Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that (...) active interference in peoples’ personal lives is justified - if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position. (shrink)

It is within the context of a person’s lifestory, we argue, that the idea of wearing aprosthesis assumes place and meaning. Todevelop this argument, a brightly colored hookprosthesis for children is taken as a startingpoint for reflection. The prosthesis can beseen as fitting this person perfectly, when thebodily difference is understood as positivelyadding to this person’s identity. The choicefor the prosthesis is normative in a moralsense, in that it is grounded in a person’sfundamental convictions with respect to hisbeing and living. (...) This understanding of ‘howto live’ can best be grasped – as is suggested– in contrastive terms of ‘sameness’ and‘otherness’. Striving for conformity andsimilarity would do no justice to theexperiences and ideals of unique persons, andwould come at great cost. Moreover, society isnot benefited by persons who merely conform,who copy and imitate others, but by those whowillfully live up to their own unique standards. (shrink)