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)

“de-extinction” refers to the process of resurrecting extinct species by genetic methods. This science-fiction-sounding idea is in fact already in early processes of scientific implementation. Although this recent “revival of the dead” raises deep ethical questions, the ethics of de-extinction has barely received philosophical treatment. Rather than seeking a verdict for or against de-extinction, this paper attempts an overview and some novel analyses of the main ethical considerations. Five dimensions of the ethics of de-extinction are explored: (a) the possible contribution (...) of de-extinction to promoting ecological values, (b) the deontological argument that we owe de-extinction to species we rendered extinct, (c) the question of “playing God” through de-extinction, (d) the utilitarian perspective, and (e) the role of aesthetic considerations in the ethics of de-extinction. A general feature arising from the paper’s discussion is that, due to de-extinction’s special character, it repeatedly tests the limits of our ethical notions. (shrink)

Sowohl in der klinischen und rechtlichen Praxis als auch in der Medizinethik besteht Uneinigkeit darüber, was die (moralische) Verbindlichkeit von Patientenverfügungen begründet und wie mit ihnen in der Praxis zu verfahren ist. Dieser Artikel versucht, die ethisch-normative Basis von Patientenverfügungen näher zu beleuchten. Eine Bestimmung erfolgt in drei Schritten. Erstens wird analysiert, welche Autonomiekonzeption Patientenverfügungen zugrunde liegt. Patientenverfügungen, so meine These, sind Ausdruck eines relationalen, um den Aspekt der Persönlichkeit angereicherten Autonomiebegriffs. Eine moralische Verbindlichkeit ist mit dieser Analyse noch nicht (...) geklärt. Im Anschluss werden daher Argumente gesammelt, warum eine Patientenverfügung für Drittpersonen moralische Bindungskraft haben könnte. In der Achtung der Persönlichkeit sehe ich hier einen zentralen Punkt. Ob die Legitimität der in einer Patientenverfügung geäußerten Wünsche relativ zu einer bestehenden Rechtskultur, dem Allgemeinverständnis einer Gesellschaft oder der Kultur einer medizinischen Praxis ist, oder unabhängig vom soziokulturellen Kontext begründet werden kann, bleibt dabei eine offene Frage. (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)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

The aim of this paper is to critically discuss the plausibility of legal moralism with an emphasis on some central and recent versions. First, this paper puts forward and defends the thesis that recently developed varieties of legal moralism promoted by Robert P. George, John Kekes and Michael Moore are more plausible than Lord Devlin's traditional account. The main argument for this thesis is that in its more modern versions legal moralism is immune to some of the forceful challenges made (...) to Devlin by Hart, Dworkin and Feinberg among others. Second, however, the paper challenges the new generation of legal moralists and suggests some areas for further development. Although Devlin's position has been scrutinized thoroughly in the literature on the philosophy of law, there has, to my knowledge, been no comparable, systematic critique of these different proponents of legal moralism. (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)

Welfarism is the view that morality is centrally concerned with the welfare or well-being of individuals. The division between welfarist and non-welfarist approaches underlies many important disagreements in ethics, but welfarism is neither consistently defined nor well understood. I survey the philosophical work on welfarism, and I offer a suggestion about how the view can be characterized and how it can be embedded in various kinds of moral theory. I also identify welfarism's major rivals, and its major attractions and weaknesses.

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 paper I problematise quite a simple assertion: that the two major frameworks used in assessing consent to post-mortem organ donation, presumed consent and informed consent, are procedurally similar in that both are ‘default rules.’ Because of their procedural common characteristic, both rules do exclude marginalized groups from consent schemes. Yet this connection is often overlooked. Contract theory on default rules, better than bioethical arguments, can assist in choosing between these two rules. Applying contract theory to the question of (...) post-mortem organ donation suggests that the default rule should be one that goes against the wishes of the stronger party in consent decisions. (shrink)

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best (...) with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances. (shrink)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Even where willingness-to-pay as a measure of welfare impact is adjusted for diminishing marginal utility, welfare economics is shown to favour policies that add to the life expectancy or that enhance the quality of life of persons who are already better-off. I propose an alternative, Equal Respect methodology, under an axiomatic claim that at the point of decision the prospective life years of all individuals are of equal intrinsic social value. This justifies equal valuation of risk mitigation across all persons; (...) similarly, all appraised impacts should be scaled to accord equal respect to difficult but no-less-valuable lives. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 32-41, January/February 2022.

In their thoughtful and rigorous article, Peterson and colleagues extend an account of supported decision-making that was originally developed for people with static cognitive impairments, t...

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)

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.

