe our concept of evil in such a way that we can leave some parameters to be filled in by a large variety of objective psychological factors. Even this runs the risk that the really relevant factors cannot be forced into the role that the philosophical account requires. In... (shrink)

Most of us believe that it would be unjust to act with indifference about the plight of future generations. Zipper arguments in intergenerational justice aim to show that we have duties of justice regarding future generations, regardless of whether we have duties of justice to future generations. By doing so, such arguments circumvent the foundational challenges that come with theorising duties to remote future generations, which result from the non-existence, non-identity and non-contemporaneity of future generations. I argue that zipper arguments (...) face several significant challenges. The ought-implies-can challenge points out that because prior generations determine what later generations can transfer, they determine how much they ought to transfer. In addition, both intentional and non-intentional non-compliance can break the chain of duties towards future generations on which zipper arguments rely. Some versions are surprisingly resilient especially in real-world circumstances. This paper does not show that zipper arguments inevitably fail, but all ways forward come at significant theoretical costs. Unless the challenges posed here are met (or shown as irrelevant), theorists of justice cannot side-track the foundational challenges that come with doing intergenerational justice. (shrink)

This paper argues that, if we are committed to a Pro-choice stance with regard to selective abortion for disability, we will be unable to justify the prohibition of sex-selective abortion (SSA), for two reasons. First, familiar Pro-choice arguments in favour of a woman’s right to select against fetal impairment also support, by parity of reasoning, a right to choose SSA. Second, rejection of the criticisms of selective abortion for disability levelled by disability theorists also disposes, by implication, of the key (...) objections to SSA, as developed, most notably, by feminists. The paper, then, consists of a conditional defence of SSA, under which SSA should be available, and protected by a right, if selective abortion for disability is. Opponents of SSA might respond by conceding additional restrictions on selection against disabled fetuses. It should become clear throughout the paper, however, that any such new restrictions would be unacceptably onerous for women. (shrink)

In “An Obscure Rider Obstructing Science,” Sarah Rodriguez, Lisa Campo-Engelstein, Candace Tingen, and Teresa Woodruff (2011) adopt a “developmental view” when contrasting the moral status of embry...

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

Ballantyne and colleagues (2009) cogently present the conflict that arises in jurisdictions in which prenatal diagnosis (PND) is available and abortions are prohibited. They primarily focus on two...

Pleasants has developed the idea of basic moral certainties. Analogous to Wittgenstein's basic empirical certainties, they are best described as universal moral certainties which are natural and nonpropositional, and show unreflectively in the way we act. A clear-cut example is the wrongness of killing innocent human beings. Philosophers have levelled three damaging criticisms against Pleasants' proposal by (i) offering counterexamples to his proposed example of moral certainty, (ii) highlighting some disanalogies between moral certainties and Wittgenstein's basic empirical certainties and, lastly, (...) (iii) showing the lack of arguments and evidence offered by Pleasants to substantiate the claim that moral certainties are natural. To address these criticisms, Laves has revised Pleasants' proposal by providing numerous amendments. In this paper, I develop some concerns about Laves' proposed amendments and indicate that, at present, they are unable to fully overcome the criticisms levelled against the idea of basic moral certainty. Whether Laves' proposal can escape these troubles demands further attention. (shrink)

This paper is to argue that there are no degrees in a Bodhisattva's compassion and also to explore the Western account of compassion, which suggests that there are degrees in our compassion. After analyzing and comparing both positions, I affirm that they are opposite views.

This essay is to identify two views of Buddhist ethics: egalitarianism and non-egalitarianism. In the time of the Buddha, there was no conflict between the concept of equality and the Buddha’s teac...

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might be suitable (...) as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

Persons with dementia often prefer to participate in decisions about their health care, but may be prevented from doing so because healthcare decision-making law facilitates use of advance directives or surrogate decision makers for persons with decisional impairments such as dementia. Federal and state disability law provide alternative decision-making models that do not prevent persons with mild to moderate dementia from making their own healthcare decisions at the time the decision needs to be made. In order to better promote autonomy (...) and wellbeing, persons with dementia should be accommodated and supported so they can make their own healthcare decisions. (shrink)

