This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

The mainstream concept of death—the biological one—identifies death with the cessation of an organism. In this article, I challenge the mainstream position, showing that there is no single well-established concept of an organism and no universal concept of death in biological terms. Moreover, some of the biological views on death, if applied in the context of bedside decisions, might imply unacceptable consequences. I argue the moral concept of death—one similar to that of Robert Veatch—overcomes such difficulties. The moral view identifies (...) death with the irreversible cessation of a patient’s moral status, that is, a state when she can no longer be harmed or wronged. The death of a patient takes place when she is no longer capable of regaining her consciousness. In this regard, the proposal elaborated herein resembles that of Veatch yet differs from Veatch’s original project since it is universal. In essence, it is applicable in the case of other living beings such as animals and plants, provided that they have some moral status. (shrink)

For the sake of consistency with settled principles from other theological and ethical questions, there is a need for a Christian reexamination of in vitro fertilization (IVF). Both Old and New Testaments demonstrate that human personal life begins at conception or fertilization. Additionally, the Bible teaches that human beings are persons in the image of God from the very beginning of their existence. Thus, it can be concluded that the embryos created via IVF are persons in God’s image. Applying this (...) to the destruction and freezing of embryos, several limitations or restrictions present themselves—embryos should not be purposefully destroyed or wasted, all embryos ought to be implanted, and embryos should not be frozen. Ultimately, however, due to the immense quantity of embryo wastage, it is concluded that Christians should avoid this form of assisted reproductive technology and consider it a pro-life issue. (shrink)

This paper criticizes Jerome Wakefield’s harmful dysfunction analysis of disorder by arguing that the conceptual linkage it establishes between the medical concepts of health and disorder and the prudential notions of well-being and harm makes the account inapplicable to nonsentient organisms, such as plants, fungi, and many invertebrate animals. Drawing on a previous formulation of this criticism by Christopher Boorse, and noting that Wakefield could avoid it if he adopted a partly biofunction-based account of interests like that often advocated in (...) the field of environmental ethics, I argue that integrating such an account of interests into the HDA would generate serious concerns. Specifically, it would make dysfunction sufficient for disorder and so reestablish between dysfunction and disorder precisely the kind of sufficiency relation that harm-requiring accounts of disorder strive to avoid; blur the line between the HDA’s dysfunction and harm components and, in so doing, deprive the HDA of its alleged main advantage over monistic dysfunction-based accounts of disorders like Boorse’s; and tie the HDA to an understanding of harm that is in itself problematic. I argue that these three concerns, and the dilemmas they generate, rob the HDA of much of its prima facie appeal, ultimately indicating that a satisfactory account of disorder should most likely eschew all references to prudential notions of well-being and harm. (shrink)

There are increasing calls for rejecting the ‘dead donor’ rule and permitting ‘organ donation euthanasia’ in organ transplantation. I argue that the fundamental problem with this proposal is that it would bestow more worth on the organs than the donor who has them. What is at stake is the basis of human equality, which, I argue, should be based on an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be (...) to make our worth contingent upon variable quality of life of judgments that can only be based on properties that come in degrees. Thus, rejecting the ‘dead donor’ rule comes at the expense of our egalitarian principles with respect to the value each individual human life has in relation to the protections against killing. (shrink)

Although much has been written on the dead-donor rule in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of (...) the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward. (shrink)

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

The literature of bioethics suffers from two serious problems. (1) Most authors are unable to take seriously both the rights of the great apes and of severely disabled human infants. Rationalism—moral status rests on rational capacities—wrongly assigns a higher moral status to the great apes than to all severely disabled human infants with less rational capacities than the great apes. Anthropocentrism—moral status depends on membership in the human species—falsely grants all humans a higher moral status than the great apes. Animalism—moral (...) status is dependent on the ability to suffer—mistakenly equates the moral status of humans and most animals. (2) The concept person is widely used for justificatory purposes, but it seems that it cannot play such a role. It seems that it is either redundant or unable to play any justificatory role. I argue that we can solve the second problem by understanding person as a thick evaluative concept. This then enables us to justify assigning a higher moral status to the great apes than to simple animals: the great apes are persons. To solve the first problem, I argue that certain severely disabled infants have a higher moral status than the great apes because they are dependent upon human relationships for their well-being. Only very limited abilities are required for such relationships, and the question who is capable of them must be based on thick evaluative concepts. Thus, it turns out that to make progress in bioethics we must assign thick evaluative concepts a central role. (shrink)