What attitude would a just state take to the inheritance of property? Would confiscatory taxes on the estate of the deceased be morally acceptable, or would they represent some kind of wrong? While there is a good amount of political philosophical scholarship that considers the desirability of inheritance tax, there appears to be little that has considered it from the perspective of rights theory, asking what kind of thing a right to bequeath or to inherit would be, and whether those (...) putative rights are defeasible. I argue here that putative inheritance rights are best made sense of as interest-rights. However, while agents may have interests in bequest and inheritance, it is also plausible that the community as a whole has interests that would be served by a confiscatory inheritance tax; and if inheritors’ and testators’ interests are strong enough to generate a prima facie right, it is also plausible that the community would have a competing prima facie right. Importantly, there is reason to think that the community’s interests trump the testator’s and the inheritor’s; if there are thoroughgoing rights in respect of inheritance, it is not at all clear that a highly confiscatory tax would violate them. (shrink)

It is sometimes proposed that killing or harming abortion providers is the only logically consistent position available to opponents of abortion. Since lethal violence against morally responsible attackers is normally viewed as justified in order to defend innocent parties, pro-lifers should also think so in the case of the abortion doctor and so they should act to defend the unborn. In our paper, we defend the mainstream pro-life view against killing abortion doctors. We argue that the pro-life view can, in (...) various ways, reject the assumption that defensive violence to save innocent individuals is always permissible. Now even if that assumption is accepted, we contend that defensive violence against abortion doctors still is not justified. Drawing on Frances Kamm’s work, we contend that there are structural similarities between abortion and letting someone die who needs your help to stay alive; and we argue that it is impermissible to kill those who kill in order to avoid giving life-saving aid. (shrink)

Life-saving health resources like organs for transplant and experimental medications are persistently scarce. How ought we, morally speaking, to ration these resources? Many hold that, in any morally acceptable allocation scheme, the young should to some extent be prioritized over the old. Govind Persad, Alan Wertheimer and Ezekiel Emanuel propose a multi-principle allocation scheme called the Complete Lives System, according to which persons roughly between 15 and 40 years old get priority over younger children and older adults, other things being (...) equal. They defend this ‘modified youngest first’ principle in part by appealing to the greater social investment that has been made in 15-year-olds than in younger children. Ruth Tallman has proposed a distinctive defense of modified youngest first, one that appeals not at all to social investment. We find this defense wanting. Tallman’s argument depends on the idea, which we try to show to be implausible, that allocations should maximize the number of people in the midst of a possibly complete life who actually complete their lives. Moreover, Tallman does not justify the priority modified youngest first gives 15-year-olds over, for example, 5-year-olds. Tallman fails to dispel a serious shortcoming with modified youngest first: its fundamental unfairness to pre-adolescents. (shrink)

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

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)

According to standard comparativist views, death is bad insofar as it deprives someone of goods she would otherwise have had. In The Ethics of Killing, Jeff McMahan argues against such views and in favor of a gradualist account according to which how bad it is to die is a function of both the future goods of which the decedent is deprived and her cognitive development when she dies. Comparativists and gradualists therefore disagree about how bad it is to die at (...) different ages. In this paper I examine two prominent criticisms of gradualism and show that both misconstrue McMahan. I develop a related criticism that seems to show that a gradualist cannot coherently relate morbidity and mortality. This criticism also fails, but has an instructive implication for how policy-makers setting priorities for health care investments should regard choices between life-saving interventions and interventions against non-fatal diseases in the very young. (shrink)

The main purpose of this article is an analysis of the Continuity Argument, one of the most influential arguments upon which the moral condemnation of scientific and medical practices such as embryo research and experimentation, assisted reproduction, abortion, therapeutic cloning, etc. are based. I have firstly given a very brief account of the approach that attributes the status of marker event to fertilization, identifying the Continuity Argument between other argumentation. Further, I have tried to distinguish the three possible interpretations of (...) the notion of continuity assumed in the Continuity Argument, and to isolate the most persuasive formulation of Continuity Argument. Finally, I argue that even from the most convincing philosophical and scientific interpretation of the post-fertilization continuity, it does not follow: that fertilization is a necessary determinant of moral status; that fertilization is the most reasonable determinant of moral status. In short, this article has two goals: to show that this very argument does not entail the stance that the above mentioned practices are morally impermissible; to suggest that some pragmatic strategies which treat sorites-infected paradoxes could insure a philosophically and scientifically appropriate framework for an alternative approach. (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)

This paper explores the claim that someone can reasonably consider themselves to be under a duty to respect the autonomy of a person who does not have the capacities normally associated with substantial self-governance.

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)

This thesis explores the concept of "Sanctity of Life" from the perspective of what "life," in particular human life, means today. With the rapid advances in science and modern medical practice, the concept of life has undergone many changes, shaking the foundations of what before made us view life as sacred. Modern thought has brought new forms of understanding to the concept of life.