Viele Menschen halten Patientenverfügungen für ein geeignetes Mittel, um selbstbestimmt zu entscheiden, wie mit ihnen im Fall schwerer Demenz umgegangen werden soll. Die meisten Bioethiker stimmen ihnen zu: Demenzverfügungen seien Ausdruck der „verlängerten Autonomie“ der Patientin. Doch ob sie recht haben, ist unklar. Dem viel beachteten Identitätseinwand zufolge sind die Ausstellerin der Verfügung und ihre schwer demente Nachfolgerin numerisch verschieden: Sie sind zwei und nicht eins. Wenn das stimmt, kann die Ausstellerin nicht verfügen, wie mit ihr im Falle schwerer Demenz (...) umgegangen werden soll. Die Demenzverfügung ist ungültig. In meinem Aufsatz möchte ich eine neue Replik auf diesen Einwand vorstellen. Ihr Ansatzpunkt ist der menschliche Organismus, den wir sehen, wenn wir in den Spiegel blicken. Er kann schwer dement werden, und auch er hat die Patientenverfügung unterschrieben. Warum sollte sie dann ungültig sein? Auf den ersten Blick hat diese Replik eine Reihe von Vorzügen. Insbesondere akzeptiert sie die populären Annahmen, auf denen der Identitätseinwand basiert. Bei näherem Hinsehen zeigen sich jedoch Probleme, die so gravierend sind, dass wir von ihr Abstand nehmen sollten. (shrink)

Normative discourse on genocide frequently refers to group injuries, but this can be problematic for those for whom normative justification ought, in principle, to be reducible to individual terms. Such ethical individualists may hold that an ultimately individualizable description of injury is always theoretically superior (in lacking either superfluous or ontologically suspect entities). Accepting the strictures of individualistic justification, this paper presumes that attributing injury to group subjects will be unsatisfying if this attribution does not include a normatively significant group (...) character. Taking up these challenges, this essay analyzes the conceptual possibility of normatively significant group injury, describing its necessary and sufficient conditions. (shrink)

In a rational system defences should interlock with the elements of the offence to ensure that conviction labels are differentiated according to the defendant’s degree of wrongdoing and culpability. The overall grading structure of criminal homicide, as represented in contemporary doctrine, goes some way to reflect this ethic. But the substance lacks precision and, in some key details, moral coherence. The recent Law Commission Consultation Paper, in a pragmatic and sensible attempt to rid the law and procedure of murder of (...) the malign influence of the mandatory sentence, has unnecessarily compromised such structural coherence as it currently enjoys and which could properly form a satisfactory basis for reform already precise and morally coherent. This is evident both in relation to the abandonment of the attack based template for the fault element in murder, and also in the unwillingness to view the partial defences as affecting the wrong in homicide as opposed to the grade. (shrink)

This paper provides a new analysis and critique of Rawlsian public reason’s handling of the abortion question. It is often claimed that public reason is indeterminate on abortion, because it cannot say enough about prenatal moral status, or give content to the (allegedly) political value which Rawls calls ‘respect for human life’. I argue that public reason requires much greater argumentative restraint from citizens debating abortion than critics have acknowledged. Beyond the preliminary observation that fetuses do not meet the criteria (...) of political personhood, I contend, public reasoners may say nothing about prenatal moral status. Indeed, respect for human life (as distinct from respect for persons) is not, I show, a genuine political value, whose interpretation lies within public reason’s remit. This fact does not, however, prevent deliberators from drawing determinate conclusions regarding the law of abortion. Instead, I show, public reason has radically permissive implications for the legal regulation of feticide, inclining heavily towards the view that abortion should be allowed with little or no qualification, right until birth. I end by giving grounds for thinking that, even if the argumentative restraint which public reason enjoins over prenatal moral status does not generate indeterminacy, it is nonetheless objectionable. (shrink)

Volume 20, Issue 8, August 2020, Page 104-106.