A Moorean fact, in the words of the late David Lewis, is ‘one of those things that we know better than we know the premises of any philosophical argument to the contrary’. Lewis opens his seminal paper ‘Elusive Knowledge’ with the following declaration.

An increasing shortage of transplant donor organs currently results in an escalating number of preventable human deaths. Xenotransplantation. the use of animal organs for transplantation into humans, is now heralded as medicine's most viable answer to the urgent and insurmountable human organ scarcity. Although claimed to be a biomedical prerogative, xenotransplantation is a cultural phenomenon - a procedure engaging both the physical and symbolic manipulation of human and nonhuman bodies, thereby transforming corporeality, identity, and culture. Biomedical and scientific discourses about (...) xenografts have obscured issues related to nonhuman animals and also could be distressful to human organ recipients, revealing that the xenograft may not be widely embraced. (shrink)

Having encountered landmines in offering a critique of philosophy based on my experience as the mother of a cognitively disabled daughter, I ask, “Should I continue?” I defend the idea that pursuing this project is of a piece with the invisible care labor that is done by people with disabilities and their families. The value of attempting to influence philosophical conceptions of cognitive disability by virtue of this experience is justified by an inextricable relationship between the personal, the political, and (...) the philosophical. If one grants that the “special relationship” between mother and child requires moral recognition, then I need first to make vivid the case that this relationship in the case of a child who lacks some “normal capacities” is indistinguishable from any mother‐child relationship. If this is so, then I believe I can make a case that has as its conclusion that the moral personhood of even the severely cognitively disabled must be granted. Moreover, such recognition, I argue, necessitates the recognition of others who bear no special relationships to the child. (shrink)

How should a philosophical inquiry into the moral status of (nonhuman) animals proceed? Many philosophers maintain that by examining the “morally relevant” psychological or physiological capacities possessed by the members of different species, and comparing them with similar capacities possessed by human beings, the moral status of the animals in question can be established. Others contend that such an approach runs into serious moral and conceptual problems, a crucial one being that of how to give a coherent account of the (...) natural sense of concern for profoundly cognitively impaired human beings if moral status is assumed to depend on features that centrally include cognitive capacities. The present article discusses this debate with reference to Wittgenstein-influenced philosophers whose respective approaches, on the face of it, diverge dramatically. With a primary focus on Hans-Johann Glock and Cora Diamond, and a secondary focus on recent work by Alice Crary, I argue that, despite an overt disavowal of the kind of approach favoured by Diamond and Crary, Glock’s affirmation that we simply do “value human life” brings him closer to that approach than he acknowledges. (shrink)

Lockean accounts of personhood propose that an individual is a person just in case that individual is characterized by some advanced cognitive capacity. On these accounts, human beings with severe cognitive impairment are not persons. Some accept this result—I do not. In this paper, I therefore advance and defend an account of personhood that secures personhood for human beings who are cognitively impaired. On the account for which I argue, an individual is a person just in case that individual belongs (...) to a natural kind that is normally characterized by advanced cognitive capacities. Since “human being” is just such a natural kind, individual human beings can be persons even when they do not themselves have advanced cognitive capacities. I argue, furthermore, that we have good reason to accept this account of personhood over rival accounts since it is uniquely able to accommodate the intuitive concept of an impaired person. (shrink)