This essay first discusses the three major arguments in favor of euthanasia and physician-assisted-suicide in contemporary Western society, viz ., the arguments of mercy, preventing indignity, and individual autonomy. It then articulates both Confucian consonance and dissonance to them. The first two arguments make use of Confucian discussions on suicide whereas the last argument appeals to Confucian social-political thought. It concludes that from the Confucian moral perspectives, none of the three arguments is fully convincing.

The main objection to human embryonic stem cell research is that it involves killing human embryos, which are essentially beings of the same sort that you and I are. This objection presupposes that we once existed as early embryos and that we had the same moral status then that we have now. This essay challenges both those presuppositions, but focuses primarily on the first. I argue first that these presuppositions are incompatible with widely accepted beliefs about both assisted conception and (...) monozygotic twinning. I then argue that we never existed as embryos. If this last claim is right, killing an embryo does not kill someone like you or me but merely prevents one of us from existing. (shrink)

In this paper I examine the prevailing assumption that there is a right to procreate and question whether there exists a coherent notion of such a right. I argue that we should question any and all procreative activities, not just alternative procreative means and contexts. I suggest that clinging to the assumption of a right to procreate prevents serious scrutiny of reproductive behavior and that, instead of continuing to embrace this assumption, attempts should be made to provide a proper foundation (...) for it. I argue that the focus of procreative activities and discourse on reproductive ethics should be on obligations instead of rights, as rights talk tends to obfuscate recognition of obligations toward others, particularly those who bear the most significant burdens of the procreative process. I examine some possible foundations of a right to procreate as well as John Robertson’s thoughtful account of “procreative liberty” but conclude that at the present time there exists no compelling account of a right to procreate. Finally, I conclude that in the absence of a satisfactory account of a right to procreate, we should refrain from grounding practices or polices on the assumption that there is such a right. (shrink)

This article considers whether any interpretation of the idea of equal claims to the natural world can resolve the Canyon Dilemma (i.e. can justify protecting the Grand Canyon but not a small canyon from mining by a poor generation). It first considers and ultimately rejects the idea of subjecting natural resource rights to an intergenerational equal division. It then demonstrates that a pluralist theory of environmental justice committed to both respect for the separateness of persons and to the collective good (...) can justify a type of intergenerational non-absolute equal division of natural resource rights that can navigate the Canyon Dilemma. (shrink)

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

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)

Dignity may just be the most promiscuous normative abstraction. This article, informed by dignity’s historical variability, political theoretic multipurpose, and conflicting jurisprudence, focuses on a particular but influential invocation of the term: dignity as the normative ground for the ‘capabilities approach’ (CA) model of social justice. We ask whether or not the CA, in particular the influential version propounded by philosopher Martha Nussbaum, requires dignity as its foundational premise, and whether or not dignity may be more costly than beneficial for (...) the CA’s vision of a minimally just society. The first section of this article rehearses the warrants of and criticisms against the dignity-basis of Nussbaum’s CA. We canvass the relatively sparse scholarship on dignity within the CA to situate our contribution. The next two sections are case studies, demonstrating dignity’s shortcomings for assessing and regulating sex and abortion, respectively. The fourth section rebuts two possible objections to our criticisms of dignity. The fifth and final section gestures toward another normative abstraction, ‘minimum conditions of individuation’, less polysemic than dignity, which might alternatively ground the CA. (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)

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)

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)

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)

There is an important moral difference between laws that criminalize drugs and prostitution and laws that make them illegal in other ways: criminalization violates our moral rights in a way that nonlegalization does not. Criminalization is defined as follows. Drugs are criminalized when there are criminal penalties for using or possessing small quantities of drugs. Prostitution is criminalized when there are criminal penalties for selling sex. Legalization is defined as follows. Drugs are legalized when there are no criminal penalties for (...) manufacturing, selling and possessing large quantities of drugs. Prostitution is legalized when there are no criminal penalties for owning or operating a brothel or escort service, no criminal penalties for working as a paid agent for sex work, and no criminal penalties for paying someone for sex who is above the age of legal employment and sexual consent. The criminalization of drugs and prostitution violate the right of self-sovereignty in depriving individuals of important forms of control over their own minds and bodies, but nonlegalization does not violate this right. It is therefore consistent, as a matter of principle, to advocate decriminalization but to oppose legalization. (shrink)

The article analyses the three terms autonomy, dignity and vulnerability. The relevance and practical application of the terms is tested in two spheres. First, as guiding principles in the area of ethics of medicines and science. Second, as human rights principles, serving to guide the conduct of public policies for an effective realization of human rights. The article argues that all human beings have the same dignity, but that the autonomy—and therefore vulnerability—differs considerably. Simply said, with reduced autonomy comes increased (...) vulnerability, implying extra attention to the protective dimensions. The article finds that the three terms approach the protection of human beings in different ways and that all are relevant and applicable in both spheres, but that an isolated notion of autonomy and a ‘group-based’ notion of vulnerability are not adequate. (shrink)

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (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)