The aim of this paper is to expand upon the conclusions reached by Orr and Genesen in their 1997 article , Requests for ‘inappropriate’ treatment based on religious beliefs.1 Assuming, with Orr and Genesen, that claims made in the name of religion are not absolute, I will propose some principles for determining when claims based on religious beliefs or cultural sensibilities “trump” other considerations and when they do not.

Ranging over central issues of morals and politics and the nature of freedom and authority, this study examines the role of value-neutrality, rights, equality, ...

In contemporary discussions on practical ethics, the concepts of autonomy and dignity have frequently been opposed. This tendency has been particularly visible in controversies regarding cloning, abortion, organ sales, and euthanasia. Freedom of research and freedom of choice, as instances of professional and personal autonomy, have been cited in arguments favouring these practices, while the dignity and sanctity of human life have been evoked in arguments against them. In the moral theory of Immanuel Kant, however, the concepts of autonomy and (...) dignity seem to coexist in mutual harmony. Respect for the freely chosen moral law and respect for the absolute value of humanity coincide, and give rise to a unified understanding of our duties toward ourselves and others. My question in this paper is, was Kant on to something here? Can autonomy and dignity, in the sense in which they are used in current debates, be brought together, and can the arguments be settled in a way that would satisfy both disagreeing parties? My answer to the question is, yes and no. Kant was definitely on to something in that he recognized two competing views in modern moral philosophy, and tried to consolidate them in an attempt to create a universal model of ethics. But in the end, he failed to fuse the two views together on equal terms. Instead, he sacrificed the modern idea of the self-governance of individuals on the altar of the premodern notion of the absolute inner worth of humanity. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

Currently, some of the most significant moral issues involving genetic links relate to genetic knowledge. In this paper, instead of looking at the frequently addressed issues of responsibilities professionals or institutions have to individuals, I take up the question of what responsibilities individuals have to one another with respect to genetic knowledge. I address the questions of whether individuals have a moral right to pursue their own goals without contributing to society's knowledge of population genetics, without adding to their family's (...) knowledge of its genetic history, and without discovering genetic information about themselves and their offspring. These questions lead to an examination of the presumed right to genetic ignorance and an exploration of a variety of social bonds. Analyzing cases in light of these considerations leads to a surprising conclusion about a widely accepted precept of genetic counseling, to some ethical insights into typical problems, and to some further unanswered questions about personal responsibility in the face of genetic knowledge. (shrink)