The reemergence of the question of suicide in the medical context of physician-assisted suicide seems to me one of the most interesting and fertile facets of late modernity. Aside from the disruption which this issue may cause in the traditional juridical relationship between individuals and the state, it may also help to transform the dominant conception of subjectivity that has been erected upon modernity's medicalized order of death. To enhance this disruptive potential, I am going to examine the perspectives on (...) death offered by two contemporary writers: Zygmunt Bauman and Jean Baudrillard. Each of these writers recognizes the centrality of death to modern culture, as Heidegger did, but they also go beyond him in specifying the ways in which death maintains a presence in late modernity, despite efforts to conceal it. In particular, both of these writers recognize the important role that medicine has played in ordering the modern conception of death. After situating these two perspectives in relation to each other, and in relation to Heidegger, who will serve here as a sort of benchmark, I will return to the issue of suicide. Given the differences in their readings of the role that death and medicine play in modern culture, these post-Heideggerians take strikingly different positions on this issue. By engaging these perspectives, I intend not only to point out the tremendous potential which this issue holds for a fundamental rethinking of modern subjectivity, but also reveal some of the dangers that may beset any naive optimism about the right to die. (shrink)

Many people today believe that scientific and religious approaches to morality are mutually incompatible. Militant secularists claim scientific backing for their claim that the evolution of morality discredits religious conceptions of ethics. Some of their opponents respond with unhelpful apologetics based on fundamentalist views of revelation. This article attempts to provide an alternative option. It argues that public discussion has been excessively influenced by polemics generated by the new atheists. Religious writers have too often resorted to overly simplistic arguments rooted (...) in literalist approaches to the Bible and the religious traditions. More historically conscious methods can avoid implausible claims about both religion and science. (shrink)

This essay has two purposes. The first is to argue that our moral duties towards human embryos should be assessed in light of the Golden Rule by asking the normative question, “how would I want to be treated if I were an embryo?” Some reject the proposition “I was an embryo” on the basis that embryos should not be recognized as persons. This essay replies to five common arguments denying the personhood of human embryos: (1) that early human embryos lack (...) ontological individuation; (2) that they are members of the species Homo sapiens but not yet human persons; (3) that the argument for personhood commits the “heap argument” fallacy; (4) that since human procreation in nature is inefficient, human embryos cannot be persons; and (5) the “burning building” scenario proves that all arguments for personhood are irrational or inconsistent. The second purpose is to set forth and criticize in light of the normative judgement defended in part one the present legal situation of cryo-preserved embryos in the U.S. The essay ends by proposing legislative reforms to protect ex utero human embryos. (shrink)

In 1977 John Money published the first modern case histories of what he called ‘apotemnophilia’, literally meaning ‘amputation love’ [Money et al., The Journal of Sex Research, 13(2):115–12523, 1977], thus from its inception as a clinically authorized phenomenon, the desire for the amputation of a healthy limb or limbs was constituted as a sexual perversion conceptually related to other so-called paraphilias. This paper engages with sex-based accounts of amputation-related desires and practices, not in order to substantiate the paraphilic model, but (...) rather, because the conception of these (no doubt) heterogeneous desires and practices as symptoms of a paraphilic condition (or conditions) highlights some interesting cultural assumptions about ‘disability’ and ‘normalcy’, their seemingly inherent (un)desirability, and their relation to sexuality. In critically interrogating the socio-political conditions that structure particular desires and practices such that they are lived as improper, distressing and/or disabling, the paper constitutes an exercise in what Margrit Shildrick [Beyond the body of bioethics: Challenging the conventions. In M. Shildrick and R. Mykitiuk (Eds.), Ethics of the body: Postconventional challenges (pp. 1–26). New York: MIT Press, 2005] refers to as “postconventional ethics”. (shrink)