In a well known story Derek Parfit describes a disconnection between two entities that normally (in real life) travel together through space and time, namely your personal identity consisting of both mind and body. Realising the possibility of separation, even if it might never happen in real life, new questions arise that cast doubt on old solutions. In human reproduction, in real life, at present the fetus spends approximately nine months inside the pregnant woman. But, we might envisage other possibilities. (...) Historically, the first era is the normal conception inside the woman, the growth of the fetus in the womb and then, after nine months, birth and the appearance of a new individual. The second era is In Vitro Fertilisation (IVF). The fetus starts outside the woman as a fertilised egg, moves to the body of the woman and spends nine month there, where the body of the woman and the fetus travel together in space-time to separate at birth. In the third era of reproductive ectogenesis, the two never travel together. The fetus spends its gestational time entirely outside the woman’s body. We have two entities separated in space-time the whole time. The intimate connection consisting in the fetus being a part of the woman’s body is gone. (shrink)

The right not to be subjected to torture, cruel, inhuman or degrading treatment or punishment is invariably associated with ‘human dignity’. The idea of dignity plays some role in this right’s interpretation, although the content of the idea in this context, as in others, is unclear. Making sense of the dignity idea involves a number of challenges. These challenges give rise to the methodological-type question at the heart of this article: how should human rights lawyers go about articulating the content (...) of ‘dignity’? The article proposes, and models, a methodological approach in response. Its core argument is that human rights law needs the vocabulary provided by theorizations of dignity but that these theorizations should be anchored in authoritative human rights jurisprudence. It argues that this approach can help make sense of the dignity idea in a way that facilitates a richer understanding of its influence on interpretation. (shrink)

We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics guidance. But Walsh’s account of the moral value (...) of the preferences of patients with dementia suffers from three major problems: (1) it does not engage the actual practices of clinical ethics; (2) it provides an inadequate account of why these patients’ preferences matter; and (3) it offers a poor explanation of clinicians’ intuitions in these cases. Her arguments engage a philosophical debate that is largely irrelevant to clinical practice and she therefore leaves pressing real-world clinical ethics questions unaddressed. After underscoring some of Walsh’s main points, we will discuss each of these shortcomings. (shrink)

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

In recent years, debates about euthanasia and assisted suicide have increased to the point that now, many people defend the recognition of the right to die, the right for people to decide upon the end of their life. Consistently, advocates fight to legalise practices such as euthanasia to guarantee patients’ possibility to die when they request it. In this paper, I review two of the strongest arguments invoked by proponents of physician-assisted suicide: the argument for compassion and the argument for (...) dignity. The focus of this paper is to propose a review of these arguments through the lens of virtue ethics to inform the debate on physician-assisted suicide and question the relevance of such arguments for the legalisation of that right that would greatly ease the possibilities to end the life of a patient asking for it. (shrink)

Habermas’s postmetaphysical reading of Kierkegaard is paradigmatic for his understanding of religion. It shows, why Habermas reduces religion to fideism. Therefore the paper reconstructs Habermas’s reception of Kierkegaard and compares it with the accounts of Dieter Henrich and Michael Theunissen. Furthermore it demonstrates how Habermas makes use of Kierkegaard’s dialectics of existence to formulate his postmetaphysical thesis of a cooperative venture.

This text focuses on selected basic arguments of libertarianism that could be found in certain debates on the moral issues of euthanasia and the application of moral fictionalism in bioethics. Firstly, I devote my article to the criticism of libertarian arguments (as one of the dominant discourses related to the debate over euthanasia) in a wider perspective of moral philosophy. The article is based on an approach that understands morality as a kind of social practice and the primary goal is (...) to grasp the key theoretical concepts which are included in the mechanism for identifying and assessing our moral intuitions. This text is primarily an analysis of selected arguments of current normative theories of libertarianism on two levels: first it examines the idea of self-ownership in connection with certain debates over euthanasia, while the latter part of the article concerns an analysis of the critique of libertarian arguments and a comparison of the alternative arguments of moral fictionalism. The last part of this text, focusing on moral fictionalism and its general application in bioethics, is the core of the article. (shrink)

Comprender los dilemas éticos en torno a la subrogación de útero exige un conocimiento preciso de los conceptos de libertad y autonomía reproductiva. Una aproximación pertinente debe reconocer la naturaleza de la opresión sexual, sobre todo de cómo influye en la autonomía de las mujeres, en sus elecciones, en la identidad propia y en las relaciones interpersonales. El objetivo de este ensayo es defender la relevancia de las críticas del feminismo radical a las corrientes liberales progresistas, que a menudo prestan (...) mayor atención a los intereses de los denominados padres intencionales. Considerando lo que varias filósofas igualitaristas han expuesto desde una perspectiva socio-relacional de la autonomía para permitir la subrogación bajo ciertas condiciones -específicamente, sostienen que la regulación es compatible con la autonomía reproductiva de las mujeres si se sigue una modalidad altruista en un ambiente de protección y apoyo ante la revocación del consentimiento-, defiendo que las feministas radicales esclarecen apropiadamente cómo la opresión contra la mujer permanece en el ambiente cultural que aprueba los contratos de subrogación. La metodología macroscópica, basada en la metáfora del ave enjaulada de la filósofa norteamericana Marilyn Frye, es una herramienta provechosa para comprender por qué la subrogación no implica una mejoría para la autonomía reproductiva de las mujeres, incluso si permite que algunas madres gestantes obtengan un ingreso suficiente para sobrellevar la presión económica. (shrink)

