Assisted migration (AM) is a translocation of the representatives of species to areas outside their natural habitats as a response to climate change. This article seeks to identify how customary norms and general principles of international environmental law could guide the development of regulation of AM maximizing the benefits of using AM and minimizing AM-related risks. Among the customary norms and principles of international environmental law discussed in the article and relevant to the regulation of AM are the permanent sovereignty (...) over natural resources, the principle of cooperation, the no-harm rule, the precautionary principle, the principles of prevention, due diligence, and obligation to conduct environmental impact assessment (EIA), the principles of integration and intergenerational equity, common but differentiated responsibilities, and the polluter pays principle, the principles of non-regression, progression, resilience, in dubio pro natura, the principle of ecological proportionality, and the principle of access to information, public participation, and access to justice in environmental matters (principle of good governance, environmental democracy). (shrink)

The principle of assistance says that the global rich should help the global poor because they are able to do so, and at little cost. The principle of contribution says that the rich should help the poor because the rich are partly to blame for the plight of the poor. This paper explores the relationship between the two principles and offers support for one version of the principle of assistance. The principle of assistance (...) is most plausible, the paper argues, when formulated so as to identify obligations that arise from the needs of particular identifiable members of the global poor, not from impersonal rules or values. Under that formulation, the principle can explain why knowledge of the circumstances faced by individual members of the global poor can have such a marked effect upon the willingness of the global rich to provide help, and can offer a better grounded motivational basis for helping the global poor. These are real advantages, the paper argues, and ones that cannot be matched by stories that focus upon the ways in which the global rich contribute to global poverty. (shrink)

Excerpt from The Principle of Synthetic Unity in Berkeley and Kant This little volume was prepared as a thesis for the degree of Doctor of Philosophy in the University of Michigan. By the advice of Dr. John Dewey I have undertaken to interpret the Metaphysical Notes of Berkeley's Commonplace Book, and as far as possible discover the Principle of Unity which occasionally manifests itself in Berkeley's works and which formed a basis for a Treatise on the Will which (...) Berkeley contemplated but never produced. I wish to express my indebtedness to Dr. Dewey for his assistance in the selection of collateral reading and for his suggestions in the development of the thesis. No literature could be secured bearing upon the interpretation of the Notes, hence the Notes have been classified and such as bear upon the theme under discussion have been used. Often the phraseology has been preserved but where that could not be done the thought has been expressed in phraseology as nearly Berkeleian as the author could select so as to preserve the unity that runs through the Notes. This principle of unity found in Berkely has been compared and contrasted with the Unity of Kant. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

In Catholic moral theology, the principle of double effect has been an effective normative tool for centuries, and it can be used to determine the ethicality of actions that contain both good and evil consequences. The principle of double effect is especially useful in end-of-life care, because many end-of-life treatment options inherently have both good and evil conse­quences. The principle of double effect can be used to make both practical and moral distinctions between the acts of euthanasia, (...) physician-assisted suicide, palliative sedation, and the withholding and withdrawal of life-sustaining treatment, which can be classified as either unjustified acts of killing or jus­tifiable acts of allowing to die. (shrink)

The book comprises contemporary legal theory pertaining to Democratic States based on the Rule of Law from the perspective of general principles of law. It explains in detail, theoretically and based on the specific case law, the phenomenon of general principles of law - as a source of law and directly applicable legal norms. It is a work of legal theory, legal philosophy, and legal method, but it will also assist scholars and practitioners in the transitional justice field as it (...) shows how this theory of general principles of law has assisted Latvia to move away from the socialist legal tradition. (shrink)