Personhood is a foundational concept in ethics, yet defining criteria have been elusive. In this article we summarize attempts to define personhood in psychological and neurological terms and conclude that none manage to be both specific and non-arbitrary. We propose that this is because the concept does not correspond to any real category of objects in the world. Rather, it is the product of an evolved brain system that develops innately and projects itself automatically and irrepressibly onto the world whenever (...) triggered by stimulus features such as a human-like face, body, or contingent patterns of behavior. We review the evidence for the existence of an autonomous person network in the brain and discuss its implications for the field of ethics and for the implicit morality of everyday behavior. (shrink)

According to the mainstream position in the bioethical definition of death debate, death is to be equated with the cessation of an organism. Given such a perspective, some bioethicists uphold the position that brain-dead patients are dead, while others claim that they are alive. Regardless of the specific opinion on the status of brain-dead patients, the mere bioethical concept of death, according to many bioethicists, has the merit of being unanimous and univocal, as well as grounded in biology. In the (...) present article, we challenge such a thesis. We provide evidence that theoretical biology operates with a plurality of equally valid organismic concepts, which imply different conclusions regarding the organismal status of a brain-dead patient. Moreover, the theoretical biology concepts of an organism are very distant from the view on an organism that appears by way of bioethicists theorizing on death. We conclude that if death is to be understood as the cessation of an organism, there is no single correct answer to the question of whether a brain-dead patient is alive or dead. (shrink)

In recent time the critique of the whole brain death as the criterion of human death, that was introduced in 1968, has been growing. The paper aims to show in systematically that there are good reasons based on empirical findings combined with Thomistic Christian anthropology to accept the traditional cardiopulmonary criterion as the criterion of human death. This will be shown through a systematic critique of other criteria of death: whole brain death, higher brain death, brain stem death, and controlled (...) cardiac/circulatory death. The traditional cardiopulmonary criterion of death provides the opportunity to maintain the dead donor rule for organ transplantation. This also affirms the respect for human life required by the ethics of the sanctity of human life. The paper further provides a justification of dead donor rule. The paper proposes 35 minutes period after cardiac arrest to declare the patient dead, since at that time there is no possibility to autoresuscitate the heart. (shrink)

In this article I argue that the fundamental axiological claim of the New Natural Law Theory, according to which human life has an intrinsically valuable, cannot be defended within the framework assumed by the New Natural Law Theory itself, and further, that such a claim turns out to be false relative to a wider eudaimonistic framework that the Natural Law theorist is committed to accept. I do this this by adopting a dialectical standpoint which excludes any assumptions that could be (...) denied by the New Natural Law theorist, except for the axiological claim, and show that the New Natural Law theorist cannot argue for the axiological claim's plausibility, and moreover, that in such a setting the New Natural Law theorist is compelled to replace the axiological claim by the claim that human life is instrumentally valuable. La afirmación axiológica fundamental de la Nueva Ley Natural según la cual la vida humana tiene un valor intrínseco, no puede ser defendida dentro del marco teórico asumido por dicha teoría, y resulta ser falsa en un marco eudemonista más amplio, que debe ser aceptado por el teórico de la ley natural. Se asume una posición dialéctica que excluye cualquier suposición que pueda ser negada por el teórico de la NLN, con excepción de la afirmación axiológica, y se demuestra que él no puede mostrar la plausibilidad de la afirmación axiológica; más aún, que se ve forzado a reemplazar la afirmación axiológica por la aceptación de que la vida humana tiene un valor instrumental. (shrink)

Science is a discipline defined by empiricism and reliable methodologies that result in predictable outcomes. Yet, cutting-edge experiments inevitably involve an element of the unknown, an aspect which science fiction exploits for dramatic effect. Furthermore, fictional science is freed from the ethical constraints that regulate real-world experimentation and is therefore often transgressive. Even as films capitalize on unethical practices and cutting-edge scenarios for dramatic and commercial reasons, the origin of the filmmaker and/or place of production may affect a film’s content. (...) A film is also obviously subject to legal constraints, according to the country of origin, and classification codes in its place of exhibition. Thus, while the very nature of science fiction may cause it to appear morally unbridled, there are nonetheless multiple inhibitions entrenched in such depictions. By drawing on relevant cinematic examples, including Prometheus, The Hunger Games and District 9, and scientific scenarios on which these films are based, this essay explores how the unpredictable nature of advances in science, in combination with a lack of ethics, foregrounds the dangerous dimensions of science fiction. (shrink)

