This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper (...) understanding of some of the most controversial issues in modern medicine. (shrink)

BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the ethical (...) principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care?ResultsTwenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care.ConclusionFurther studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress. (shrink)

The aim of this article is to bring to social theorists’ attention the growing visibility of the notion of dignity within human rights legislation, bioethics and public discourse generally, as well as to evaluate this term’s potential to enhance our capacities to respond to old and new challenges. The article starts with a short presentation of the career of the concept and discussion of the various impasses and conceptual tensions connected with the notion of human dignity. It is followed by (...) an exploration of how the idea of human dignity has become one of the main achievements of modern times. The question of how respect for human dignity has turned out to be the fundamental feature of democratic society is addressed with help from both Waldron’s perspective on human dignity as the ground of human rights and Habermas’s approach that stresses the moral content of human rights. The final part of the article examines the value of the notion of dignity for social theorizing by looking at ways the employment of the concept may contribute to sociological thought and enquiry. (shrink)

This article proffers a personhood-based conception of a meaningful life. I look into the ethical structure of the salient idea of personhood in African philosophy to develop an account of a meaningful life. In my view, the ethics of personhood is constituted by three components, namely (1) the fact of being human, which informs (2) a view of moral status qua the capacity for moral virtue, and (3) which specifies the final good of achieving or developing a morally virtuous character. (...) In light of the ethics of personhood, I will propose the view that a meaningful life is a function of achieving moral excellence or perfection. The moral perfection proposed here, to embody a meaningful life, is of a deontological and satisficing kind. The achievement of satisfactory levels of moral excellence, within sociopolitical and moral limits, captures the essence of a meaningful life. I conclude the article by considering objections against the view proposed here. (shrink)

Secular arguments for equal and exclusively human worth generally tend to follow one of two strategies. One, which has recently gained renewed attention because of a novel argument by S. Matthew Liao, aims to directly ground worth in an intrinsic property that all humans have in common, whereas the other concedes that there is no morally relevant intrinsic difference between all humans and all other animals, and instead appeals to the membership of all humans in a special kind. In this (...) article, I argue that both strategies necessitate drawing a line that is both arbitrary and implausibly opens a moral gulf between individuals whose difference from one another in terms of empirical reality is entirely unremarkable, providing reasons to reject them that go beyond the standard objections in the literature. I conclude that, if all humans are to be included in the community of equals, we must lay to rest the idea that we can do so without also including a wide range of non-human animals. (shrink)

The development of biotechnologies has broadly interfered with a number of life processes, including human birth. An important moral question arises from the application of such medical technologies to birth: do biotechnological advancements violate human dignity? Many valid arguments have been raised. Yet bioethicists are still far from reaching a consensus on how best to protect the dignity of human birth. Confucianism is an influential ethical theory in China and presents a distinctive understanding of human dignity. In this paper, we (...) reconstruct the two Confucian concepts of dignity—namely, universal dignity and personal dignity. We then apply these concepts to human birth in the context of biotechnologies involving embryos and genetic enhancement. We conclude that the dual Confucian understanding of dignity contributes a valuable perspective to the question of whether biotechnologies related to human birth violate human dignity. (shrink)

Death with dignity is a significant issue in modern bioethics. In modern healthcare, the wide use of new technologies at the end of life has caused heated debate on how to protect human dignity. The key point of contention lies in the different understandings of human dignity and the dignity of death. Human dignity has never been a clear concept in Western ethical explorations, and the dignity of death has given rise to more confusions. Although there is no such term (...) as “dignity” in Confucian ethics, there are discussions of a number of ideas related to human dignity and the dignity of death. Therefore, Confucian bioethics can offer a new perspective for understanding the theoretical difficulties associated with the dignity of death and new methods for solving them. In this article, we attempt to reconstruct Confucian views on human dignity and the dignity of death and, based on those views, to analyze the following issues: the relationship between the dignity of death and biological life, the relationship between the dignity of death and suffering, the relationship between the dignity of death and the autonomy of human beings, and the relationship between the dignity of death and social justice. This article will also compare the Confucian views on these issues with the views of Western philosophers. Confucian ethics can offer distinct answers to the above issues and help resolve some confusions concerning concepts and theories in Western research on the dignity of death. (shrink)

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel–patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical (...) dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients’ life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. (shrink)