B a c k g r o u nd. The article critically examines the concept of peace in the context of the Sino-Soviet Treaty of Friendship, Alliance and Mutual Assistance. This study delves into the historical, diplomatic, and philosophical dimensions of the Treaty between the Soviet Union and the People's Republic of China in the mid-twentieth century. M e t h o d s. The study is based on a systematic analysis of the original documents of the Sino-Soviet Treaty (...) and other primary sources that record the context and content of the agreement. The article uses a comprehensive analysis of primary sources, diplomatic correspondence, political discourse, and philosophical narrative to illuminate various interpretations and implementations of the treaty's peace provisions. Analyzing the philosophical basis of the agreement, it is taken into account how the ideas and concepts of friendship, union and mutual assistance were interpreted in the philosophical context of both countries. The article uses methods of comparative analysis to establish common and distinctive features between the ideology of the Sino-Soviet Treaty. Re s u l t s. The study provides valuable information about the geopolitical dynamics of the 20th century, shedding light on how the two major communist powers managed their diplomatic relations. By examining the ideological underpinnings and practical implications of the Treaty's peace-oriented provisions, the article contributes to understanding the broader landscape of international relations in this dynamic period. C o n c l u s i o n s. The study provides important information about the geopolitical dynamics of the 20th century, revealing how the two leading communist states managed their diplomatic relations. The article also considers the prospects for the development of dynamics between the Soviet Union and the People's Republic of China, examining the difficulties and problems that arose in maintaining peaceful relations between powerful states with common political ideologies based on the principles of Marxism. Analyzing the ideological foundation and practical consequences of the peacekeeping principles in the treaty, the article contributes to a better understanding of the broad context of international relations and philosophical narrative. (shrink)

The article by S. Prysukhin “The Principle of Subsidiarity: Lessons from the Social Teaching of the Catholic Church” analyzes the achievements of the Social Teaching of the Catholic Church, represented by the works of Leo XIII, Pius XI, Pius XII, John Paul II, revealing the meaningful characteristics of the concept of “the principle of subsidiarity”, its role and meaning in the system of Christian values. The principle of subsidiarity makes possible such relationships in social life, when the (...) community of higher order does not interfere in the internal life of the community of the lower order, taking over the proper functions of that function; for the common good it gives it when necessary support and assistance, thereby coordinating its interaction with other social structures. The principle of subsidiarity guides social practice to the promotion of the common good in the human community. The spread and application of the principle of subsidiarity opposes the danger of "nationalization" of society and the most terrible manifestations of collectivism, restricts the absoluteization of power, bureaucratization of state and socio-cultural structures, becoming one of the guarantors of respect for the rights and freedoms of citizens of their country. (shrink)

Abstract: In Vacco v. Quill, 521 U.S. 793 (1997), the Supreme Court for the first time in American case law explicitly applied the principle of double effect to reject an equal protection claim to physician-assisted suicide. Double effect, traced historically to Thomas Aquinas, proposes that under certain circumstances it is permissible unintentionally to cause foreseen evil effects that would not be permissible to cause intentionally. The court rejected the constitutional claim on the basis of a distinction marked out by (...) the principle, i.e., between directly intending the death of a terminally ill patient as opposed to merely foreseeing that death as a consequence of medical treatment. The Court held that the distinction comports with fundamental legal principles of causation and intent. Id. at 802. -/- Critics allege that the principle itself is intrinsically flawed and that, in any event, its employment in Vacco is without legal precedent. I argue in response to contemporary objections that double effect is a valid principle of ethical reflection (Part II); claims to the contrary notwithstanding, double effect analysis is a pervasive, albeit generally unacknowledged principle employed regularly in American case law (Part III); and drawing on the preceding two sections, Vacco's application of the principle of double effect is appropriate (Part IV). -/- My conclusion is that [o]peration of some form of the principle, by whatever name, is inevitable. In an imperfect world where duties and interests collide, the possibility of choices of action foreseen to have both good and evil consequences cannot be avoided. In rare circumstances, ethics and the law require that a person refrain from acting altogether. More often, however, they provide that a determination of whether an actor may pursue a good effect although knowing it will or may unintentionally cause an harmful effect requires a more complex analysis - a double effect analysis. -/- Keywords: Equal protection, double effect, intention, physician-assisted suicide, Constitutional Law, Bioethics. (shrink)

Cognitive neuroscience aims to improve our understanding of aspects of human learning and performance by combining data acquired with the new brain imaging technologies with data acquired in cognitive psychology paradigms. Both neuroscience and psychology use the philosophical assumptions underpinning the natural sciences, namely the scientific method, whereby hypotheses are proposed and tested using quantitative approaches. The relevance of 'brain science' for the classroom has proved controversial with some educators, perhaps because of distrust of the applicability of so-called 'medical models' (...) to education. Nevertheless, the brain is the main organ of learning, and so a deeper understanding of the brain would appear highly relevant to education. Modern science is revealing the crucial role of biology in every aspect of human experience and performance. This does not mean that biology determines outcomes. Rather, there is a complex interplay between biology and environments. Improved knowledge about how the brain learns should assist educators in creating optimal learning environments. Neuroscience can also identify 'biomarkers' of educational risk, and provide new methodologies to test the effects of educational interventions. (shrink)

