Most recent accounts of personal autonomy acknowledge that the social environment a person lives in, and the personal relationships she entertains, have some impact on her autonomy. Two kinds of conceptualizing social conditions are traditionally distinguished in this regard: Causally relational accounts hold that certain relationships and social environments play a causal role for the development and on-going exercise of autonomy. Constitutively relational accounts, by contrast, claim that autonomy is at least partly constituted by a person’s social environment or standing. (...) The central aim of this paper is to raise the question how causally and constitutively relational approaches relate to the fact that we exercise our autonomy over time. I argue that once the temporal scope of autonomy is opened up, we need not only to think differently about the social dimension of autonomy. We also need to reconsider the very distinction between causally and constitutively relational accounts, because it is itself a synchronic (and not a diachronic) distinction. (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)

Both, bioconservatives and bioliberals, should seek a discussion about ideas of human perfection, making explicit their underlying assumptions about what makes for a good human life. This is relevant, because these basic, and often implicit ideas, inform and influence judgements and choices about human enhancement interventions. Both neglect, and polemical but inconsistent use of the complex ideas of perfection are leading to confusion within the ethical debate about human enhancement interventions, that can be avoided by tackling the notion of perfection (...) directly. In the recent debates, bioconservatives have prominently argued against the ‘pursuit of perfection’ by biotechnological means. In the first part of this paper, we show that—paradoxically—bioconservatives themselves explicitly embrace specific conceptions of human perfection and perfectionist assumptions about the good human life in order to argue against the use of enhancement technologies. Yet, we argue that the bioconservative position contains an untenable ambiguity between criticising and endorsing ideas of human perfection. Hence, they stand in need of clarifying their stance on human perfection. In the second part of the paper, we ask whether bioliberals in fact (implicitly) advocate a particular conception of perfection, or whether they are right in holding that they do not, and that discussing perfection is obsolete anyway. We show that bioliberals also rely on a specific idea of human perfection, based on the idea of autonomy. Hence, their denial of the relevance of perfection in the debate is unconvincing and has to be revised. (shrink)

Whatever ethical stance one takes in the debate regarding the ethics of human enhancement, one or more reference points are required to assess its morality. Some have suggested looking at the bioethical notions of safety, justice, and/or autonomy to find such reference points. Others, arguing that those notions are limited with respect to assessing the morality of human enhancement, have turned to human nature, human authenticity, or human dignity as reference points, thereby introducing some perfectionist assumptions into the debate. In (...) this article, we ask which perfectionist assumptions should be used in this debate. After a critique of views that are problematic, we take a positive approach, suggesting some perfectionist elements that can lend guidance to the practice of human enhancement, based on the work of Martha Nussbaum's Capability Approach. We suggest that the central capabilities can be used to define the human aspect of human enhancement and thereby allow a moral evaluation of enhancement interventions. These central capabilities can be maximized harmoniously to postulate what an ideal human would look like. Ultimately, the aim of this article is twofold. First, it seeks to make explicit the perfectionist assumptions found in the debate and eliminate those that are problematic. Second, the paper clarifies an element that is often neglected in the debate about human enhancement, the view of the ideal human towards which human enhancement should strive. Here, we suggest that some central capabilities that are essential for an ideal human being can be maximized harmoniously and can therefore serve as possible reference points to guide human enhancement. (shrink)

In response to the COVID-19 pandemic, countries around the world developed ICU triaging guidelines. One important point of convergence was an explicit commitment to...

Einer weit verbreiteten Auffassung zufolge ist es moralisch besser, eine andere Person in die Irre zu führen als sie anzulügen. Diese Auffassung ist in neuerer Zeit jedoch ausführlich von Bernard Williams und Jennifer Saul kritisiert worden – ihnen zufolge verdankt sich unsere moralische Präferenz für Irreführungen einem Irrtum und lässt sich bei näherer Betrachtung nicht aufrechterhalten. Im ersten Teil des Aufsatzes versuche ich demgegenüber zu zeigen, dass es in manchen Fällen tatsächlich moralische Gründe gibt, statt zu lügen in die Irre (...) zu führen. Im Mittelpunkt steht dabei eine expressive und beziehungsorientierte Analyse von Irreführungen: Wir können mit Irreführungen, so die zentrale These, im Unterschied zu Lügen zumindest in manchen Fällen zum Ausdruck bringen, dass wir die andere Person respektieren und uns die Fortführung einer vertrauensvollen Beziehung mit ihr am Herzen liegt. Im zweiten Teil weise ich dann allerdings nach, dass die moralische Präferenz für Irreführungen nicht in allen Fällen gerechtfertigt ist – zum einen, weil der mit Irreführungen zum Ausdruck gebrachte Respekt gegenüber anderen Personen nicht immer angemessen ist, und zum anderen, weil mit Irreführungen nicht in allen Situationen Respekt vor der anderen Person und ein Interesse an einer vertrauensvollen Beziehung mit ihr zum Ausdruck gebracht werden kann. (shrink)