Mind perception is the essence of moral judgment. Broadly, moral standing is linked to perceptions of mind, with moral responsibility tied to perceived agency, and moral rights tied to perceived experience. More specifically, moral judgments are based on a fundamental template of two perceived minds—an intentional agent and a suffering patient. This dyadic template grows out of the universal power of harm, and serves as a cognitive working model through which even atypical moral events are understood. Thus, all instances of (...) immorality are perceived to involve both blameworthy agents (i.e., acts) and suffering victims (i.e., consequences). Because moral cognition simultaneously concerns acts and consequences, theories which focus primarily on acts (i.e., deontology) or consequences (i.e., utilitarianism) do not accurately describe moral cognition. Indeed, the phenomenon of dyadic completion suggests that deontological and utilitarian concerns are not only simultaneously active, but also typically compatible and reinforcing: wrong acts have harmful consequences, and harmful consequences stem from wrong acts. The cognitive fusion of acts with consequences suggests that normative conflicts between deontology and utilitarianism are not reflected in everyday moral judgment. This in turn suggests that empirical conclusions drawn from moral dilemmas that pit utilitarianism against deontology—i.e., trolley problems—give an skewed account of moral cognition. (shrink)

: Many people have lamented the proliferation of human rights claims. The cure for this problem, it may be thought, would be to develop a theory that can distinguish ‘real’ from ‘supposed’ human rights. I argue, however, that the proliferation of human rights mirrors a deep problem in human rights theory itself. Contemporary theories of natural rights to welfare are historical descendants from a theory of rights to subsistence which was developed in twelfth-century Europe. According to this theory, each human (...) being has a special role to fulfil in God's plan and therefore has inalienable rights to subsist. Later theories have secularized this idea by claiming that human beings are purposive agents. Secularization, however, comes at a price. In the case of these theories, the price is a failure to provide satisfactory answers to the most basic questions we would expect of a theory of natural rights to answer. They have failed to provide a basis for ascribing these rights to all and only to human beings. They have not been able to generate a clear and viable criterion for ascribing duties correlative to these rights. And they cannot limit rights-claims in a non-arbitrary way. Hence we should abandon these theories. (shrink)

Singer claims that there are two ways of challenging the fact that brain-dead patients, from whom organs are usually retrieved, are in fact biologically alive. By means of the first, the so called dead donor rule may be abandoned, opening the way to lethal organ donation. In the second, it might be posited that terms such as “life” and “death” do not have any primary biological meaning and are applicable to persons instead of organisms. This second possibility permits one to (...) acknowledge that brain-dead patients are deceased because they are irreversibly unconscious. In the commentary which follows, I will argue that Singer’s second option is preferable since it provides a higher amount of organs available for transplant, and is better suited to the meaning of “death” which occurs in ordinary language. I will also defend such a concept of death against the objections raised by Michael Nair-Collins in the article Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation. (shrink)

Peter Singer’s recent appointment to Princeton University created considerable controversy, most of it focused on his proposal for active euthanasia of disabled infants. Singer articulates utilitarian ideas that often appear in public discussions of euthanasia. Drawing on Pope John Paul II’s work on ethics and suffering, I argue that Singer’s utilitarian theory of value is impoverished. After introducing the Pope’s ethic based on the imago dei, I discuss love as self-gift. I show how this concept supports a theory of value (...) in which spiritual goods are preeminent over material goods. I then describe how suffering reveals spiritual goods, discussing how participation in Christ’s suffering can alter our perception of value. I also consider how communal responses to suffering provide opportunities for self-giving. Third, I consider Singer’s proposal for killing infants with hemophilia, arguing that it arbitrarily ignores spiritual goods. I then discuss proposals to kill anencephalic infants, discussing how parental response to their suffering can demonstrate an extraordinary love in seemingly hopeless circumstances. I conclude by calling for a more sustained social response to euthanasia initiatives. (shrink)