In The Case for Animal Rights, Tom Regan argues that, in addition to the negative duty not to harm nonhuman animals, moral agents have a positive duty to assist nonhuman animals who are victims of injustice. This claim is not unproblematic because, in many cases, assisting a victim of injustice requires that we harm some other nonhuman animal(s). For instance, in order to feed victims of injustice who are obligate carnivores, we must kill some other animal(s). It seems, then, that (...) sometimes the duty to assist nonhuman animals who are victims of injustice conflicts with the prima facie duty not to harm nonhuman animals. In defense of Regan’s theory against this apparent inconsistency, I introduce an additional principle, the “guardianship principle,” which can be used to illustrate how we can be justified, under certain conditions, in overriding our prima facie duty not to harm nonhuman animals in order to fulfill our duty to assist nonhuman animals who are victims of injustice. (shrink)

This article explores the evolution of Principles of Biomedical Ethics by Tom Beauchamp and James Childress over its seven editions. Many changes have occurred in the text over the last thirty-five years, including the expansion of the section on virtue ethics, the modification of the authors’ position on physician-assisted suicide, and the addition of many other ethical theories to the original two found in the first editions. The basis for these changes and others seems to be their development of the (...) theme of the “common morality.” The author suggests that Beauchamp and Childress develop the connection between their common morality and metaphysics, as it would serve to strengthen their theory and make it less susceptible to changes in society’s opinions and traditions. National Catholic Bioethics Quarterly 14.3 : 459–475. (shrink)

During the last half of the twentieth century, legal philosophy (or legal theory or jurisprudence) has grown significantly. It is no longer the do main of a few isolated scholars in law and philosophy. Hundreds of scho lars from diverse fields attend international meetings on the subject. In some universities, large lecture courses of five hundred students or more study it. The primary aim of the Law and Philosophy Library is to present some of the best original work on legal (...) philosophy from both the Anglo American and European traditions. Not only does it help make some of the best work available to an international audience, but it also en courages increased awareness of, and interaction between, the two major traditions. The primary focus is on full-length scholarly monographs, aIthouogh some eidted volumes of original papers are also included. The Library editors are assisted by an Editorial Advisory Board of inter nationally renowned scholars. (shrink)

With appreciation toward those who commented and provided insight on “From reciprocity to autonomy in physician assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert H...

In this paper, I will argue that Rawls’s duty of assistance offers an incomplete picture of our international social and economic responsibilities. I will start by presenting the two main interpretations of the ‘Rawlsian circumstances of egalitarian distributive justice’ – the first requiring the existence of a ‘certain kind’ of cooperation, the second the existence of a ‘certain kind’ of interaction with the will – and then show that none of them rules out the applicability of international principles of (...) egalitarian distributive justice. My argument will draw on societies’ participation in the World Trade Organisation (WTO). So, in the second section I will show that even though this organization is not endowed with a centralized coercive authority, its participants are asked to accept significant constraints on their behaviour and are therefore owed a special justification for these constraints. I will also suggest that the alleged voluntariness of this organization may not only be contested (especially when developing societies are involved), but may also not be sufficient to rule out requirements of distributive equality. In the third section, I will show that, as any system of cooperation, the WTO gives rise to requirements of fairness and that, given the purpose it claims to serve, not all inequalities that can be traced back to so-called ‘domestic’ factors can be considered justified. More specifically, I will argue that the fairness of the WTO requires that all its participants be given a fair chance of benefiting from global market competitions, and that this is likely to entail significant egalitarian distributive duties among societies. (shrink)

There is a significant omission in the whole endeavor of moral analysis as commonly used in bioethics. Whether the analysis is based on a set of moral principles grounded in common morality, on a deontological or a consequentialist theory, or on other considerations, the focus has been to assist moral agents in making ethically appropriate decisions. Little or no attention has been paid to the issue of who the appropriate moral agent or decision maker is in any given situation. Yet, (...) how to make a decision and who should make that decision are equally important, albeit separate, issues. The principle of respect for autonomy, which favors self-determination of the patient or the surrogate, generally is invoked when .. (shrink)