There are few moral convictions that enjoy the same intuitive plausibility and level of acceptance both within and across nations, cultures, and traditions as the conviction that, normally, it is morally wrong to kill people. Attempts to provide a philosophical explanation of why that is so broadly fall into three groups: Consequentialists argue that killing is morally wrong, when it is wrong, because of the harm it inflicts on society in general, or the victim in particular, whereas personhood and human (...) dignity accounts see the wrongness of killing people in its typically involving a failure to show due respect for the victim and his or her intrinsic moral worth. I argue that none of these attempts to explain the wrongness of killing is successful. Consequentialism generates too many moral reasons to kill, cannot account for deeply felt and widely shared intuitions about the comparative wrongness of killing, and gives the wrong kind of explanation of the wrongness of killing. Personhood and human dignity accounts each draw a line that is arbitrary and entirely unremarkable in terms of empirical reality, and hence ill-suited to carry the moral weight of the difference in moral status between the individuals below and above it. Paying close attention to the different ways in which existing accounts fail to convince, I identify a number of conditions that any plausible account of the wrongness of killing must meet. I then go on to propose an account that does. I suggest that the reason that typically makes killing normal human adults wrong equally applies to atypical human beings and a wide range of non-human animals, and hence challenge the idea that killing a non-human animal is normally easier to justify than killing a human being. This idea has persisted in Western philosophy from Aristotle to the present, and even progressive moral thinkers and animal advocates such as Peter Singer and Tom Regan are committed to it. I conclude by discussing some important practical implications of my account. (shrink)

Recent discussion on the ethics of killer robots has focused on the supposed lack of respect their deployment would show to combatants targeted, thereby causing their undignified deaths. I present two rebuttals of this argument. The weak rebuttal maintains that while deploying killer robots is an affront to the dignity of combatants, their use should nevertheless be thought of as a pro tanto wrong, making deployment permissible if the affront is outweighed by some right-making feature. This rebuttal is, however, vulnerable (...) to the charge that killer robots would cause unnecessary suffering. The strong rebuttal, in contrast, argues that the use of killer robots would not disrespect the dignity of combatants, for reasons discussed. I also argue that, irrespective of whether killer robots disrespect the dignity of combatants, they would not necessarily bring about their undignified deaths: for one can maintain dignity in the face of indignity. (shrink)

As is often the case in clinical ethics, the discourse in COVID-19 has focused primarily on difficult and controversial decision-making junctures such as how to decide who gets access to intensive care resources if demand outstrips supply. However, the lived experience of COVID-19 raises less controversial but arguably more profound moral questions around what it means to look after each other through the course of the pandemic and how this translates in care for the dying. This piece explores the interface (...) between the pandemic, ethics, and the role of palliative care. We argue that the ethical discourse should be broader, and that the principles that underly the discipline of palliative care provide a solid ethical foundation for the care of all patients through the coronavirus pandemic. (shrink)

Shortages in the number of donated organs after death and the growing number of end-stage organ failure patients on waiting lists call for looking at alternatives to increase the number of organs that could be used for transplantation purposes. One option that has led to a legal and ethical debate is to have regulated markets in human organs. Opponents of a market in human organs offer different arguments that are mostly founded on contingent factors that can be adjusted. However, some (...) authors have asked the question whether we still have a reason to believe that there is something wrong with offering human organs for sale for transplantation purposes, even if the circumstances under which the practice takes place are improved. One prominent argument regarding this appeals to the notion of human dignity. It is argued that organ selling violates human dignity. This paper presents a systematic discussion of dignity-based arguments in the organ selling debate, and then develops a social account of dignity. It is argued that allowing the practice of organ selling inherently runs the risk of promoting the notion that some persons have less worth than others and that persons have a price, which is incompatible with dignity. The approach is defended against possible objections and it is shown that it can capture the notion that autonomy is linked to human dignity in important ways, while dignity at the same time can constrain the autonomous choices of persons with regards to certain practices. (shrink)