We discuss the meaning of “being alive” and “being dead.” Our primary aim is to pave the way for a sound and accurate ethical debate concerning these two concepts. In particular, we analyze a metabolic approach and a genetic one and discuss the reasons for their failure to constitute a good starting point for successive debates. We argue that any ethical or social discussion of topics involving life and death must introduce cultural constructs such as, on the one hand, the (...) concept of clinical death and, on the other hand, the concept of existence. We argue that these two cultural constructs, although consistent with biomedical knowledge, cannot be ontologically grounded in it. To conclude, we apply our findings to the case of human embryos. (shrink)

Animal advocates cannot allow the idea to take hold that only the great apes and certain other “higher” animals are fit to be “persons.” Working to change the moral status of the great apes or sea mammals; for example; is a legitimate and important undertaking; but it should not be done at the expense of other animals. Such thinking is not only disconnected from real animals in the real world; it perpetuates the view that beings belonging to species deemed “nonpersons” (...) or “merely conscious” are of lesser; or no; moral significance until or unless; through an institutionalized system of painful; stressful; and demeaning experiments over decades or centuries; some of them might “prove” themselves worthy of being called persons or semi-persons or sort-of-persons entitled to whatever privileges such designations may confer. (shrink)

In this article I argue that the fundamental axiological claim of the New Natural Law Theory, according to which human life has an intrinsically valuable, cannot be defended within the framework assumed by the New Natural Law Theory itself, and further, that such a claim turns out to be false relative to a wider eudaimonistic framework that the Natural Law theorist is committed to accept. I do this this by adopting a dialectical standpoint which excludes any assumptions that could be (...) de-nied by the New Natural Law theorist, except for the axiological claim, and show that the New Natural Law theorist cannot argue for the axiological claim’s plausibility, and moreover, that in such a setting the New Natural Law theorist is compelled to replace the axiological claim by the claim that human life is instrumentally valuable. (shrink)

The motives of philosophers tend to be personal. Philosophy has mattered politically as part of continuing political debates. Its effects on politics, religion and the development of the sciences have been evident. Philosophy has been supposed to have special educational value, from its contents or from the benefits of its methods and arguments. This is doubtful. Rather, philosophy matters because its concerns matter. How much philosophy matters, or should matter, may be a question of local taste.

Liberal articulations of the right to die generally focus on balancing individual rights against state interests, but this approach does not take full advantage of the disruptive potential of this contested right. This article develops an alternative to the liberal approach to the right to die by engaging the seemingly discordant philosophical perspectives of Michel Foucault and Thomas Hobbes. Despite Foucault’s objections, a rapprochement between these perspectives is established by focusing on their shared emphasis on the role that death plays (...) in the order of modernity. After the article has established the complementarity of Foucault and Hobbes, Hobbes’ unique stance toward suicide is first viewed in the context of the early-modern hostility toward suicide, and then contrasted with Foucault’s Stoic-inspired affirmation of suicide. This comparison of these two philosophers’ positions on suicide opens to contestation dimensions of modern subjects that remain undisturbed by liberal approaches to the right to die Key Words: bio-power • Michel Foucault • governmentality • Thomas Hobbes • liberalism • right to die • self-preservation • Seneca • Stoicism • suicide. (shrink)

The question of enhancement occupies a prominent place not only in current bioethical debates but also in wider public discussions about our human future. In all of these, the problem of enhancement is usually articulated via two sets of questions: moral questions over its permissibility, extent and direction; and technical questions over the feasibility of different forms of regenerative and synthetic alterations to human bodies and minds. This article argues that none of the dominant positions on enhancement within the field (...) of bioethics is entirely satisfactory due to the limited, monadic, pre-technological and non-cultural conception of the human that is adopted in these models. Critically engaging with both opponents of enhancement (Habermas) and its advocates (Harris, Agar, Bostrom, Dworkin), Zylinska also takes some steps towards outlining a nonnormative ethics of enhancement. The latter sees its human and non-human subjects as always already enhanced, and hence dependent, relational and coevolving with technology. (shrink)