Euthanasia and assisted suicide have proved to be very contentious topics in medical ethics. Some ethicists are particularly concerned that allowing physicians to carry out these procedures will undermine their professional obligations and threaten the very goals of medicine. However, I maintain that the fundamental goals of medicine not only do not preclude the practice of euthanasia and assisted suicide by physicians, but can in fact be seen to support these practices in some instances. I look at two influential views (...) of the goals of medicine, one based on the broad guiding principles of autonomy, beneficence and nonmaleficence, and the other focusing on several more concrete aims, concluding that both approaches can be seen to support euthanasia and assisted suicide. I then turn to the popular concern that allowing physicians to carry out euthanasia and assisted suicide will lead to widespread abuse. I argue that the possibility for abuse can be minimised if we make the patient's autonomous consent an essential requirement of the practice. (shrink)

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as well as the nature and limits (...) of the authority they exercise over them. (shrink)

Background Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. Methods A cross-sectional observational study was carried out through the application of an online questionnaire that collected the (...) socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. Results A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple’s life. Conclusion There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care. (shrink)

We need a metaphysics of respect for nature in order to establish the foundation for a humanistic philosophical anthropology. A metaphysics of respect for human beings will assist us in overcoming the human crisis. Genuine metaphysical respect for nature and for humans needs no supernatural substance. Matter is realized as causa sui and can be also defined as Natura sapiens. Humans are not the only intelligent life forms in the universe. Man is primordial a creative being: Homo creans. The predestination (...) of philosophical anthropology consists in clearing and co‐creating the essence (logos) of human being. (shrink)

A governing principle in medical ethics is respect for patient autonomy. This principle is commonly drawn upon in order to argue for the permissibility of assisted dying. In this paper I explore the proper role that respect for patient autonomy should play in this context. I argue that the role of autonomy is not to identify a patient’s best interests, but instead to act as a side-constraint on action. The surprising conclusion of the paper is that whether or (...) not it is in the best interests for the patient to die is a morally objective matter. This allows for the possibility that it can be in the best interests of the patient to die even if she autonomously considers it to be in her best interest to continue living. I argue that concerns about ‘mandatory’ euthanasia can be met when patient autonomy is respected as a side-constraint on action. Ultimately, this means that assisted dying is permissible, not because the autonomous patient views her suffering to be unbearable, but because it is in her objective best interests and she permitted it via her consent. (shrink)

This book evaluates some of the most common ethical issues confronted by reproductive endocrinologists, embryologists, and their teams. The authors apply core ethical principles and approaches to problem solving to each of the cases raised. This work is a guide for both those on the front lines of patient care as well as for students in the field, whatever their background. By outlining sample cases, the book is an instigator for ethical discussions among ethicists, medical practitioners and students.

Ethical debates about assisted dying typically assume that only medical professionals should be able to provide patients with assisted dying. This assumption partially rests on the unstated principle that assisted dying providers may not be motivated by pecuniary considerations. Here I outline and defend a mixed provider model of assisted dying provision that contests this principle. Under this model, medically competent non-physician professionals could receive fees for providing assisted dying under the same terms and conditions as physicians can (...) in those juris- dictions where medically assisted dying is lawful. The mixed provider model blunts objections to assisted dying rooted in supposed clashes with medical values. In addition to generating a market likely to expand access to assisted dying, the mixed provider model would not create markets that are unjust because they are “noxious” in Satz’ sense or because they raise “semiotic” concerns about the value of human life. (shrink)

BackgroundSafeguarding the right to die according to the principles of autonomy and freedom of each person has become more important in the last decade, therefore increasing regulation of Euthanasi...

A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assisted suicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. Unfortunately, the use (...) of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs. (shrink)

_The purpose _of this article is to find out whether philosophical and anthropological studies of human nature affect the legitimization of decisions about human life and death, using the example of a philosophical analysis of the problem of euthanasia. _Theoretical__ basis._ Philosophically and anthropologically based situational analysis in bioethics is chosen as the research methodology, which reveals the legitimation of euthanasia as a complex and highly responsible moral decision, which should be based on both the consideration of all the patient’s (...) special circumstances and the competent and adequate application of fundamental knowledge about the human being. _Originality._ From a philosophical point of view, it would be correct to legalize euthanasia, but under the condition of significantly limiting the cases of its application, clearly defining the conditions for its provision and strict control over its implementation. It is morally unacceptable to justify either murder or torture, so euthanasia appears as an attempt to avoid both at the same time. _Conclusions._ Specific solutions to practical problems often indicate the necessary direction for solving theoretical difficulties. Thus, making proper moral decisions about euthanasia requires reliance on fundamental knowledge about human beings, but at the same time it provides arguments "for" and "against" artificial termination of life. The basic principles of bioethics – autonomy, nonmaleficence, beneficence and respect for the dignity of human life – serve as criteria for making balanced ethical decisions both in theory and in practice. These principles should be complemented by a coherent ethical, legal and philosophical position on euthanasia, which is achieved through legitimation procedures. Decisive for making a decision on euthanasia should be the strong desire of the patient himself. (shrink)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires (...) physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

