Abstract‘Assisted dying’ (an umbrella term for euthanasia and/or assisted suicide) is frequently defended as an act of autonomous self-determination in death but, given a choice, between 93.3% and 100% of patients are reluctant to self-administer (median 99.5%). If required to self-administer, fewer patients request assisted death and, of these, a sizable proportion do not self-administer but die of natural causes. This manifest avoidance runs counter to the concept of autonomous self-determination, even on the supposition that suicide could truly be autonomous. (...) The avoidance of self-administration does not show that self-administration, when it occurs, is necessarily autonomous. It suggests, rather, that there are other frames by which assisted dying is being understood. One such is desire for medical control, a desire shared by patients and doctors. Such a frame is not directed towards an exacting autonomy (self-directed action by the patient) but towards a comforting heteronomy (letting the doctor take control). (shrink)

This article explores the implications of what it means to moralize about future technological innovations. Specifically, I have been invited to comment on three papers that attempt to think about what seems to be an impending social reality: the availability of life-like sex robots. In response, I explore what it means to moralize about future technological innovations from a secular perspective, i.e., a perspective grounded in an immanent, socio-historically contingent view. I review the arguments of Nancy Jecker, Mark Howard and (...) Robert Sparrow, and Wang Jue and respond to their arguments concerning the permissible limits of human-robot sexual interaction. I argue that we are in a poor epistemic position regarding what the actual future human response will be towards sex robots and how it affects society generally. Given this poor epistemic position, I argue that moralizing about future trends like human-robot sex is difficult because we do not have the relevant facts to work with. Furthermore, I remain skeptical as to policy recommendations based on socio-historically contingent moral viewpoints both because they do not carry in principle moral authority to say what future others may or may not do with their property and they may not even appeal to future secular others, insofar as secular morality is plural and consistently develops anew. (shrink)

Dressing up animals in ridiculous costumes, shaming dogs on the internet, playing Big Buck Hunter at the local tavern, feeding vegan food to cats, and producing and consuming “knockout” animals, what, if anything, do these acts have in common? In this article, I develop two respect-based arguments that explain how these acts are morally problematic, even though they might not always, if ever, affect the experiential welfare of animals. While these acts are not ordinary wrongs, they are animal dignitary wrongs.

This article explores the concept of human dignity in the work of French philosopher Gabriel Marcel. It demonstrates how this lesser-known aspect of his philosophical thinking is organic to his work and draws attention to the current relevance of the way he resolves the question of human dignity for philosophy and ethics. The first part of the article looks at the basic ideas behind Marcel’s understanding of man as a being on the road, as unfinished, temporal, in the process of (...) becoming, and creatively open on the road of transcendence to the mystery of being. This is followed by an explanation of Marcel’s criticism of the traditional understanding of human dignity, which has degenerated into the formalism. Criticizing this rationalist conception of dignity as a particular kind of power, Gabriel Marcel produces an original conception of existential dignity as weakness—the fragile vulnerable finitude of the human individual. But it is an active weakness/finitude that lies in the ability of the individual to creatively resist attempts to humiliate him and in his effort to recognize his unique human values. Part of this finitude, on the inter-subjective level, is an encounter with the neighbour in love, which is a service to others in defence of man’s weakness. The author draws attention to the fact that Marcel’s conception of human dignity has been partially accepted in philosophy, ethics and bioethics. (shrink)

The ever-increasing technological advances of modern medicine have increased physicians’ capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new “types” of living where a patient’s cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care. For some patients (...) and clinicians, religious teachings about the duty to seek medical care and the care of the dying offer ethical guidance when faced with such choices. Accordingly, this paper argues that traditional Sunni Islamic ethico-legal views on the obligation to seek medical care and Islamic theological concepts of human dignity and inviolability provide the ethical grounds for non-intervention at the end-of-life and can help calibrate goals of care discussions for Muslim patients. In closing the paper highlights the pressing need to develop a holistic ethics of healthcare of the dying from an Islamic perspective that brings together multiple genres of the Islamic intellectual tradition so that it can meet the needs of the patients, clinicians and Muslim religious leaders interacting with the healthcare system. (shrink)

In the context of the end of life, many authors point out how the experience of identity is crucial for the well-being of patients with advanced disease. They define this identity in terms of autonomy, control, or dependence, associating these concepts with the sense of personal dignity. From the perspective of the phenomenology of embodiment, Kay Toombs and other authors have investigated the ways disease can impact on the subjective world of patients and have stressed that a consideration of this (...) personal world can promote understanding and recognition of their experience. Based on the findings of qualitative studies of the perception of dignity and autonomy in patients at the end of life, this analysis assesses concepts such as being-in-the-world in illness, embodiment, lived body versus objective body or the gaze of the other from a Toombsian phenomenological perspective. (shrink)

The concept of dignity is widely used in society, particularly in reference to human rights law and bioethics. Several conceptions of dignity are identified, falling broadly within two categories: full inherent dignity (FID) and non-inherent dignity (NID). FID is a quality belonging equally to every being with full moral status, including all members of the human natural kind; it is permanent, unconditional, indivisible and inviolable. Those beings with FID ought to be treated deferentially by others by virtue of their belonging (...) to a noble caste. FID grounds fundamental human rights, such as the rights to freedom and equality.The concept of dignity forms a network of interconnected ideas related to worth and value particularly within legal and ethical discourse; it is a rich and meaningful concept, irreducible to one or two quasi-legal principles. Fundamentally, dignity matters because it forms the foundation of civilized society; without it, serious abuse of people is more likely to occur. (shrink)

Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to (...) better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account. (shrink)

The term ‘dignity’ is used in a variety of ways but always to attribute or recognize some status in the person. The present paper concerns not the status itself but the virtue of acknowledging that status. This virtue, which Thomas Aquinas calls ‘observantia’, concerns how dignity is honoured, respected, or observed. By analogy with justice observantia can be thought of both as a general virtue and as a special virtue. As a general virtue observantia refers to that respect for human (...) dignity that is implicit in all acts of justice. As a special virtue it concerns the specific way we show esteem for people. Healthcare represents a challenge to observantia because those in need of healthcare are doubly restricted in expressing their dignity in action: in the first place by their ill health, and in the second place by the conditions required by healthcare. To be understood properly, especially in the context of healthcare, the.. (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 COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient (...) ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood – of residents and staff – are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued. (shrink)

As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? I argue that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions (...) of these values should be re-framed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This paper offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable. (shrink)

This symposium contributes to the broader discussion about humanism in management and organizational well-being. Dignity plays a crucial role as both a fundamental value and as an end state in the process of humanizing organizational cultures, workplaces and relationships. However, despite its significance, it has yet to be addressed properly in the growing discourse on humanistic capitalism and management, and indeed in business ethics as a whole. This symposium seeks to inform and inspire emerging research and approaches towards human dignity (...) through the lens of artistic expression and explores how arts may promote human dignity in organizational life. (shrink)

Background Dignity is a central human value supported by nurses’ professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing’ roles, but little is known about dignity among public health nurses and primary care settings. Purpose This study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland. Research design (...) An inductive qualitative descriptive approach with semi-structured focus group interviews was utilised. Participants and research context Twenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings. Ethical considerations Before data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews. Findings Based on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users’ trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors. Discussion and conclusion Professional dignity is simultaneously an essential prerequisite and an outcome of public health nurses’ work. In future, more information would be needed to implement strategies in primary health care to foster nurses’ professional dignity also in international public health arenas. (shrink)

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, which (...) features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. (shrink)