Most legal analyses of selective nontreatment of seriously ill children centre on the question of whether it is in a child’s best interests to be kept alive in the face of extreme suffering and/or an intolerable quality of life. Courts have resisted any direct confrontation with the question of whether the child’s death is in his or her best interests. Nevertheless, representations of death may have an important role to play in this field of jurisprudence. The prevailing philosophy is to (...) configure death as a release from a futile or painful existence and/or as a dignified end in an objectively hopeless situation. However, there can be disagreement about the meaning of death in these settings. Some parents object that death would be premature or that it represents a culpable neglect of their child. A closer examination of these discordant interpretations allows for a better comprehension of the cultural understandings that underscore clinical and legal accounts of death following end-of-life decisions. (shrink)

Over the last 50 years, there has been significant development of qualitative research and related methods in healthcare. Theoretical frameworks support researchers in selecting appropriate research approaches, procedures and analytical tools. However, the implications of the choice of theory are sparsely elucidated. Based on a text excerpt from a public debate article, the study aimed to show how different theory‐inspired analytical perspectives produced varied understandings of the same text. The study presented three subanalyses inspired by Bourdieu's sociological theory, Lazarus and (...) Folkman's psychological theory and utilitarian ethics, respectively. The analyses showed that by using different theoretical analytical perspectives in inductive processes, an immediate interpretation of the text was not obvious. It became possible to spot the underlying meta‐theoretical assumptions, as the interpretations were not taken for granted or indisputable. Our analyses suggest that different theoretical lenses lead to different interpretations of the same empirical material, recognising the existence of multiple truths or realities. Thus, utilising a theoretical perspective in inductive analyses can enhance transparency and rigour because the analytical optics are made explicit to the reader. This allows the reader to follow the analysis processes and comprehend from which theoretical starting point a truth arises. (shrink)

In his paper “The challenge of brain death for the sanctity of life ethic”, Peter Singer advocates two options for dealing with death criteria in a way that is compatible with efficient organ transplantation policy. He suggests that we should either redefine death as cortical death or go back to the old cardiopulmonary criterion and scrap the Dead Donor Rule. We welcome Singer’s line of argument but raise some concerns about the practicability of the two alternatives advocated by him. We (...) propose adding a third alternative that also – as the two previous alternatives – preserves and extends the possibility of organ transplantation without using anyone without their consent. Namely, we would like to draw readers’ attention to a proposal by Robert Veatch, formulated 42 years ago in his 1976 book “Death, dying, and the biological revolution” and developed further in his later publications. Veatch argues for a conscience clause for the definition of death that would permit people to pick from a reasonable range of definitional options. This autonomy-based option, we believe, is more likely to be practicable than the two options advocated by Singer. Furthermore, we present data from a study with Lithuanian participants that suggest that there is quite pronounced variation of preferences concerning death determination. (shrink)

Physicians have long aided their patients in dying in an effort to ease human suffering. It is only in the nineteenth and twentieth centuries that the prolongation of life has taken on new meaning due to the powers now available to physicians, through new drugs and high technology interventions. Whereas earlier physicians and patients could readily acknowledge that nothing further could be done, today that judgment is problematic.Most often, aiding the dying took the form of not doing anything further to (...) prolong life. Morally, this act of restraint was not difficult, because few options could have been considered. However, some physicians, rarely, would help patients die either by hastening death directly or by increasing pain control with the risk of hastening death, the so-called double effect. When directly hastening death, physicians either directly caused the death of the patient through euthansia, or supplied the means to the patient to bring about death with or without encouragement to use these means. The latter is physician-assisted suicide. (shrink)