I argue that the concept ‘physician-assisted suicide’ covers two procedures that should be distinguished: giving someone access to humane means to end his own life, and taking co-responsibility for the safe and effective execution of that plan. In the first section I explain the distinction, in the following sections I show why it is important. To begin with I argue that we should expect the laws that permit these two kinds of ‘assistance’ to be different in their justificatory structure. (...) Laws that permit giving access only presuppose that the right to self-determination implies a right to suicide, but laws that permit doctors to take co-responsibility may have to appeal to a principle of mercy or beneficence. Actually this difference in justificatory structure can to some extent be found in existing regulatory systems, though far from consistently. Finally I argue that if one recognizes a right to suicide, as Oregon and other American states implicitly do, and as the European Court of Human Rights has recently done explicitly, one is committed to permit the first kind of ‘assistance’ under some conditions. (shrink)

Medical assistance in dying (MAiD) is scheduled to be legalized in Canada as of March 2024 for individuals with mental disorder/illness as their sole underlying medical condition (MAiD MD-SUMC). As guidelines are being developed for the safe and consistent provision of MAiD MD-SUMC, sufficient consideration must be given to the interpretation of ambiguous terminology in current legislation, and to ensuring sound use of acceptable ethics principles in these interpretations.

Compromise on moral matters attracts ambivalent reactions, since it seems at once laudable and deplorable. When a hotly-contested phenomenon like assisted dying is debated, all-or-nothing positions tend to be advanced, with little thought given to the desirability of, or prospects for, compromise. In response to recent articles by Søren Holm and Alex Mullock, in this article I argue that principled compromise can be encouraged even in relation to this phenomenon, provided that certain conditions are present . In order to qualify (...) as appropriately principled, the ensuing negotiations require disputants to observe three constraints: they should be suitably reflective, reliable and respectful in their dealings with one another. The product that will result from such a process will also need to split the difference between the warring parties. In assisted dying, I argue that a reduced offence of ‘compassionate killing’ can achieve this. I acknowledge, however, that splitting the difference can induce splitting headaches, as there remain certain questions to be answered. Hopefully, however, sufficient work is done here to defend attempts to occupy the middle ground, whether these relate to assisted dying specifically or to other disputed moral matters. (shrink)

In The Assisted Reproduction of Race, Camisha Russell states: "My central aim here is to explore how notions of race and racial identity function within assisted reproductive technologies ". The way she does this may surprise some bioethicists. Moving beyond principles and traditional ethical theories, Russell instead draws on the work of critical race theory and the philosophy of technology. By showing the usefulness of these theories, she encourages bioethicists to expand our theoretical toolbox.After giving an overview of the main (...) responses critical race theorists give to what race is, Russell ultimately wants to focus more on what race does. For example, one of the points Russell makes over and over... (shrink)

In the paper, titled ‘Choosing death in unjust conditions: hope, autonomy and harm reduction,’ Wiebe and Mullin argue that people living in unjust social conditions are sufficiently autonomous to request medical assistance in dying (MAiD). The ethical issue is that some people may request MAiD primarily because of unjust social conditions, not their illness, disease, disability or decline in capability. It is easily agreed that people living in unjust social conditions can be autonomous. Nevertheless, Wiebe and Mullin fail to (...) appreciate that autonomy is only a necessary condition for MAiD. In addition to autonomy, one must decide that providing assisted dying to a patient because they are living in unjust social conditions is ethical. Central to making this ethical decision is the principle of non-maleficence, famously articulated as ‘do no harm.’ The authors admit that performing MAiD in response to unjust social circumstances is harmful, but they justify this harmful action by appealing to the principle of harm reduction. A fundamental flaw of their approach is that it relies on the legislative definition of intolerable suffering, which is based on circular reasoning and given that 99.2% of patients that have applied for MAiD satisfied this criterion, it is essentially equivalent to no standard/criterion. Canadian society is struggling with the ethical implications of its permissive MAiD programme, and, fundamental to this debate, will be determining the proper balance between autonomy and non-maleficence for people living in unjust social conditions. (shrink)