Adherents of different moral views hold conflicting views on the permissibility of embryonic stem cell research. Pace Ronald Dworkin, no liberal compromise is possible. Whichever way the decision goes, some people will be deeply hurt and feel that basic moral principles are being flouted. And yet, when a majority exists in defence of such research, it should not hesitate to allow it.

Jon Shields's finding—that certain evangelical pro‐life activist groups are more interested in deliberative discussions about abortion than are pro‐choice activists—is wrong on methodological, normative, and philosophical grounds. He generalizes about pro‐life civility from a small, trained sample group, and ignores possibly important variables that would explain pro‐choicers' incivility. Further, politeness is not necessarily a requirement of democratic deliberation—which entails not forcing one's own beliefs on the public, as pro‐lifers manifestly are trying to do, despite their calm demeanor. Conversely, some pro‐choicers' (...) refusal to engage in debates is not a deliberative failure, as Shields suggests, as deliberation includes such things as campaigning and canvassing. Lastly, Shields, and the pro‐lifers he has observed, use the weakest of the pro‐choice arguments, instead of focusing on the best academic work in the field. (shrink)

The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one’s life. The suffering can also be (...) related to no longer being able to be the person one wants to be in the eyes of others, to losing one’s dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient’s body. Matters of physician assisted suicide and/or euthanasia—if it should be legalized and if so under which conditions—need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized. (shrink)

In this article I investigate the ways in which phenomenology could guide our views on the rights and/or wrongs of abortion. To my knowledge very few phenomenologists have directed their attention toward this issue, although quite a few have strived to better understand and articulate the strongly related themes of pregnancy and birth, most often in the context of feminist philosophy. After introducing the ethical and political contemporary debate concerning abortion, I introduce phenomenology in the context of medicine and the (...) way phenomenologists have understood the human body to be lived and experienced by its owner. I then turn to the issue of pregnancy and discuss how the embryo or foetus could appear for us, particularly from the perspective of the pregnant woman, and what such showing up may mean from an ethical perspective. The way medical technology has changed the experience of pregnancy—for the pregnant woman as well as for the father and/or other close ones—is discussed, particularly the implementation of early obstetric ultra-sound screening and blood tests for Down’s syndrome and other medical defects. I conclude the article by suggesting that phenomenology can help us to negotiate an upper time limit for legal abortion and, also, provide ways to determine what embryo–foetus defects to look for and in which cases these should be looked upon as good reasons for performing an abortion. (shrink)

I cannot be certain what people have in mind when they wish to expose medical students to ethics, but if what I have said so far is sound, then they ought not to mean moral philosophy alone. The moral life of medicine and the moral life in general have certainly given rise to rules of thumb, guidelines and principles which summarise our sentiments about interactions within that life. However, the substance of that life is human vulnerability and our responses to (...) it. This is not to say that the theories found in moral philosophy are not a rich terrain for intellectual ingenuity, they are, but there is no reason whatever to believe that their study sharpens moral sensitivity.Sensitivity to human vulnerability is the dimension which medical ethics education should seek to explore. One reason is that medical practice is at the hard edge of moral practice, and the character of the practitioners is one of our major concerns as consumers of health care.My conclusion is easy enough to state. Many have started the business of medical ethics on the assumption that moral philosophy has an applied correlate. This has proven to be a chimera. Let's have the courage to admit that a promising research project has petered out and start to look for a more plausible one. Perhaps we could start by looking for good narratives of suffering, of living under adversity, and of caring for the suffering. (shrink)