For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a (...) broader debate over fundamentals, and a different approach to bioethical debate. (shrink)

Innovation processes are extremely complex and opaque, which makes it tough or even impossible to govern them. Innovators lack control of large parts of these developments and lack of foreknowledge about the possible consequences of emerging technologies. Because of these features some scholars have argued that innovation processes should be structurally reformed and the agent-centered model of responsibility for innovation should be dismissed altogether. In the present article it will be argued that such a structural idea of responsible research and (...) innovation presumes rational agents who can be motivated by reasons. Instead of dismissing the agent-centered approach to responsibility for innovation processes a virtue ethical approach will be developed. Virtues should be considered as the intellectual and moral dispositions presumed for good decision making. It will be shown that creativity and eagerness are creditable character traits that have a distinct positive value for managing the opaqueness of innovation processes. Such traits are mandatory for change and betterment. Furthermore, it will be argued that the notion of responsibility of innovators should not be understood merely as means for constraining them but also as a tool to perpetuate their integrity and happiness. Through discussing the captivating examples of Steve Jobs and the protagonist of Mary Shelley’s Frankenstein it will be shown how to apply this virtue ethical framework for innovators in practice. (shrink)

This paper forms part of the feminist critique of the regulatory consequences of biomedicine’s systematic exclusion of the role of women’s bodies in the development of reprogenetic technologies. I suggest that strategic use of notions of the sacred to decontextualise and delimit disagreement fosters this marginalisation. Here conceptions of the sacred and sacralisation afford a means by which pragmatic consensus over regulation may be achieved, through the deployment of a bricolage of dense images associated with cultural loyalties to solidify support (...) or exclude contradictory elements. Hence an explicit renegotiation of the symbolic order structuring salient debates is necessary to disrupt and enrich the entrenched and exclusionary dominant discourse over reprogenetic regulation. I draw upon previous analyses of strategic rhetoric associated with the regulation of infertility treatment and embryo research in the United Kingdom, the cultural anthropology of biomedicine and feminist ethnographies of reprogenetics to illustrate these claims. (shrink)

Se analizan las bases hermenéuticas de toda decisión ética. La normatividad moral exige una comprensión de las circunstancias, porque solo desde su intelección se puede realizar un buen juicio ético. Si, para Peter Singer, las herramientas para tal aprehensión son de tipo racional, Mauricio Beuchot las amplía por medio de la intuición y la sutileza. Se discute si las pretensiones argumentales de Singer se actualizan en sus obras.

Det er muligens ikke lenger et spørsmål om, men når mennesker med Downs syndrom ikke lenger finnes blant oss. Moderne medisinsk teknologi brukt i masseundersøkelser av gravide, tilsier at det nesten ikke behøver å bli født mennesker med Downs syndrom i fremtiden. I den politiske debatten i flere av de nordiske landene er dette kontroversielt. Det handler om et samfunn der det er plass til alle, hevdes det. På samme tid tas moderne genteknologi i bruk for bl.a. å forhindre at (...) mennesker disponert for Huntingtons sykdom eller arvelig brystkreft blir født. Om noen generasjoner kan slike sykdommer være utryddet. Dette påkaller imidlertid ikke henvisninger til «sortering» og «seleksjon». I denne artikkelen undersøkes de viktigste forutsetningene for hvorfor fosterdiagnostikk på noen indikasjoner vekker etisk debatt, mens det ikke skjer i andre tilfeller. Det argumenteres for at den medisinske forståelsen av alvorlighetsgrad ved en sykdom/funksjonshemming ikke gir oss nøkkelen til å forstå den etiske bekymringen rundt seleksjon. Identitets- og anerkjennelsesproblematikk, hevdes det, er kjernen i kontroversene rundt fosterdiagnostikk i Norden. Derfor står det noe vesentlig på spill i fosterdiagnostikkdebatten. Men bare for noen grupper. (shrink)