While some lament the slide of Western culture into relativism and nihilism and others celebrate the trend as a liberating sort of progress, Charles Taylor calls on us to face the moral and political crises of our time, and to make the most ...

Hospices consider themselves places that practise a holistic form of terminal care, encompassing physical and psychological symptoms, and also the social and spiritual support for a dying patient. So far, the underlying ethical principles have been treated predominantly in terms of a normative theoretical discussion. The interview study discussed in this paper is a qualitative investigation into general and hospice-related conceptions of morality among full-time and voluntary workers in German inpatient hospices. It examines moral conflicts and efforts leading to their (...) solution. The main ideas identified include moral neutrality towards the patients and their requests, the capability of acceptance, the idea of self-restraint with respect to the dying patient and the principle of respect for the natural course of dying. Essential triggers for moral conflicts were the inadequate education of patients, problems of acceptance in view of incurable disease, and disagreements between members of patients' families. The interviewees expressed their scepticism towards formal institutions of ethical counselling. The study has shown a type of virtue ethics that forms an integral part of the overall concept of hospice care, which cannot be treated separately from a holistic idea of care at the end of life. (shrink)

Definition of the problem: Is respect for autonomy in medicine synonymous with respect for autonomous choices? Does it depend on the competency of patients? Arguments: The article criticizes this opinion, which is widely held in the field of medical ethics. This position does not recognize the problem of paternalism in its full import in modern medicine. It misunderstands the moral meaning of autonomy in its primacy over the psychological meaning, as well as the close ties between autonomy and beneficence. These (...) ties are made evident by reflection on basic anthropological conditions of ethics. Conclusion: Proceeding from this reflection I outline consequences for the praxis of non- paternalistic care that also respects the will of non-competent patients. (shrink)

ZusammenfassungIst Achtung der Autonomie in der Medizin gleichbedeutend mit der Achtung autonomer Entscheidungen? Ist sie nur gegenüber entscheidungsfähigen Patienten möglich? Der Artikel kritisiert diese in der Medizinethik verbreitete Meinung. Sie wird der Problematik des Paternalismus in der modernen Medizin nicht voll gerecht und verkennt den Primat der moralischen gegenüber der psychologischen Bedeutung des Autonomiebegriffs sowie den engen Zusammenhang zwischen Autonomie und Fürsorge. Durch eine Reflexion anthropologischer Grundbedingungen der Moral zeige ich diesen Zusammenhang auf und skizziere Konsequenzen für die Praxis nicht-paternalistischer (...) Fürsorge, die den Willen auch nicht-kompetenter Patienten achtet. (shrink)

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the (...) debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

This is the third volume of Joel Feinberg's highly regarded The Moral Limits of the Criminal Law, a four-volume series in which Feinberg skillfully addresses a complex question: What kinds of conduct may the state make criminal without infringing on the moral autonomy of individual citizens? In Harm to Self, Feinberg offers insightful commentary into various notions attached to self-inflicted harm, covering such topics as legal paternalism, personal sovereignty and its boundaries, voluntariness and assumptions of risk, consent and its counterfeits, (...) coercive force, incapacity, and choice of death. (shrink)

Why has autonomy been a leading idea in philosophical writing on bioethics, and why has trust been marginal? In this important book, Onora O'Neill suggests that the conceptions of individual autonomy so widely relied on in bioethics are philosophically and ethically inadequate, and that they undermine rather than support relations of trust. She shows how Kant's non-individualistic view of autonomy provides a stronger basis for an approach to medicine, science and biotechnology, and does not marginalize untrustworthiness, while also explaining why (...) trustworthy individuals and institutions are often undeservingly mistrusted. Her arguments are illustrated with issues raised by practices such as the use of genetic information by the police or insurers, research using human tissues, uses of new reproductive technologies, and media practices for reporting on medicine, science and technology. Autonomy and Trust in Bioethics will appeal to a wide range of readers in ethics, bioethics and related disciplines. (shrink)