Is it necessary to have an ideal of perfection in mind to identify and evaluate true biotechnological human “enhancements”, or can one do without? To answer this question we suggest employing the distinction between ideal and non-ideal theory, found in the debate in political philosophy about theories of justice: the distinctive views about whether one needs an idea of a perfectly just society or not when it comes to assessing the current situation and recommending steps to increase justice. In this (...) paper we argue that evaluating human enhancements from a non-ideal perspective has some serious shortcomings, which can be avoided when endorsing an ideal approach. Our argument starts from a definition of human enhancement as improvement, which can be understood in two ways. The first approach is backward-looking and assesses improvements with regard to a status quo ante. The second, a forward-looking approach, evaluates improvements with regard to their proximity to a goal or according to an ideal. After outlining the limitations of an exclusively backward-looking view, we answer possible objections against a forward-looking view. Ultimately, we argue that the human enhancement debate would lack some important moral insights if a forward-looking view of improvement is not taken into consideration. (shrink)

BACKGROUND: There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient's rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy (...) makers. METHODS: We used a qualitative design to examine Swiss healthcare stakeholders' experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. RESULTS: All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries' patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients' rights and citizens' involvement on the other. CONCLUSIONS: The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both concurrently. On a normative level, this study thus provides material from which to develop further ethical reflection towards a more cooperative approach involving patients and citizens in the governance of their health-related big data. (shrink)

The concept of human dignity has remained surprisingly absent from philosophical discussions about the ethics of childhood so far. Likewise, children as a group are mostly neglected in the ongoing discourse on human dignity. In this paper, we attempt to close this double gap by showing that there is, first, a meaningful way to speak of children’s dignity, and that, second, considering children as a group can be illuminating for dignity theorists in general. After an analysis of the reasons why (...) the debates on human dignity and the ethics of childhood have been conducted almost entirely separately, we develop a concept of respecting children as respecting their dignity. Drawing upon personhood accounts of human dignity, we suggest that respecting a child’s dignity means respecting her activity, which means essentially developing and maintaining a perspective of one’s own. Construed in that way, respecting children’s dignity is in some important respects different from concerns about their well-being and their autonomy. In the last section, we will take a step back from the debate about the ethics of childhood and point to some possible conclusions for the debate about human dignity in general. (shrink)

There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient’s rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. (...) We used a qualitative design to examine Swiss healthcare stakeholders’ experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries’ patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients’ rights and citizens’ involvement on the other. The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both concurrently. On a normative level, this study thus provides material from which to develop further ethical reflection towards a more cooperative approach involving patients and citizens in the governance of their health-related big data. (shrink)

Introduction: The coronavirus disease 2019 pandemic has placed intensive care units (ICU) triage at the center of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria—e.g. medical prognosis, age, life-expectancy or quality of life—are ethically acceptable. The paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. Sources of data: Published articles, news articles, book chapters, ICU triage guidelines (...) set out by professional societies and health authorities. Areas of agreement: Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served policy or quality-adjusted life-years and (ii) to rely on medical prognosis, maximizing lives saved, justice as fairness and non-discrimination. Areas of controversy: Points of disagreement in existing guidelines and the ethics literature more broadly regard the use of exclusion criteria, the role of life expectancy, the prioritization of healthcare workers and the reassessment of triage decisions. Growing points: Improve outcome predictions, possibly aided by Artificial intelligence (AI); develop participatory approaches to drafting, assessing and revising triaging protocols; learn from experiences with implementation of guidelines with a view to continuously improve decision-making. Areas timely for developing research: Examine the universality vs. context-dependence of triaging principles and criteria; empirically test the appropriateness of triaging guidelines, including impact on vulnerable groups and risk of discrimination; study the potential and challenges of AI for outcome and preference prediction and decision-support. (shrink)