In Roman civil procedure legal representatives (cognitores, procuratores) functioned together with their different assistants (advocati, patroni, oratores) who had the right to participate in the procedure together with the party and not instead of it. This article aims to show the peculiarities of the legal status of advocates, patrons, rhetoricians and other assistants of the litigants in civil procedure, the concept of a bar, as a professional corporation, presumption of its origin and mission in ancient Rome, origins of state guaranteed (...) legal aid and the institute of obligatory participation of the advocate in the procedure, the conditions of the agreement between the advocate and the client (mandatum), the peculiarities of the advocate’s fees for legal services, the responsibility of the advocate for improper execution of duties and other issues. (shrink)

The welfare of the child is the prevailing principle and concern regarding access to assisted reproduction in Western countries today, and there is a wish to avoid harm to future children. New research fields have developed in order to provide scientific evidence on the welfare of children living with different “types” of parents. Assisted reproductive technologies (ART) seems to be heading in a responsible direction where the care and concern for future children is vital. However, the claim of this (...) article is that the principle of the welfare of the child confuses the ethical framing of ART. Several philosophers in the past have argued that potential people must be regarded as outside the moral domain, and therefore cannot be harmed or benefitted. This message has not reached the policymakers, probably because the welfare of the child principle seems to fit so elegantly with common sense. In this article a different ethical framing of ART is proposed. The author argues that “futile care” and not “the welfare of the child” should be the guiding principle for eventually rejecting access to ART. The desired goal of ART treatment should be understood to be the production of functional families. Assisted reproduction is primarily about us, actual people in an actual society, and how potential children may affect us. (shrink)

In the field of medically assisted reproduction (MAR), there is a growing emphasis on the importance of introducing new assisted reproductive technologies (ARTs) only after thorough preclinical safety research, including the use of animal models. At the same time, there is international support for the three R’s (replace, reduce, refine), and the European Union even aims at the full replacement of animals for research. The apparent tension between these two trends underlines the urgency of an explicit justification of the use (...) of animals for the development and preclinical testing of new ARTs. Considering that the use of animals remains necessary for specific forms of ART research and taking account of different views on the moral importance of helping people to have a genetically related child, we argue that, in principle, the importance of safety research as part of responsible innovation outweighs the limited infringement of animal wellbeing involved in ART research. (shrink)

Fundamental principles : the nature of the dispute -- Types of euthanasia -- Psychiatric assisted suicide -- Neonates -- Incompetent adults -- Human life is sacred -- The slippery slope -- Medical views -- Four methods of easing death and their effect on doctors -- Looking further ahead.

Infertility is an unpredictable but widespread condition. While high‐income countries grapple with when, or how to cover the costs of assisted reproductive technology (ART), such as in‐vitro fertilisation (IVF), these services are generally only available to wealthy persons at private facilities in low‐ and middle‐income countries (LMICs). Although the principle of non‐interference with normal individual reproductive rights is robust, whether it is also the responsibility of collective society to provide the means (when ART applies) to achieve pregnancy, is controversial. (...) Recently, a low‐cost model was developed at a South African public institution. The target population for this model was “helpless and marginalised, childless couples”, but a new threat has arisen, namely, infertile couples who could conceivably afford private care. In the allocation of this scarce resource, we argue for a prioritarian response that first addresses the worst‐off, in order to even out unequal access imposed by sharp differences in income. (shrink)

On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of (...) active assistance to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate. (shrink)

Much biomedical research cannot be performed without recruiting human subjects. Increasingly, volunteer registries are being developed to assist researchers with this challenging task. Yet, volunteer registries raise confidentiality issues. Having recently developed a registry of volunteers, the authors searched for normative guidance on how to implement the principle of confidentiality. The authors found that the protection of confidentiality in registries are based on the 10 key elements which are elaborated in detail in the Canadian Standards Association Model Code. This (...) paper describes how these 10 detailed key principles can be used during the developmental stages of volunteer registries. (shrink)