An ‘Information Centre’ has recently been established by law which has the power to collect, collate and provide access to the medical information forall patients treated by the National Health Service in England, whether in hospitals or by General Practitioners. This so-called ‘care.data’ scheme has given rise to major and ongoing controversies. We will sketch the background of the scheme and look at the responses it has elicited from citizens and medical professionals. In Autumn 2013, NHS England set up a (...) care.data website where citizens could record their concerns regarding the collection of health-related data by the Information Centre. We have reviewed all the comments on this website up until June 2015. We have also analysed the readers’ comments on the coverage of the care.data scheme in one of the main national UK newspapers. When discussing the responses of citizens, we will make a distinction between the problems that citizens detect and the solutions they propose. The solutions that are being perceived as the most relevant ones can be summarized as follows: citizens wish to further the common good without being manipulated into doing it, while at the same time being safeguarded against various abuses. The issue of trust turns out to figure prominently. Our analysis of reactions to the scheme in no way pretends to be exhaustive, yet it provides various relevant insights into the concerns identified by citizens as well as medical professionals. These concerns, moreover, have a more general relevance in relation to other contexts of medical data-mining as well as biobank research. Our analysis also offers important pointers as to how those concerns might be addressed. (shrink)

Since certain temporal aspects of the relation between duties, rights, and the interests that rights protect have not been fully theorized, a puzzle arises when we come to consider whether and how entities such as members of future generations, fetuses, deceased persons, and unconscious persons are able to possess rights. This paper evolves a unified structure for attributing the ability to possess rights to such entities. It demonstrates that while, under any cogent theory of rights-attributions, rights and duties must be (...) strictly contemporaneous, the interests that rights protect need not temporally coincide with those rights. (shrink)

The question of when we have justification for overriding ordinary, everyday decisions of persons with dementia is considered. It is argued that no single criterion for competent decision-making is able to distinguish reliably between decisions we can legitimately override and decisions we cannot legitimately override.

We first heard about this case from nurses in one of our intensive care units while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death (...) with persistent vegetative state. But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility. A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients. (shrink)

We first heard about this case from nurses in one of our intensive care units while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death (...) with persistent vegetative state. But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility.A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients. (shrink)

BackgroundDementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on (...) promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts.MethodsThe CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs.ResultsTo address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers.ConclusionWe conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers. (shrink)

Prenatal diagnosis challenges the issue of parental autonomy. Two ethical aspects of the parental decision making process with reference to PND have been taken into consideration: the duty to know and the right not to know. Whilst the first approach has been widely discussed in literature, the latter seems to be overlooked. In order to find good moral reasons supporting the right not to know, firstly the duty to know approach was critically analysed. Subsequently, the emphasis was put on the (...) unconditional parental love and the issue of child’s best interests as the features supporting parental right not to know. The clarification of what is good parenthood was presented as the best normative approach supporting the parental right not to know in case of PND. Apart from parental autonomy, raising the question of the right not to know is important in the debate about the place and role of people with disabilities in society. (shrink)

In a footnote to the first edition of Political Liberalism, John Rawls introduced an example of how public reason could deal with controversial issues. He intended this example to show that his system of political liberalism could deal with such problems by considering only political values, without the introduction of comprehensive moral doctrines. Unfortunately, Rawls chose “the troubled question of abortion” as the issue that would illustrate this. In the case of abortion, Rawls argued, “the equality of women as equal (...) citizens” overrides both “the ordered reproduction of political society over time” and also “the due respect for human life.” It seems fair to say that this was not the best choice of example and also that Rawls did not argue for his example particularly well: a whole subset of the Rawlsian literature concerns this question alone. (shrink)

Though the reputation of eugenics has been tarnished by history, eugenics per se is not necessarily a bad thing. Many advocate a liberal new eugenics—where individuals are free to choose whether or not to employ genetic technologies for reproductive purposes. Though genetic interventions aimed at the prevention of severe genetic disorders may be morally and socially acceptable, reproductive liberty in the context of enhancement may conflict with equality. Enhancement could also have adverse effects on utility. The enhancement debate requires a (...) shift in focus. What the equality and/or utility costs of enhancement will be is an empirical question. Rather than philosophical speculation, more social science research is needed to address it. Philosophers, meanwhile, should address head-on the question of how to strike a balance between liberty, equality, and utility in cases of conflict (in the context of genetics). (shrink)