Cultured meat, like any new technology, raises inevitable ethical issues. For example, on animal ethics grounds, it may be argued that reformed livestock farming in which animals’ lives are worth living constitutes a better alternative than cultured meat, which, along with veganism, implies the extinction of farm animals. Another ethical argument is that, just as we would undermine human dignity by producing and consuming meat that is grown from human cells, eating meat that is grown from nonhuman animal cells would (...) violate animal dignity because it is a way to create an us and them, which would make veganism the only ethical option. The present study challenges this argument. First, I examine the fundamental issue of whether cultured meat provides such an attack on animal dignity. The second issue is whether, assuming that it is true that cultured meat undermines animal dignity, it would be acceptable to reject cultured meat even though this implies sacrificing nonhuman animals. (shrink)

This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated. The article (...) concludes by discussing the relevance of this concept of dignity to the spiritual and ethical care of the dying. (shrink)

The fundamental claim that the practice of medicine is essentially a moral enterprise remains highly contentious, not least among the dominant traditional moral theories. The medical profession itself is today characterized by multicultural pluralism and moral relativism that have left the Hippocratic moral tradition largely in disarray. In this paper, I attempt to clarify the ambiguity about practicing medicine as a moral enterprise and echo Pellegrino’s call for a phenomenologically and teleologically derived philosophy of medicine. I proffer a realistic trifocal (...) matrix in which the virtuous moral agency and the teleologically derived moral imperative of the physician are comprehensively integrated with an action-guiding practical analytical framework for the resolution of ethical dilemmas in medicine. I argue that this trifocal perspective points us towards an authentic philosophy of medicine that is not only verifiable through Lonerganian self-appropriation, but also authentically objective through the possible moral self-transcendence of the good physician. (shrink)

Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons in minimally conscious state (...) remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity. (shrink)

For some decades, the concept of human dignity has been widely discussed in bioethical literature. Some authors think that this concept is central to questions of respect for human beings, whereas others are very critical of it. It should be noted that, in these debates, dignity is one component of a long-lasting and widespread conceptual construct used to support a stance on the ethical question of the moral status of an action or being. This construct has been used from Modernity (...) onward to condemn slavery and torture as violations of human dignity. In spelling it out, we can come to a better understanding of what “dignity” means and become aware that there exists a quite useful place for this notion in our ethical thought, albeit a modest one. (shrink)

The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Thus, one cannot (...) conclude that these meanings are arbitrary and unrelated. This categorization and logical and linguistic analysis helps to unravel what seem to be contradictions in discourse about dignity and bioethics, and provides a hierarchy of meaning that has potential normative implications. (shrink)

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

The concept of dignity is notoriously vague. In this paper it is argued that the reason for this is that there are three versions of dignity that are often confused. First we will take a short look at the history of the concept of dignity in order to demonstrate how already from Roman Antiquity two versions of dignity can be distinguished. Subsequently, the third version will be introduced and it will be argued that although the three versions of dignity hang (...) together, they should also be clearly distinguished in order to avoid confusion. The reason for distinguishing the three versions is because all three of them are only partially effective. This will be demonstrated by taking the discussion about voluntary ‘dying with dignity’ as an example. Inspired by both Paul Ricoeur’s concept of ethics and the ethics of care a proposition will be done as to how the three versions of dignity may sustain each other and help achieve what neither one of the versions can do on its own. (shrink)

On a reproché au modèle perceptuel de la connaissance morale d'être inadéquat en ce qu'il serait incapable d'expliquer le signe distinctif et fondamental de l'éthique, à savoir son caractère normatif. Je tente de montrer que la critique n'est pas pertinente, car le normatif n'a en réalité qu'une place dérivée en morale : l'éthique est d'abord une question de valeurs, entités dont il est tout à fait plausible de dire que nous les percevons. Pour justifier la place dérivée du normatif, je (...) m'appuie sur les études de Max Scheler et sur l'examen de certains traits de la psychologie morale, qui tendent à montrer que le normatif n'est qu'un cas particulier de l'axiologique, mettant en évidence les caractères de force des valeurs, de risques de transgression et de contrainte.The perceptual model of moral knowledge has been the target of criticisms: it could be unable to explain the basic character of ethics, namely its normative character. I try to show that this criticism is misguided: in fact normativity is not central but lateral to ethics. What matters in ethics first and foremost are values, and it is quite appropriate to say we perceive values. To justify the lateral character of normativity, I rely on some analysis of Max Scheler and turn to some traits of moral psychology. It suggests that the normativity is a province of the axiological, characterized by strength of values, risks of transgression and constraint. (shrink)