International migration of work force is presently a high amplitude phenomenon. Romanian people have emigrated for work around the world, being engaged both in the physically hardest jobs and in activities that require completion of specialized courses and certification in a particular field. This last category includes social workers who, following schooling and certification and even having a minimal experience in the home country, apply for jobs in the field of social assistance. These recruiters aim to distribute social workers (...) at the workplace of interest, according to certain well-defined criteria. In the present paper we describe international migration of work force, and we illustrate it by adding case studies of life experience of social workers who underwent the process of emigration to the United Kingdom. Throughout the emigration process, these workers experienced certain changes in their life principles, mentality, values, and were marked by professional dilemmas in extreme situations. (shrink)

Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project “support and consultation in euthanasia in Amsterdam” which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the (...) general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. (shrink)

Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus (...) supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients’ wishes, be made in light of commonly shared values, unless these violate the principle of “in dubio pro vita”. The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life. (shrink)

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women (...) who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. (shrink)

That Kant’s moral thought is invoked by both advocates and opponents of a right to assisted dying attests to both the allure and and the elusiveness of Kant’s moral thought. In particular, the theses that individuals have a right to a ‘death with dignity’ and that assisting someone to die contravenes her dignity appear to gesture at one of Kant’s signature moral notions, dignity. The purposes of this article are to outline Kant’s understanding of dignity and its implications for the (...) ethics of assisted dying. According to Kant, that which has dignity must be treated as an end in itself and may not permissibly be exchanged for that which merely has price. Kant’s reasoning thus seems to preclude acts of self-killing, including voluntary assisted dying, that rest on individual self-interest, since a person’s interests merely have price. However, a recognizably Kantian view of dignity can permit assisted dying under two sets of circumstances: First, it can be permissible for agents who anticipate a degradation of their rational agency due to conditions such as dementia to direct others to end their lives once sufficiently demented. In so doing, such agents in effect exercise a right to impose obligations on others regarding how their bodies, which will at some future point no longer be the vessels of their rational agency, are to be disposed of. Second, Kant errs in supposing that our dignity can stem solely from our moral personality, i.e., from our capacity to abide by universalizable moral principles. Rather, complete dignity also requires the capacity for setting discretionary ends and the means to those ends, i.e., the dignity of humanity. Individuals with prolonged and intense depression, in severe pain, or with serious disability may lack humanity while retaining their moral personality. In such cases, I propose that their opting to end their lives, with or without the assistance of others, does not amount to exchanging their dignified selves for something which merely has price and is therefore not objectionable on Kantian grounds. (shrink)

Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution (...) is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed. (shrink)

In September 1998 the Bundesrztekammer, i.e., the German Medical Association, published new principles concerning terminal medical care. Even before publication, a draft of these principles was very controversial, and prompted intense public debate in the mass media. Despite some of the critics' suspicions that the principles prepared the way for liberalization of active euthanasia, euthanasia is unequivocally rejected in the principles. Physician-assisted suicide is considered to violate professional medical rules. In leaving aside some of the notions customarily used in the (...) euthanasia debate, e.g., passive euthanasia, the principles emphasize the obligation of physicians to offer and the right of patients to receive palliative care. The principles explicitly list modalities of basic treatment that are indispensable in all cases, such as the obligation to satisfy hunger and thirst. This statement is meant to resolve the dispute on nutrition and hydration at the end of life, as it shifts the focus of care from maintaining physiological parameters to satisfying subjective needs. For patients in a persistent vegetative state, artificial feeding is held to be obligatory. Yet, the principles make reference to recent German jurisdiction which permit the stopping of artificial feeding if it is in accordance with the patient's presumed will. Additionally, the wording concerning this issue is found to remain unclear. Patients' autonomy is strengthened by explicitly welcoming advance directives as a means to ascertain patients' wills. The principles mark some changes compared to earlier documents. They deserve careful analysis and should be considered in the international debate on issues concerning the end of life. (shrink)

Those involved in end-of-life decision making must take into account both legal and ethical issues. This book starts with a critical reflection of ethical principles including ideas such as moral status, the value of life, acts and omissions, harm, autonomy, dignity and paternalism. It then explores the practical difficulties of regulating end-of-life decisions, focusing on patients, healthcare professionals, the wider community and issues surrounding 'slippery slope' arguments. By evaluating the available empirical evidence, the author identifies preferred ways to regulate decisions (...) and minimise abuses at the end of life, and outlines an ethical theory which can provide practical guidance for those engaged in end-of-life decisions"--Provided by publisher. (shrink)